Scarcity of atrial fibrillation in a traditional African population: a community-based study

BACKGROUND: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community. METHODS: In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA. RESULTS: Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1–1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA. CONCLUSION: Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors

Responsiveness of the innate immune system and glucose concentrations in the oldest old

Abstract Patients with diabetes mellitus show in-creased risk of infectious disease as well as dis-turbances in innate immunity. In critical care settings, hyperglycemia is associated with increased risk of sepsis. It is unclear whether elevated glucose concen-trations and innate immunity are associated in a non-clinical setting. We aimed to assess the association between glucose concentrations and innate immune response in the oldest old, who are at increased risk of both disturbed glucose metabolism as well as infec-tious disease. This study was part of the Leiden 85-plus Study. In 562 subjects aged 85 years old of the general population, venous blood samples were taken for measurement of morning glucose, C-reactive protein (CRP) and glycated hemoglobin (HbA1c). The innate immune response was assessed by performing ex vivo whole blood lipopolysaccharide (LPS) stimulation for production capacity of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 1-beta (IL1-β), interleukin 10 (IL-10) and interleukin 1 receptor antagonist (IL-1Ra). Using linear regression analysis, cross-sectional analysis between glucose and cytokine production capacity was performed. We found a significant negative association between glucose concentrations, but not HbA1c, and cytokine response capacity in four out of five measured cytokines (all p<0.05). Both glucose and HbA1c were positively associated with circulat-ing levels of CRP. Higher glucose concentrations in non-diabetic elderly are associated with lower innate immune response. As elderly show increased vulner-ability for disturbances in glucose metabolism as well as infectious disease, this relation could be of clinical significance

Perspectives on the etiology of violence in later life

This article focuses on the development of a conceptual framework for explaining the etiology of violence in later life by various groups involved in the field of elder abuse. In this study, we explore this through eight focusgroups with different professionals involved in the field of elder abuse and older persons themselves and in interviews with 35 experts in the field. Our findings show that dependency, vulnerability, power and control, social isolation, stress, and care burden play a central role in their explanations for the occurrence of violence in later life. The role of a history of violence in violence in later life is equivocal. The complexity and ambiguity of dependency and vulnerability, the notion of mutual dependency, and diverse attitudes and expectations toward them that arise with the aging process are distinct features of violence in later life that were found.Dissertati

Framing abuse : explaining the incidence, perpetuation, and intervention in elder abuse

The role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator. Environmental factors also play an important role in elder abuse. In this paper, we address the framing of elder abuse as a social and health problem. Attention is paid to the factors that influence societal context and the Healthcare system, its organization, structure, and principlesWetensch. publicati

Hypotension is more risky than hypertension in very old people

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Will lifestyle changes in later life improve survival?

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Changes in Health Care Expenditure after the Loss of a Spouse : Data on 6,487 Older Widows and Widowers in the Netherlands

Background: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. Objective: To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affectedmost. Design: Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004–2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Results: Mean monthly health care expenditure in married subjects was J502 in the 42 months before the death of the spouse, and expenditure levels rose by J239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (J319; 59%) and the oldest old (J553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together J166). Conclusions: The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.Wetensch. publicati