June 15, 2009

Fighting Frailty: Ghrelin, a hormone that stimulates appetite, may help older women suffering from clinical frailty, according to a study presented by Penn Medicine researchers at ENDO, The Endocrine Society's 91st Annual Meeting. Ghrelin was given to a small group of older women diagnosed with frailty, a common geriatric condition characterized by unintentional weight loss, weakness, exhaustion and low levels of anabolic hormones, all of which increase the risk of falls, hospitalization, disability, and death. Those who received ghrelin infusions ate 51 percent more calories than the placebo group, with an increase in carbohydrate and protein intake, not fat. Their growth hormone levels were also higher throughout the ghrelin infusion. "As Americans are increasingly living into their 80s and 90s, we need to identify ways to prevent or treat common geriatric conditions, such as unexplained weight loss and frailty, which have serious health consequences," says senior author Anne Cappola, MD, ScM, Assistant Professor of Medicine in Endocrinology, Diabetes and Metabolism at the University of Pennsylvania School of Medicine in Philadelphia.

"We're gaining a better understanding of the hormonal changes that occur as we get older and, with treatments like ghrelin, we can start intervening to prevent some of the common health problems that keep elderly people from living their most productive lives."

Dementia Testing Update: British researchers have developed a simplified tool for detecting dementia. Called “Test Your Memory,” or TYM for short, it is a questionnaire that people can take and complete on their own. In initial trials, it is faster and more accurate than other current tests, according to researchers at Addenbrooke's Hospital in Cambridge. Despite its early success, however, researchers note that it has only been tried in one clinical setting, and many further studies are needed to conclusively prove its efficacy. Also, the results of the questionnaire, while generally perceived as accurate and a good indicator of dementia risk, still need to be interpreted by a professional, according to the research team. The full study is in the journal BMJ (2009;338:b2030).

Early Knee Arthritis Detection: A new x-ray analysis technique may be able to predict osteoarthritis of the knees years before the condition starts affecting movement, when there is still time to take preventive action. According to an article in The Economist, Lior Shamir and colleagues at the National Institutes of Health in Baltimore, MD, attempted to see if a computer program could be designed to analyze x-rays of knees and give early warnings of osteoarthritis. Dr. Shamir’s team digitized 200 x-rays taken during the mid-1980s as part of a project to document the aging of the human body. At the time the x-rays were taken, the knees of all those screened were diagnosed by expert radiologists as normal. But, as those people aged, many developed osteoarthritis. After analyzing the pixels of the scanned knee images to look for chemical or structural alterations in the cartilage and bone associated with degeneration of the joints, the researchers used the data to build a computer algorithm to predict who would go on to develop osteoarthritis. As published in Osteoarthritis and Cartilage, the algorithm had a 72 percent accuracy rating predicting knee arthritis nearly 20 years before symptoms were ultimately reported. Dr. Shamir told the magazine there is still a high margin of error, although with tweaking the algorithm may be improved.

Nursing Home Numbers Decline: According to the recently released “National Nursing Home Survey: 2004 Overview,” the number of nursing home beds dropped by more than 10 percent from 1.9 million in 1999 to 1.7 million in 2004. According to the study, the seventh in a series of periodic nursing home surveys conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics/ Division of Healthcare Statistics, the number of nursing home residents fell by 6 percent from 1.6 million to 1.5 million. More facilities were both Medicare and Medicaid certified in 2004 (87.6 percent) than in 1999 (81.8 percent). Of the 936,000 persons providing nursing home care in 2004, nearly two-thirds were certified nursing assistants (CNAs). Slightly more than 88 percent of the residents of the nation's 16,100 skilled nursing facilities are over the age of 65, 45.2 percent are over 85 and 71.2 percent are female. Only 1.6 percent of the entire nursing home population received no assistance with activities of daily living (ADLs) while 51.1 percent required assistance in all five ADL categories. The full study is available at http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdf.