Health
Presently, there are about 40 million Americans over the age of 65, with the fastest-growing segment of the population over 80 years old.
Traditionally, aging has been viewed as a period of progressive decline in physical, cognitive and psychosocial functioning, and aging is viewed by many as the “number one public health problem” facing Americans today.
But this negative view of aging contrasts with results of a comprehensive study of 1,006 older adults in San Diego by researchers from the University of California, San Diego School of Medicine and Stanford University.
Results of the Successful Aging Evaluation (SAGE) study – comprising a 25-minute phone interview, followed by a comprehensive mail-in survey – will be published in the Dec. 7 online issue of the American Journal of Psychiatry.
“While there is a growing public health interest in understanding and promoting successful aging, until now little published research has combined measures of physical health with cognitive and psychological assessments, in a large and randomly selected sample,” said principal investigator Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego’s Stein Institute for Research on Aging, and the current President of the American Psychiatric Association (which was not involved in this study).
The SAGE study included adults between the ages of 50 and 99 years, with a mean age of just over 77 years. In addition to measures which assessed rates of chronic disease and disability, the survey looked at more subjective criteria such as social engagement and participants’ self-assessment of their overall health.
“Sometimes the most relevant outcomes are from the perspective of the subjects themselves,” said Jeste.
The study concludes that resilience and depression have significant bearing on how individuals self-rate successful aging, with effects that are comparable to that of physical health. “Even though older age was closely associated with worse physical and cognitive functioning, it was also related to better mental functioning,” said co-author Colin Depp, PhD, associate professor of psychiatry at UC San Diego School of Medicine.
After adjusting for age, a higher self-rating of successful aging was associated with higher education, better cognitive function, better perceived physical and mental health, less depression, and greater optimism and resilience.
Participants were asked to rate the extent to which they thought they had “successfully aged,” using a 10-point scale and using their own concept of the term.
The study found that people with low physical functioning but high resilience, had self-ratings of successful aging similar to those of physical healthy people with low resilience.
Likewise, the self-ratings of individuals with low physical functioning but no or minimal depression had scores comparable to those of physically healthy people with moderate to severe depression.
“It was clear to us that, even in the midst of physical or cognitive decline, individuals in our study reported feeling that their well-being had improved with age,” Jeste said. This counterintuitive increase in well-being with aging persisted even after accounting for variables like income, education and marriage.
Jeste suggests there’s a take-away message for clinicians, which is that an optimistic approach to the care of seniors may help reduce societal ageism. “There is considerable discussion In public forums about the financial drain on the society due to rising costs of health care for older adults – what some people disparagingly label the ‘silver tsunami.’ But, successfully aging older adults can be a great resource for younger generations,” he said.
The findings point to an important role for psychiatry in enhancing successful aging in older adults. “Perfect physical health is neither necessary nor sufficient,” Jeste said. “There is potential for enhancing successful aging by fostering resilience and treating or preventing depression.”
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ST. HELENA, Calif. – Continuing its tradition of leadership in cardiac care, a surgical team at St. Helena Hospital Napa Valley, part of Adventist Heart Institute, led by Dr. Andreas Sakopoulos, MD, has performed the first procedure using an Impella heart pump in the North Bay area.
The Impella procedure joins a long list of St. Helena firsts in cardiac treatment spanning more than three decades, including the first to offer coronary angiograms, coronary angioplasty and coronary bypass surgery, as well as the first to offer “off pump” coronary bypass surgery and endovascular repair of thoracic aortic aneurysms.
“We utilized this device recently on a patient with a heart that was functioning at 10 to 15 percent,” said Dr. Sakopoulos. “With the use of the Impella, the patient had a five way bypass operation. Without this new technology he would have had a harder time recovering from surgery and might not have survived.”
The Impella, the world’s smallest artificial heart pump, can be inserted through a catheter in minutes, using a small incision in the groin.
Smaller in diameter than a pencil, and only 10 to 12 centimers in length, the Impella does not require a sternotomy.
Approved by the FDA for partial circulatory support for six hours, the device delivers 2.5 liters of blood flow per minute, drawing blood from the left ventricle and pumping it into the aorta and out into the body.
A larger model is also available which can pump 5 liters of blood per minute, replacing the entire heart function.
“This is an exciting advance in cardiac care, creating a new standard,” said Dr. Sakopoulos. “What this means for our patients is that we can now perform life-saving procedures on many who would previously have been considered ineligible for angioplasty or surgery due to the severity of their heart condition. This is a minimally invasive procedure that supports cardiac function delivering blood to the body while we work on a heart, performing angioplasty/stenting or coronary artery bypass surgery.”
Manufactured by Abiomed, the Impella established a successful track record in Europe for a number of years before being approved for use in the United States.
It is considered ideal for patients with reduced heart pumping action who need to have the blood vessels to their hearts opened.
In addition to providing support during angioplasty, the pump can also be used to help a patient’s weakened heart gain strength before and after surgery.
This opens up the possibility of life-saving procedures for more patients than ever before.
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