Health Promotion for Older Adults: What Is the Potential? 11th Annual Herbert Lourie Memorial Lecture on Health Policy

As a greater number of people reach old age, medicine is challenged to develop new approaches to this population. Health promotion, not just treatment of disease but improving the quality of life for older persons, must play a role. What happens to individuals in terms of health status as they get older, and what are the implications for health care needs? Where should we focus to get the biggest benefits in terms of health promotion? Overall, we have learned a tremendous amount over the last 25 years about the components of health as people get older, and what modifies their health. We know, for example, that the health status of older adults is a composite of the chronic diseases that they may have, of how many chronic diseases are present, and of underlying physiological changes of aging, such as a decline in muscle strength, that appear to be an intrinsic part of the aging process. Disability can result from chronic disease. In addition, people are more susceptible to acute illnesses and injuries as they get older.

Effects of HMG-CoA reductase inhibitors (statins) on progression of kidney disease

Chronic kidney disease, especially in the setting of proteinuria, is characterized by hyperlipidemia. In animal models, hyperlipidemia causes glomerular foam cells and glomerulosclerosis. Treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) ameliorates kidney disease in these models. The data of the role of hyperlipidemia in progression of human kidney disease are less clear. Data from small studies in glomerular disease suggest that statins decrease proteinuria. Data mainly from cardiovascular studies suggest that statins decrease the loss of glomerular filtration. The benefit of statins may derive from their lipid lowering effects. More recently, data suggest that the benefit of statins is greater than lipid lowering alone. The pleiotropic effects of statins may derive from inhibition of other downstream targets (isoprenoids) of the mevalonic acid pathway that are separate from cholesterol synthesis. Statins inhibits isoprenylation of Ras and Rho GTPases. These effects may lead to decreased monocyte/macrophage infiltration in the glomerulus, decreased mesangial proliferation and decreased accumulation of extracellular matrix and fibrosis. In addition, inhibition of RhoA and Ras may decrease inflammation and increase eNOS activity. These effects could lead to improvement in the progression of kidney disease

Health Promotion for Older Adults: What Is the Potential?

As a greater number of people reach old age, medicine is challenged to develop new approaches to this population. Health promotion, not just treatment of disease but improving the quality of life for older persons, must play a role. What happens to individuals in terms of health status as they get older, and what are the implications for health care needs? Where should we focus to get the biggest benefits in terms of health promotion? Overall, we have learned a tremendous amount over the last 25 years about the components of health as people get older, and what modifies their health. We know, for example, that the health status of older adults is a composite of the chronic diseases that they may have, of how many chronic diseases are present, and of underlying physiological changes of aging, such as a decline in muscle strength, that appear to be an intrinsic part of the aging process. Disability can result from chronic disease. In addition, people are more susceptible to acute illnesses and injuries as they get older

L'«empowerment» des femmes dans la gestion participative des forêts sacrées du sud du Bénin : le cas de la forêt «Bamèzounmè»

Au Bénin, la promotion des femmes dans les sphères décisionnelles est sujette à des pesanteurs socioculturelles. Dans le cas des forêts sacrées gérées de façon traditionnelle, l'implication des femmes pourrait être perçue comme un affront aux dirigeants traditionnels, si des politiques pouvant favoriser cette implication des femmes n'étaient pas étudiées. L'objectif principal visé par cette étude intitulée: « l'empowerment des femmes dans la gestion participative des forêts sacrées du Sud du Bénin: le cas de la forêt Bamèzounmè » est d'identifier les composantes des stratégies adéquates à une implication plus accrue des femmes dans la gestion participative de ladite forêt. Quatre objectifs spécifiques ont été dégagés. Il s'agit: 1) d'identifier, parmi les éléments endogènes de gestion de la forêt sacrée Bamèzounmè, ceux qui joueraient en faveur de la participation des femmes; 2) d'identifier les mécanismes de participation des femmes à la gestion actuelle de la forêt sacrée Bamèzounmè ; 3) d'évaluer l'empowerment des femmes; 4) de proposer des mesures pouvant faciliter le renforcement de l'empowerment des femmes dans la gestion participative de la forêt sacrée Bamèzounmè. La recherche documentaire, l'observation directe du milieu et les entrevues avec les acteurs intervenant dans la gestion de la forêt sacrée Bamèzounmè sont les méthodes utilisées pour la collecte de l'information. Les données ont été traitées de façon qualitative et quantitative à l'aide du logiciel Excel. Les critères sociologiques donnant accès à la gestion de la forêt Bamèzounmè sont la langue, l'âge, le sexe et le statut familial de l'individu. Grâce aux activités artistiques notamment à la danse, les femmes jouent le rôle spécifique de griottes lors des cérémonies culturelles. Mais leur participation à la gestion de cette forêt n'est que symbolique et limitée à la réception de l'information. Pour améliorer cette position, les répondantes pourraient user de ce levier qu'est la danse. Cependant, l'empowerment de ces femmes indique qu'à l'exception des aptitudes communicationnelles et des compétences en médecine traditionnelle dont disposent les répondantes, leur conscience critique et leur estime de soi communautaire ne sont pas à un niveau qui puisse favoriser le renforcement de leur pouvoir d'agir dans la gestion participative de la forêt sacrée Bamèzounmè. En amont de toute politique visant une participation plus accrue des femmes dans la gestion participative de la forêt sacrée Bamèzounmè, une sensibilisation des femmes et de tous les acteurs concernés est indispensable. La reconsidération des femmes dans la gestion participative passera par le développement de la danse qui ne sera possible que via un développement éco-touristique axé sur la forêt sacrée Bamèzounmè. L'organisation des femmes en groupements de danse et d'activités génératrices de revenus est aussi envisageable. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Femmes, Gestion participative, Forêts sacrées, Genre et empowermen

Is Aging Biology Ageist?

