More than half of older adults in the United States – an estimated 18.7 million people – have experienced bothersome pain in the previous month, impairing their physical function and underscoring the need for public health action on pain.
Many of those interviewed by investigators for a study published in the current issue of PAIN reported pain in multiple areas.
The interviews, which included assessments of cognitive and physical performance, were completed by trained survey research staff in the homes of study participants living in the community or in residential care facilities, such as retirement or assisted-living communities.
“Pain is common in older adults and one of the major reasons why we start slowing down as we age,” said lead investigator Kushang V. Patel, PhD, MPH, of the Center for Pain Research on Impact, Measurement, and Effectiveness in the Department of Anesthesiology and Pain Medicine at the University of Washington.
The researchers gained several insights from the new study:
The overall prevalence of bothersome pain in the last month in the study group was 52.9 percent. Pain did not vary across age groups, and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy responses, and residential-care living status.
Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms. The majority (74.9%) of older adults with pain reported multiple sites of pain.
Several measures of physical capacity, including muscle strength and lower-extremity physical performance, were associated with pain and multisite pain.
For example, self-reported inability to walk three blocks was 72 percent higher in participants with pain than without pain.
Participants with one, two, three, and four or more sites were 41 percent, 57 percent, 81 percent and 105 percent more likely to report inability to walk three blocks, respectively, than older adults without pain.
“Considering that pain is often poorly managed in the geriatric population, our findings underscore the need for public health action, including additional epidemiologic research and the development and translation of interventions aimed at improving pain and function in older adults,” Patel concluded.
Population aging is occurring in nearly every country of the world. Not only are the number and proportion of older adults increasing globally, but the older adult population itself is getting older as well.
Gains in life expectancy at older ages have fueled the rapid growth of the oldest-old segment of the population, although it is unclear whether improvements in functional status of older adults have kept pace.
Since disability in late life is a major predictor of medical and social service needs, investigating risk factors for functional decline is a major public health priority.
The study in PAIN by Patel and colleagues clearly identifies the high burden of pain in the older adult population.
Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the United Kingdom – similar to giving statins to everyone over 50 years who is not already taking them – according to a study in the Christmas edition of The BMJ.
The researchers conclude that the 150 year old public health message: “An apple a day keeps the doctor away” is able to match more widespread use of modern medicine, and is likely to have fewer side effects.
The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.
In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease.
As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.
Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population.
They analyzed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.
The researchers assumed a 70 percent compliance rate and that overall calorie intake remained constant.
They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.
They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70 percent of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.
However, side effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.
Additional modeling showed a further 3 percent reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.
“This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK,” said the authors.
“This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets,” they concluded.
Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: “The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: 'An apple a day keeps the doctor away.' It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.”
Briggs added, “While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit.”
PORTLAND, Ore. – Medical science has known for years that people who drink moderate amounts of alcohol actually have a reduced risk of death.
In general, they are healthier and have better cardiovascular function that those who don't drink alcohol at all.
Now, new research from Oregon Health & Science University adds a fascinating twist: moderate drinking may actually bolster our immune system and help it fight off infection.
The research, published Dec. 17 in the journal Vaccine, not only opens a new window into scientific understanding of the immune system, it also could help scientists find new ways to improve the human body's ability to respond to vaccines and infections.
The scientists did their research in rhesus macaques, which have an immune system very similar to humans.
To conduct the study, the researchers trained a group of 12 rhesus macaques to consume alcohol – a 4 percent ethanol mixture – of their own accord.
Researchers vaccinated the monkeys against smallpox as part of the study. They then separated the animals into two groups – those with access to the 4 percent ethanol and those with access to sugar water. All of the animals had regular access to pure water, and to food.
The researchers then monitored the animals' daily ethanol consumption for 14 months. And the animals were vaccinated again, seven months after the experiment began.
“Like humans, rhesus macaques showed highly variable drinking behavior,” said Ilhem Messaoudi, the lead author of the paper, a former assistant professor at the Vaccine and Gene Therapy Institute at OHSU and assistant scientist in the Division of Pathobiology and Immunology at the Oregon National Primate Research Center and now an associate professor of biomedical sciences at the University of California, Riverside. “Some animals drank large volumes of ethanol, while others drank in moderation.”
