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This article addresses the need and relevance of preventing development of drug-resistant pathogens and limiting their transmission in frail older, disabled, and immunocompromised people. The author suggests limited usage of potent antibiotics that are currently available and developing newer and more efficient agents against pathogenic microorganisms.

Results reveal that age does not affect or influence the immediate or long-term results of direct-current external cardioversion of atrial fibrillation. The implication of the findings in attempting to restore sinus rhythm with external cardioversion is discussed.

Research shows that the Chinese traditional exercise Tai Chi Chuan has a positive effect on endothelium-dependent dilation in skin vasculature of older people. Further, Tai Chi Chuan practive may delay deterioration of age-related venous compliance and hyperemic arterial response.

This article discusses the relationship between aging, physical disability, and muscle mass loss in the aged. An analysis of body mass index, body composition, health behavior, and comorbidity is presented.

This article discusses the development and assessment of a geriatric clerkship for medical students. An evaluation of lessons on cognitive dysfunction, hospice care, hormone replacement therapy, osteoporosis, and cardiovascular disease is presented.

Whether vision function is related to physical functional ability in older adults is discussed based on a longitudinal cross-sectional study. Vision functions other than standard visual acuity may affect day-to-day functioning of older adults. More study of the other aspects of vision and how they can be treated or rehabilitated are needed to determine whether they have a role in strategies for reducing disability in older adults.

Research presented explores the relationship between telomeres, telomerase, and aging. Topics addressed include the biology of aging, the work of scientists to increase life expectancy and life span, premature aging, and the influence of telomerase on aging cells.

Nursing home patients with hyponatremia were studied to see if they also had a syndrome of inappropriate antidiuretic hormone secretion (SIADH). Those that did were studied for an underlying cause for this syndrome and in most cases, there was none. Elderly patients may just be at risk for hyponatremia and SIADH.

In a longitudinal study of older Chinese men and women in Hong Kong, body mass was shown to shrink with old age and not because of health factors. This loss of body mass and fat in the body led to poorer health and eventually to increased mortality.

In a study of 1,566 patients aged 65 and older a significant correlation was found between depression and low bone density. The researchers speculate that a third factor, perhaps a steroid imbalance, may be causing both conditions.

This article examines the relationship between aging and circulating concentrations of proinflammatory cytokines in older adults diagnosed with septic shock. Findings indicate that advanced age is not associated with reductions in levels of circulatory proinflammatory cytokines.

Suggested cutoff points for waist circumference are only useful to a limited extend for identifying subjects with overweight and obesity and/or central fat distribution in an older population. This is mainly because of increased central distribution of fat as age increases. Waist action levels established for young and middle-aged adults are not very useful in diagnosis. Conclusions are based on results from the Rotterdam Study, a population-based cohort study involving 6,423 people older than 54

A cross-sectional observational study has been carried out in 1205 patients, 404 over age 70 and 83 over age 80, to investigate whether differences are seen in glycemic control in older subjects vs younger ones with type 2 diabetes mellitus. Subjects were enrolled in the Fremantle Diabetes Study, a prospective study of diabetes care, control and complications in an urban setting. It was found that octogenarians do not show the usual progressive deterioration of glycemic control with diabetes duration seen in type 2 diabetes mellitus.

A correlational study has been carried out in 24 older women of mean age 74.4 years and 16 younger women of mean age 20.7 years to compare stepping performance during obstacle clearance women and to examine the relationship between lower extremity strength and stepping performance during obstacle clearance in older women. Findings showed dramatic differences in the speed of volitional stepping performance in older vs younger women. Lower extremity strength in older women was not related to volitional stepping performance.

Nocturnal polyuria in older people has been studied relative to pathophysiology and clinical implications. Alzheimer's disease adds to the risk. Treatment with the antidiuretic hormone analog desmopressin can bring lower nocturnal urine production and improvement in symptoms. Several factors contribute to changes in the circadian rhythm of water excretion with aging.

A cross-sectional study has been carried out in a university hospital in New York to evaluate cellular divalent cations in normal subjects at different ages and their relationship to ion levels in essential hypertension and diabetes. It was found that aging is associated with onset of altered cytosolic free calcium (Cai) and magnesium (Mgi) levels, indistinguishable from those observed in hypertension and diabetes, independent of age. The ionic changes may be clinically significant and may underlie predisposition of older subjects to cardiovascular and metabolic diseases. NMR techniques were used for intracellular measurement.

