[ photo by Steven Wright ]

The Chartered Care Collection (01/19/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

The journal Age and Aging published the article, “Self Reported Vision and Hallucinations in Older Adults: Results from Two Longitudinal U.S. Health Surveys” by Hamedanni, A., et al. This study worked to determine the association between visual impairment and hallucinations in the general population. Two longitudinal studies were performed, National Health and Aging Trends Study and the Health and Retirement Study. Each study included participants aged greater than 65. There were multiple data points collected for each participant. Overall, both studies showed the prevalence of visual hallucinations ranged from 8% among 65-74 year-olds to 60.6% of those older than 85. Factors associated with hallucinations included older age, female, race, hypertension, never smoking and hearing loss. Those with a history of stroke also were more likely to report hallucinations as were those with visual deficits. During my career I have helped many patients who have endured hallucinations. They can be quite scary for those experiencing them and are often hard to manage. These hallucinations might often impact one’s ability to live independently.

The next study I found interesting looked at the association between comprehensive cognitive reserve and the neuropsychological profile. This article by Lee, S., et al.  was printed in the October 2020 edition of Frontiers in Aging Neuroscience. Essentially, it found that cognitive reserve, which can be thought of as your brain’s ability to find alternate ways to perform a task, is associated with global cognitive function. Individuals with subjective cognitive decline or mild cognitive impairment underwent psychiatric and a comprehensive neuropsychological evaluation in order to determine the cognitive reserve. Those individuals with greater cognitive reserve tended to have overall better global cognitive function, indicating that greater cognitive reserve often equates to better protection from cognitive decline. Or, said another way, those with larger cognitive reserve are less likely to experience symptoms of dementia. There is some evidence that cognitive reserve can be improved with specific training.

Chronic pain affects many in the aging population, The Scandivavian Journal of Rheumatology recently released a study in which it investigated the effects of short-term, noninvasive vagus nerve stimulation on disease activity and inflammation in patients with Rheumatoid Arthritis (RA). Those patients in the study with active RA showed a small but significant reduction in inflammatory markers specific to RA. Those patients with RA that did not have active disease at the time of study did not show a change with treatment. These findings indicated the possibility of using this noninvasive vagus nerve stimulation to provide for anti-inflammatory effects and thus reduce symptoms in those with active RA. In those with RA this could be a helpful way to alleviate pain without the need of an additional medication for pain management. 

I know many people are affected by low back pain due to a condition known as spondylolisthesis. Unfortunately, conservative treatment does not always lead to pain relief. In those cases, surgery might be indicated. The article in the Journal of Neurosurgery and Spine compared the outcomes of an open laminectomy (removal of bone from the spine) versus performing the procedure via minimally invasive surgery (MIS). It looked specifically at those patients with a grade I spondylolisthesis. Seventy-one patients underwent the open procedure and 69 underwent the MIS. Those with the MIS had a shorter length of stay post-operatively (0.68 days) compared to the open decompression (1.83 days). Complications in the MIS group were at 1.4% and at 7.2% in the open group. For both groups, it was fairly even in the overall improvement of back and leg pain and quality of life. For various reasons, a surgeon might recommend one approach versus the other. This study concluded that the final goal outcome of the surgeries should be fairly similar, but it is worth noting the post-op recovery in the MIS versus the open group.

Lastly, I wanted to highlight a study printed in the journal Clinical Rehab. This study by Steinmetz, Cl, et al. looked at the effects of a two-week prehabilitation program for patients that undergo elective coronary bypass graft (CABG) surgery. The study was done at a single surgery center. Patients that were placed in the intervention group participated in a two-week individualized, supervised exercise program versus a control group that did not involve any guided prehabilitation. In short, there was a greater positive postoperative outcome at the two week follow-up in regards to functional capacity and quality of life for those that underwent the two week prehabilitation course. The study did not look at long-term outcome beyond two weeks post-operatively. 

References:

Hamedani, Al, et al. Self-Reported Vision and Hallucinations in Older Adults: Results from Two Longitudinal U.S. Health Surveys. Age and Aging. 2020; 49: 843-849.

Lee, S., et al. Cognitive Reserve Leisure Activity and Neuropsychological Profile in the Early Stage of Cognitive Decline. Front Aging Neuroscience. 2020; October: 12.

Drewes, A., et al. Short-Term Transcutaneous, Non-invasive Vagus Nerve Stimulation may Reduce Disease Activity and Pro-Inflammatory Cytokines in Rheumatoid Arthritis: Results of a Pilot Study. Scand J Rheumatology. 2020.

Bisson, E., et al. Open versus Minimally Invasive Decompression for Low-Grade Spondylolisthesis: Analysis from the Quality Outcomes Database. J Neurosurg Spine. 2020; 33(3): 349-359.

Steinmetz, C., et al. Prehabilitation in Patients Awaiting Elective Coronary Artery Bypass Graft Surgery-Effects on Functional Capacity and Quality of Life: A Randomized, Controlled Trial. Clinical Rehab. 2020; 34(10): 1256-1267.

Share your thoughts on these articles in the Comments section.

© 2021 Jessica Kluetz, DO