Influences of Body Composition, Multimorbidity and Polypharmacy on Physical Mobility of Older Adults

Background and Purpose: The prevalence of falls, and the resulting injuries and complications reflect a key concern in the older adult population. An increased risk of falls is highly correlated with decreases in physical mobility and related functions. The Timed Up-and-Go test (TUG) has an established reliability and validity in assessing physical function and the risk of falling in the older adult population. With age, a person typically has an increased number of health morbidities, which may be reflected in changing body composition and the number of medications associated with diseases. However, the influence of these factors on physical mobility in the older adult population has not been quantified. The purpose of this study was to investigate how common indicators of health, including body mass index (BMI), presence of multimorbidity and polypharmacy influence the TUG performance in the older adult population. Methods: A total of 222 individuals ≥ 65 years of age were recruited (68 men and 154 women, mean age = 75.1 yrs). Additional subjects (28 men and 54 women, mean age = 72.7 yrs) from previous research were included in the analysis of BMI on TUG performance with a total of 304 subjects (96 men and 208 women, mean age= 74.4 yrs). Height and weight were obtained in conjunction with a medical history survey. Subjects completed 3 trials of the TUG test at 3 and 9 m walking distances. Comparison was made between 3 participant groups according to their BMI (underweight: BMI \u3c 24 kg/m2, normal weight: BMI 24-30 kg/m2, overweight: BMI \u3e 30 kg/m2). Multimorbidity was categorized into 2 groups (multimorbidity: ≥ 2 morbidities, non-multimorbidity: 0-1 morbidity). Polypharmacy was categorized into 2 groups (polypharmacy: ≥ 5 medications, non-polypharmacy: 0-4 medications). Non-parametric tests were run for all 3 variables (BMI, multimorbidity, and polypharmacy). Results: The underweight BMI group exhibited a trend of slower performance than normal weight BMI group for the 3 m (underweight = 8.8±5.3s, normal weight = 8.5±3.3s, p = 0.055) and the 9 m TUG distances (underweight = 17.3±8.9s, normal weight = 17.0±6.1s, p = 0.071). There was a trend toward the overweight BMI group having slower performance than the normal weight BMI group on the 9 m distance (normal weight = 17.0±6.1s, overweight = 18.0±5.5s, p = 0.069). The group with ≥ 2 morbidities had slower performance on the 3 m (multimorbidity = 9.2±3.9s, non-multimorbidity = 7.7±2.1s, p \u3c 0.001) and 9 m TUG distances (multimorbidity = 18.3±6.8s, non-multimorbidity = 15.6±4.0s, p \u3c 0.001). The polypharmacy group had slower performance on the 3 m (polypharmacy = 9.6±3.3s, non-polypharmacy = 8.3±3.4s, p = 0.001) and 9 m TUG distances (polypharmacy = 19.1 ± 5.9s, non-polypharmacy = 16.7±6.0s, p = 0.001). Discussion: Being underweight and overweight were shown to impact a person’s walking ability. We expected overweight individuals to have a slower performance on the TUG but underweight individuals did as well. This could be due to frail older adults having decreased muscle mass and strength. Polypharmacy and multimorbidity were shown to also have a significant impact on mobility performance. Limitations: The examined older adult population was relatively healthy as they are community dwelling individuals who are active in the retirement community. Conclusion: This study provided quantitative information regarding the effects of common health indicators (BMI, status of multimorbidity and polypharmacy) on mobility. Understanding the impact of BMI, multimorbidity, and polypharmacy on TUG performance will assist in identifying patients at risk of decrease physical mobility and falls. Wellness interventions might include reducing/altering medications used or adopting a healthier BMI to improve mobility

Effects of Climate Change in North America: An Overview

As forecast by many researchers, climate change can be expected to impact regions through direct effects (e.g., temperature shifts, changes in sea level, extreme weather events, and precipitation changes) and indirect effects (e.g., migrations of species and changes in ecosystems). Previous studies have reported how various regions will face challenges as to adaptations and vulnerabilities brought on by climate change differently according to their wealth. Interrelated impacts have been forecast to occur in North America stemming from variations due to climate change, including economic, ecological, environmental, and social impacts, as well as social and ecological changes. This study overviews the effects (direct and indirect) of climate change on various sectors in North America. It concludes, along with the suggestions of the AR4, that future studies should focus on regional studies of climate change, impacts of extreme weather events, and in-depth integrated models for mitigation, adaptation, and impact based on future simulations of climate change

The Facts of the Weather Extreme Events in the United States: Is there a Trend?

Numerous weather and climate extremes impact human society, the societal infrastructure, and the natural environment. The main purposes of this study were to review the historical record of weather extremes in the United States, identify the frequency and intensity of severe storms in the historical record, and examine the extent of economic damage resulting from those extreme events which occurred over the most recent decades. Potential changes in climate are forecast to result in possible frequency and/or intensity changes in extreme events, increases in precipitation, decreases in extreme low temperatures, increases in extreme high temperature, and changes in ecological systems such as climate-induced phonological shifts and possible biological extinctions. However, the impacts of tropical storms, hurricanes, and rainfalls on society and the nature systems need to be further investigated due to the difficulties of evaluations on variations of storms’ activities (intensity and frequency). Climatologists, biologists, and social scientists need to work together to bridge the gaps among the disciplines. Future research may consider focusing on future trends and changes in frequency of extreme events based on the outcomes of the most integrated climate models to evaluate the relationships between the severe weather extremes and the continued greenhouse gas scenarios of the coming decades

Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial.

ObjectiveTo estimate the efficacy and safety of mifepristone antagonization with high-dose oral progesterone.MethodsWe planned to enroll 40 patients in a double-blind, placebo-controlled, randomized trial. We enrolled patients at 44-63 days of gestation with ultrasound-confirmed gestational cardiac activity who were planning surgical abortion. Participants ingested mifepristone 200 mg and initiated oral progesterone 400 mg or placebo 24 hours later twice daily for 3 days, then once daily until their planned surgical abortion 14-16 days after enrollment. Follow-up visits were scheduled 3±1, 7±1, and 15±1 days after mifepristone intake with ultrasonography and blood testing for human chorionic gonadotropin and progesterone. Participants exited from the study when they had their surgical abortion or earlier for gestational cardiac activity absence, gestational sac expulsion, or medically indicated suction aspiration. We assessed the primary outcome of continued gestational cardiac activity at approximately 2 weeks (15±1 day), side effects after drug ingestion, and safety outcomes including hemorrhage and emergent treatment.ResultsWe enrolled participants from February to July 2019 and stopped enrollment after 12 patients for safety concerns. Mean gestational age was 52.5 days. Two (one per group) voluntarily discontinued 3 days after mifepristone ingestion for subjective symptoms (nausea and vomiting, bleeding). Among the remaining 10 patients (five per group), gestational cardiac activity continued for 2 weeks in four in the progesterone group and two in the placebo group. One patient in the placebo group had no gestational cardiac activity 3 days after mifepristone use. Severe hemorrhage requiring ambulance transport to hospital occurred in three patients; one received progesterone (complete expulsion, no aspiration) and two received placebo (aspiration for both, one required transfusion). We halted enrollment after the third hemorrhage. No other significant side effects were reported.ConclusionWe could not estimate the efficacy of progesterone for mifepristone antagonization due to safety concerns when mifepristone is administered without subsequent prostaglandin analogue treatment. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.Clinical trial registrationClinicalTrials.gov, NCT03774745