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    <recommendedItem id="20100101_19_346"
                     title="Daytime Sleepiness More Common in Young (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/PrimaryCare/SleepDisorders/tb/18221?impressionId=1265784923025"
                     
      &lt;p&gt;Compared with 20-somethings and seniors, middle-age adults are less likely to suffer daytime sleepiness when they don&apos;t get a good night&apos;s sleep, according to a small study.&lt;/p&gt;
&lt;p&gt;When three groups of healthy adults  --  young (20 to 30 years old), middle-age (40 to 55) and older (66 to 83)  --  were studied over four nights, slow wave sleep decreased and the number of nocturnal awakenings progressively increased with age, wrote Derk-Jan Dijk, PhD, of the Surrey Sleep Center at the University of Surrey in Guildford, England, and colleagues in the Feb. 1 issue of &lt;em&gt;Sleep.&lt;/em&gt;&lt;/p&gt;

&lt;p&gt;As the likelihood for eight hours of uninterrupted deep sleep decreased with age, there was no increase in the likelihood of daytime sleepiness, which led Dijk and colleagues to conclude that as people age there may be a change in the &quot;sleep (duration and depth) required to maintain alertness.&quot;&lt;/p&gt;
&lt;p&gt;Based on that observation, the authors wrote that it could be argued that &quot;an eight-hour episode rich in [slow wave sleep] is insufficient for young adults but that an eight-hour sleep episode with less [slow wave sleep] is sufficient for older adults.&quot;&lt;/p&gt;
&lt;p&gt;As a result, middle-age and older adults are less likely to build up &quot;sleep debt&quot; during the daylight hours, so they manage with less time in deep sleep at night, less homeostatic sleep pressure.&lt;/p&gt;
&lt;p&gt;The authors hypothesized that this apparent need for less sleep may be a factor in age-related insomnia.&lt;/p&gt;
&lt;p&gt;If older adults are unaware of the need for less sleep, &quot;their self-selected time in bed, which provides an input to the sleep homeostat, may become maladaptive and lead to reduced sleep consolidation and associated complaints.&quot;&lt;/p&gt;
&lt;p&gt;Dijk and colleagues recruited 44 young adults, 35 middle-age adults, and 31 older adults for their study. All were healthy at baseline and all were initially assessed for an eight-hour nocturnal sleep episode.&lt;/p&gt;
&lt;p&gt;They were then randomized to two nights of either selective short wave sleep interruption by acoustic stimuli or sleep without disruption, followed by one night of recovery sleep.&lt;/p&gt;
&lt;p&gt;Two standardized measurement tools, the Multiple Sleep Latency Test (MSLT) and the Karolinska Sleepiness Scale (KSS), were used to assess objective and subjective sleep propensity.&lt;/p&gt;
&lt;p&gt;&quot;Total sleep time per eight hour time in bed decreased significantly and progressively across the age groups such that older adults slept approximately 20 minutes less than middle-aged, who slept 23 minutes less than young adults,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The reduction in total sleep time &quot;was primarily related to an increase in the number of awakenings and the duration of wakefulness after sleep onset, rather than an increase in latency to sleep onset.&quot;&lt;/p&gt;
&lt;p&gt;As a result, sleep efficiency decreased significantly from 92.1% for the youngest group, to 82% for the older group (effect of age, &lt;em&gt;P&amp;lt;&lt;/em&gt;0.0001).&lt;/p&gt;
&lt;p&gt;The subjective sleep propensity tests revealed that &quot;young people were significantly sleepier than the middle-age people, who were the least sleepy of the three groups.&quot; Daytime sleepiness for the oldest group &quot;fell in between the other two groups [and] was not significantly different from either.&quot;&lt;/p&gt;
&lt;p&gt;All three groups, regardless of age, demonstrated increased daytime sleepiness following a night of experimental disruption of slow wave sleep, but when the participants had an uninterrupted eight hours of deep sleep, it was only the youngest group that was drowsy during the daytime hours.&lt;/p&gt;
&lt;p&gt;The authors noted that although there was less daytime sleepiness among middle-age and older adults in this study, sleep propensity was not measured during the evening hours, so it was possible that the age-related difference might diminish at twilight.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by H. Lundbeck A/S.&lt;/p&gt;&lt;p&gt;Dijk reported receiving research support from the Air Force Office of Scientific Research, the Biotechnology and Biological Sciences Research Council, GlaxoSmithKline, H. Lundbeck A/S, Merck, Pfizer, Philips Lighting, sanofi-aventis, and Takeda.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_315"
                     title="A Few Extra Pounds May Benefit Older People (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/tb/18183?impressionId=1265784923025"
                     
