[ photo by Ethan Sees ]

The Chartered Care Collection (03/02/2021)

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 first interesting article I came across for this month was a study on the pattern of pain in older adults published in The Clinical Journal Of Pain. The goal was to better understand how pain progresses in older adults. Adults over the age of 65 were questioned annually for six years. In those adults questioned, it was found that 25% had used pain medications 5-7 times per week in the month prior to the questioning. Their pain trajectories were then followed, with the pain being characterized as persisting, high bothersome pain in 35% of the questioned, decreasing bothersome pain in 17%, increasing bothersome pain in 17% and low bothersome pain in 32%.

Based on these statistics, over half of older adults in the study had either persistently high or increasingly bothersome pain. The participants were then questioned on how the pain limited their activity. Comparing those with low bothersome pain, the participants with high bothersome pain tended to be found in those who were female, those with lower education, lower income, obesity, medicaid coverage, fair or poor self-rated health, a greater number of comorbid health conditions, depression, anxiety, and dementia. A person’s level of pain can contribute to one’s ability to be independent, so making every effort to manage the pain, preferably in methods other than medications, are very important.

Many people require additional assistance following a total knee replacement, so I thought this next study was interesting. (I have written previously about the decision the have a knee replacement and what to expect after the surgery.) This study, from Journal of the American Academy of Orthopedic Surgeons, compared two different protocols after a total knee replacement, standard rehabilitation protocol (SRP) versus rapid rehabilitation protocol (RRP), in order to see which might show a better reduction in the length of stay and a faster recovery of knee range of motion. The first group in the study underwent a total knee replacement followed by a three-day hospitalization and physical therapy initiated within the first week after surgery, which is the SRP.

The next group underwent total knee replacement and then were discharged to home on the day of surgery with medications for pain management. They also received a localized nerve block prior to the surgery. Physical therapy was started on the day of surgery. This was the RRP. Patients from both groups had significant improvement in their knee flexion in the first year after surgery, with the greatest improvement being noted within the first 12 weeks. Those that received RRP showed greater flexion at weeks two, six and twelve, thus a faster rate of regaining knee range of motion. This rapid gain of knee range of motion translates to increased independence more quickly because of the ability to move around and perform activities of daily living with less assistance.

The next study, published in the journal Frontiers in Aging Neuroscience, pertained to the management of Alzheimer’s disease. It specifically looked at methods of intervention/management of Alzheimer’s diease that did not involve the use of medications. In short, it reviewed multiple studies that showed benefits of acupuncture, exercise, and repetitive transcranial magnetic stimulation to improve scores on the Mini Mental Status Exam (MMSE), ADL independence, and/or Alzheimer’s Disease Assessment Scale-cognitive section. It also looked at music therapy, but music therapy did not show evidence of effectiveness in improving the scores on the MMSE, ADLs, or the ADAS-cog. These are all things to keep in mind for those of you caring for someone with Alzheimer’s disease. 

Staying on the theme of cognition, another study published in Frontiers in Aging Neuroscience looked at lifestyle factors and cognition in older adults. It specifically looked at fruit and vegetable intake, physical activity, and body mass index (BMI) and how they each relate to cognition in older adults. It showed that increased vegetable and fruit intake was positively associated with improved scores on all cognitive domains, as was physical activity. It also showed that BMI was negatively associated with cognitive testing scores in people up to 65 years of age but then no correlation beyond 65. 

That’s all for this month’s Collection. Feel free to read each of these studies in more detail by referring to the articles as listed below.

References:

Huang, Z., et al. Associations of Lifestyle Factors with Cognition in Community Dwelling Adults Aged 50 and Older. A Longitudinal, Cohort Study. Front Aging Neurosci. 2020, November; doi.org/10.3389/fnagi.2020.601487.

Plessl, Dl, et al. Rapid versus Standard Recovery Protocol is Associated with Improved Recovery of Range of Motion 12 Weeks after Total Knee Arthroplasty. J Am Academy Ortho Surg. 2020, November 1; 28(21): e962-e968.

Rundell, S., et al. Longitudinal Patterns of Pain Reporting Among Community Dwelling, Older Adults. Clin J Pain. 2020, December; 36(12): 912-922.

Wang, l., et al., Overview of Meta-analysis of Five Non Pharmacological Interventions for Alzheimer’s Disease. Front Aging Neurosci. 2020, November 25. doi.org/10.3389/fnagi.2020.594432.

Share your thoughts on these articles in the Comments section.

© 2021 Jessica Kluetz, DO