The monkeys' voluntary ethanol consumption segregated them into two groups. One group was made up of heavy drinkers, those that had an average blood ethanol concentration greater than 0.08 percent – the legal limit for humans to be able to drive a vehicle. The other group was made up of moderate drinkers, with an average blood ethanol concentration of 0.02 to 0.04 percent.
Prior to consuming the alcohol, all of the animals showed comparable responses to the vaccination. But after exposure to the alcohol, the two groups of monkeys responded in very different ways to the vaccination.
The heavy drinkers showed greatly diminished vaccine responses compared with the control group of monkeys who drank the sugar water.
But the more surprising finding: the moderate-drinking monkeys displayed enhanced responses to the vaccine compared to the control group. Moderate drinking bolstered their bodies' immune systems.
“It seems that some of the benefits that we know of from moderate drinking might be related in some way to our immune system being boosted by that alcohol consumption,” said Kathy Grant, Ph.D., senior author on the paper, a professor of behavioral neuroscience at OHSU and a senior scientist at the ONPRC.
The researchers stressed that excessive alcohol consumption was injurious to the monkeys' immune systems – just as excessive alcohol consumption is bad for human bodies in many ways.
“If you have a family history of alcohol abuse, or are at risk, or have been an abuser in the past, we are not recommending you go out and drink to improve your immune system,” Messaoudi said. “But for the average person who has, say, a glass of wine with dinner, it does seem in general to improve health and cardiovascular function. And now we can add the immune system to that list.”
The next steps for the researchers will be to better understand why the immune system reacts as it does to moderate alcohol.
That may lead to a pharmaceutical alternative that could provide the same benefits as the moderate alcohol consumption.
The study was funded by the National Institutes of Health (grant #8P51 ODO11092-53) and the National Institute on Alcohol Abuse and Alcoholism within the NIH (grant # R21AA021947).
The study was carried out under strict accordance with the recommendations outlined in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health, the Office of Animal Welfare and the U.S. Department of Agriculture.
The study also was approved by the Oregon National Primate Research Center Institutional Animal Care and Use Committee.
According to new data released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday, 2,115,557 people with Medicare in California received at least one preventive service at no cost to them during the first 11 months of 2013 because of the Affordable Care Act.
Nationwide, more than 25.4 million people covered by Original Medicare received at least one preventive service at no cost to them during the first eleven months of 2013, more than the 24.7 million who used preventive services by this time last year.
“Thanks to the Affordable Care Act, California seniors have been able to receive important preventive services and screenings such as an annual wellness visit, screening mammograms and colonoscopies, and smoking cessation at no cost to them,” said CMS Administrator Marilyn Tavenner. “Prevention and early detection are so vital to ensure that Americans are healthy and Medicare is healthy. The Affordable Care Act makes Medicare stronger and improves the wellbeing of millions of beneficiaries who have taken advantage of preventive services and wellness visits.”
Nationwide, an estimated 24.7 million people with Original Medicare received one or more preventive benefits at no out of pocket costs by this point in time during 2012.
In total, when factoring in Medicare Advantage utilization rates, an estimated 34.1 million people with Medicare took advantage if at least one preventive service in 2012.
According to Tuesday’s data, in the first 11 months of 2013, 297,956 people with Medicare in California took advantage of the Annual Wellness Visit established by the health care law.
Nationwide, more than 3.5 million beneficiaries with Original Medicare took advantage of the annual wellness visit established by the health care law – a significant increase from last year’s 2.8 million who used this service by this point in the year in 2012.
Before the Affordable Care Act, Medicare recipients had to pay part of the cost for many preventive health services. These out-of-pocket costs made it difficult for people to get the important preventive care they needed.
For example, before the Affordable Care Act, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to beneficiaries (with no deductible or co-pay).
The Affordable Care Act helps tear down a significant barrier for some seniors to staying healthy and helps their care providers prevent, identify and treat problems early.
Tuesday's news comes after last month’s announcement showing that the health care law also saved seniors $8.9 billion on their prescription drugs since the law’s enactment.
To see the figures for California visit http://downloads.cms.gov/files/Preventive_Services_Utilization_by_State_Jan-Nov_2013.pdf .