Patients attending an integrated syncope clinic were found to have a high diagnostic rate. The study describes finding in the first year of an integrated syncope clinic for older patients and to review the published literature on integrated syncope clinics investigating older people. Results of testing in 76 persons over the age of 60 were available for analysis and a diagnosis was achieved in 67 of them, 76% being cardiovascular. The other diagnoses were neurocardiogenic, 32%, and carotid sinus syndrome, 17%.

Key factors associated with difficulty and safety on stairs are defined in this review article. Study findings reported in the literature are interpreted in the light of possible interventions that could increase stair safety. Locomotion on stairs is one of the most hazardous and challenging things that older people do on a daily basis with falls on stairs accounting for 10%+ of fatal fall accidents. The cardiovascular and muskuloskeletal systems are called upon by need for input from the visual, somatosensory, and vestibular systems at various task stages.

Treatment of geriatric cachexia with megestrol acetate oral suspension has been studied using a 12-week double-blind, placebo-controlled study. Improvement in quality-of-life measures and stimulation of weight gain were seen three months after treatment. Weight loss is a common clinical problem in older patients.

A cross-sectional population-based study has been carried out in Amsterdam in 449 men and women aged 65 and older to investigate skeletal muscle mass and muscle strength relative to lower-extremity performance in older people. It appears that low muscle strength, but not low muscle mass, is associated with poor physical function in the elderly.

A U-shaped association has been found to exist between home systolic blood pressure (SBP) and four-year mortality in study of 1186 older men living in the community in Japan. High and low BP were both risk factors for mortality in this group. Mechanisms underlying the association between BP and mortality differ by levels of systolic BP. It appears low SBP is perhaps not only an independent mortality risk factor but also an indicator of a subclinical noncardiovascular comorbid condition. Adjustments were may for morbidity and frailty.

Deviation from the age-predicted norm in biological age may turn out to be a good predictor of cardiovascular pathology because there is a close relationship between chronological age and aortic and carotid compliance. Vascular compliance has been studied by reviewing 22 studies to see which measure is most closely related to biological age. Vascular compliance was found to be more closely related to chronological age than other measures, among them greying of hair, baldness, or skin inelasticity.

Determining the subtle changes in cognitive function with increasing age may vary depending on the research method used. According to a longitudinal model, cognition improved somewhat in 454 older people without dementia who were tested repeatedly over five years. This trend hides an early learning effect and the impact of dropout. Cross-sectional estimates indicated a slight decline in cognition, which seems more realistic.

The risk of mortality or functional decline in old age may be related to low cholesterol and albumin concentrations. Researchers examined mortality or declining health conditions in four groups of elderly people. Compared to a mortality rate of 4% in the group with normal albumin/normal cholesterol levels, 17% of those who had low albumin/low cholesterol were dead in three years. Functional decline was also more pronounced in the latter group.

Postural instability combined with visual challenges may increase the risk of falling in old age. Researchers modified the visual anchor of re-situating oneself in space by simulating the opening of elevator doors. Other effects were decreased lighting and having to count backwards. The risk of falling was higher in the group of older people as measured by foot pressure. The removal of a stable visual focus point may increase the risk of falling.

Choroidal blood flow appears to diminish with age, which could increase the risk of age-related eye diseases such as macular degeneration and glaucoma. Researchers used laser interferometry to measure ocular blood flow and also measured mean arterial pressure, intraocular pressure and ocular perfusion pressure in 130 healthy volunteers. Ocular blood flow decreased with age whereas mean arterial pressure, intraocular pressure and ocular perfusion pressure increased with age.

A randomized controlled study of growth hormone (GH) secretion when synthetic somatostatin analog (Octreotide) is being used. It was found that it suppresses daytime growth hormone secretion similarly in older men and young men. Pituitary responsiveness to somatostatin's inhibition is preserved in aging. Nine younger men, aged 35-44 and ten older men, aged 62-79, were studied. Likely daytime relative GH deficiency seen in older men is not from excessive pituitary susceptiility to somatostatin. More likely it is from impoverished endogenous GH releasing hormone (RH) drive or higher release of brain somatostatin. susceptiility

Data from the Massachusetts Framingham Heart Study is used to investigate risk factors for sarcopenia, or age-related skeletal muscle mass loss, in elderly patients living in community settings. Findings show that sarcopenia is related to a decrease in anabolic stimuli in men, such as growth hormone, but is related to a rise in catabolic stimuli in women, such as interleukin 6.