Abstract : The scientific questions we pursue are shaped by our cultural assumptions and biases, often in ways we are unaware. Here, we argue that modern biases against older adults (ageism) have unconsciously led aging biologists to assume that traits of older individuals are negative and those of younger individuals positive. We illustrate this bias with the example of how a medieval Chinese scholar might have approached the task of understanding aging biology. In particular, aging biologists have tended to emphasize functional declines during aging, rather than biological adaptation and population selection or composition processes; the reality is certainly that all these processes interact. Failure to make these distinctions could lead to interventions that improve superficial markers of aging while harming underlying health, particularly as the health priorities of older adults (autonomy, function, freedom from suffering, etc.) are often quite different from the goals of aging biologists (reducing disease, prolonging life). One approach to disentangling positive, negative, and neutral changes is to map trajectories of change across the life course of an individual (physiobiography). We emphasize that our goal is not to criticize our colleagues—we have been guilty too—but rather to help us all improve our science

Formulating a Curriculum on Aging and Health for University Undergraduates

There is a need in our society to raise the national consciousness about aging, health, and the prospects for longevity, so that many more persons take responsibility for their personal health and understand what we will need in an era of health-care reform to promote health across the life course. We address this imperative by offering a relevant curriculum through a public-health lens, designed especially for university undergraduate students. Unlike the traditional educational focus on graduate students who are already committed to a career in the health professions, the students in our sights have little prior exposure to the course content and are still largely uncertain of their career plans. We believe this proposed course will help students understand aging processes as these evolve over time, understand the opportunities that arise from greater life expectancy, encourage them to promote their own health, and make a social contract to do so for society

MODIFICATION BY FRAILTY STATUS OF AMBIENT AIR POLLUTION EFFECTS ON LUNG FUNCTION IN OLDER ADULTS IN THE CARDIOVASCULAR HEALTH STUDY

Older adult susceptibility to air pollution health effects is well-recognized. Advanced age may act as a partial surrogate for conditions associated with aging. The authors investigated whether gerontologic frailty (a clinical health status metric) modified the effects of ambient ozone or particulate matter (PM10) air pollution on lung function in 3382 older adults using 7 years of followup data from the Cardiovascular Health Study (CHS) and the CHS Environmental Factors Ancillary Study. Monthly average pollution and annual frailty assessments were related to up to 3 repeated measurements of lung function using novel cumulative summaries of pollution and frailty histories that account for duration as well as concentration. Frailty history was found to modify long-term pollution effects on Forced Vital Capacity (FVC). For example, the decrease in FVC associated with a 70 ppb-month increase in the cumulative sum of monthly average O3 exposure was 8.8 mL (95% confidence interval (CI): 7.4, 10.1) for a woman who had spent the prior 7 years prefrail or frail compared to 3.3 mL (95% CI: 2.7, 4.0) for a similar not frail woman (interaction P\u3c0.001)

SURROGATE SCREENING MODELS FOR THE LOW PHYSICAL ACTIVITY CRITERION OF FRAILTY

Background and Aims. Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Women’s Health and Aging Study (WHAS). Methods. Using data on men and women ages 65 and older from the CHS, we applied logistic regression models to rank activities by “relative influence” in predicting low physical activity. We considered subsets of the most influential activities as inputs to potential surrogate models (logistic regressions). We evaluated predictive accuracy and predictive validity using the area under receiver operating characteristic curves and assessed criterion validity using proportional hazards models relating frailty status (defined using the surrogate) to mortality. Results. Walking for exercise and moderately strenuous household chores were highly influential for both genders. Women required fewer activities than men for accurate classification. The WHAS model (8 CHS activities) was an effective surrogate, but a surrogate using 6 activities (walking, chores, gardening, general exercise, mowing and golfing) was also highly predictive. Conclusions. We recommend a 6 activity questionnaire to assess physical activity for men and women. If efficiency is essential and the study involves only women, fewer activities can be included

Elevated Serum Carboxymethyl-Lysine, an Advanced Glycation End Product, Predicts Severe Walking Disability in Older Women: The Women's Health and Aging Study I

Advanced glycation end products (AGEs) have been implicated in the pathogenesis of sarcopenia. Our aim was to characterize the relationship between serum carboxymethyl-lysine (CML), a major circulating AGE, and incident severe walking disability (inability to walk or walking speed $<0.4$ m/sec) over 30 months of followup in 394 moderately to severely disabled women, $\ge 65$ years, living in the community in Baltimore, Maryland (the Women's Health and Aging Study I). During followup, 154 (26.4%) women developed severe walking disability, and 23 women died. Women in the highest quartile of serum CML had increased risk of developing of severe walking disability in a multivariate Cox proportional hazards model, adjusting for age and other potential confounders. Women with elevated serum CML are at an increased risk of developing severe walking disability. AGEs are a potentially modifiable risk factor. Further work is needed to establish a causal relationship between AGEs and walking disability