Research suggests that high levels of physical activity may offer a protective effect against inflammation in elderly populations, as inflammatory markers of C-reactive protein and interleukin-6 are lower for this group. Implications for further health research are discussed.

Results indicate that early rising in the elderly is not fully explained by a relative circadian system phase advance. It is posited that advanced illumination and evening naps may also cause circadian system advancement in aging.

The article examines present-day conceptualizations of the physiology of aging and compares them to those held 50 years ago. Similarities include the ability to ameliorate the effects of disease and age-related disability; differences include the medical costs associated with poor care, as research suggests that poor care may be more expensive than proper care.

A reprint of a 1953 article on the physiological aspects of aging is presented, focusing on degenerative processes. Treatment processes identified include passive, palliative, therapeutic, prophylactic, and rehabilitative-prophylactic.

A prospective cohort study using data from the MacArthur Studies of Successful Aging has been carried out to explore the effect of inflammation and undernutrition in the association between hypochlolesterolemia and higher overall mortality in high-functioning older persons. Hypocholesterolemia was found not to be an independent risk factor for increased overall mortality in high-functioning community-dwelling older men and women. The association of low total cholesterol and high mortality seen in crude analysis is confounded primarily by common cardiovascular risk facors, not underlying undernutition or inflammation.

In neurodegenerative diseases such as Alzheimer's and vas cular dementia cytokine-med iated inflammatory processes play a role. Cytokines are key in the hypothalamic-pituitary-adrenal axis acitvation in stress and depression. Complex cognitive systems, such as those underlying religious beliefs can modulate ef fects of stress on the immune system. S leep problems , micro nutrient deficiency from appetite problems and various endocrine interactions are related to cytokines and c ytokine dys regulation with aging may be part of cognitive aging.

Research indicates that physical activity may curb mobility performance decline in older persons. Studies revealed a beneficial effect for both sports and nonsports physical activities regardless of whether chronic disease was present.

Research indicates that older persons have lower expectations regarding successful aging than their younger counterparts, specifically in maintaining high physical and cognitive functioning. Implications for health care seeking and health promotion are discussed.

Research indicates that a higher body mass index and a higher percentage of body fat correlate with functional limitations in older persons. Data were obtained from the National Health and Nutrition Examination Survey from 1988 to 1994.

This article discusses the relationship between illness, disability, and depression in the aged. Topics include mood change, cognitive disorder, mortality, and cardiovascular disease.

The study by A.B. Newman et al. shows that artherosclerosis and subclinical cardiovascular disease are not inescapable aspects of the aging process. The study also suggests that subclinical coronary artery disease can be detected in asymptomatic older adults who are at risk for future problems.

Studies have shown that in older people growth hormone will increase muscle mass, but not strength. Exercise is more effective for increasing muscle strength and is not enhanced by growth hormone, which has adverse effects and may be life-shortening. Supplementation with growth hormone in healthy older people is not justified based on current knowledge. In severely ill, malnourished elderly it may be useful. More study is needed.

Serum levels of interleukin-6 (IL-6) and other cytokines may be an important causal factor in development of disability in older persons and it is not likely that many more observational studies, whether case/control in nature or longitudinal, will provide the definitive answer. The cytokines may be a measure of persistent inflammation coming from specific diseases, but more study is needed to find out what the situation is and what interventions would be best. Inflammation does cause loss of muscle fiber and muscle wasting. Various types of clinical trials will be needed. They are likely to be expensive especially with healthy older people with elevated IL-6 as subjects

More research is needed to determine whether dehydroepiandrosterone (DHEA) can slow the aging process in humans. It seems to do so in laboratory rats and human studies have shown that DHEA blood levels peak in the teens and 20's and then begin to decline with age. A 1998 study found that DHEA sulfate was positively correlated to lean body mass and physical fitness, at least in men. DHEA can also affect the immune system, enhance memory, and improve mood.