      &lt;p&gt;A little excess weight after age 70 could do the body some good, according to results of a study involving 9,000 older patients.&lt;/p&gt;
&lt;p&gt;Overweight participants in the cohort study had the lowest 10-year mortality. Normal-weight and obese participants ages 70 to 75 had a similar and slightly higher risk of death, Leon Flicker, PhD, of the Western Australian Center for Health and Aging in Perth, and colleagues found.&lt;/p&gt;
&lt;p&gt;The findings add to evidence suggesting that being overweight in older age is not such a bad thing and might even be beneficial.&lt;/p&gt;
&lt;p&gt;&quot;These results lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people,&quot; the researchers concluded in an article in the &lt;em&gt;Journal of the American Geriatrics Society&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The authors also found that a sedentary lifestyle doubled the mortality risk for older women but did not affect survival of older men.&lt;/p&gt;
&lt;p&gt;The World Health Organization has established four BMI thresholds to characterize body weight: &lt;ul&gt; &lt;li&gt;&amp;lt;18.5 kg/m&lt;sup&gt;2&lt;/sup&gt;, underweight&lt;/li&gt; &lt;li&gt;18.5 to 24.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, normal weight&lt;/li&gt; &lt;li&gt;25 to 29.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, overweight&lt;/li&gt; &lt;li&gt;&amp;#8805;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, obese&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors noted that the thresholds were derived primarily from studies of younger and middle-age adults. Whether the cut points for overweight and obese are appropriate for older individuals has remained unclear.&lt;/p&gt;
&lt;p&gt;Two systematic reviews and a meta-analysis showed no increased mortality risk associated with a BMI in the overweight range for older people (&lt;em&gt;Arch Intern Med&lt;/em&gt; 2001; 161: 1194-1203, &lt;em&gt;Obesity Rev&lt;/em&gt; 2007; 8: 41-59). However, methodologic differences complicated the comparison of different studies, Flicker and colleagues wrote.&lt;/p&gt;
&lt;p&gt;So they sought to address some of the uncertainty by analyzing data from two large Australian cohort studies involving more than 9,000 individuals ages 70 to 75 (4,677 men, 4,563 women).&lt;/p&gt;
&lt;p&gt;The principal objectives were to determine the BMI threshold associated with the lowest mortality in older people and to determine whether the relationship between BMI and mortality differed between men and women.&lt;/p&gt;
&lt;p&gt;Data for the analysis came from self-reported measures of height and weight, which the authors used to calculate BMI for the study participants. Participants also provided demographic, lifestyle, and health information.&lt;/p&gt;
&lt;p&gt;Using the WHO criteria for BMI, the authors found that 1.3% of men and 3.1% of women were underweight; 43.5% of men and 50.3% of women were normal weight; 44.3% of men and 33.5% of women were overweight; and 11% of men and 13.1% of women were obese.&lt;/p&gt;
&lt;p&gt;During 10 years of follow-up, overweight study participants had a 13% lower risk of death compared with normal-weight participants (HR 0.87, 95% CI 0.78 to 0.94). Obese participants had a mortality risk similar to that of normal-weight participants (HR 0.98, 95% CI 0.85 to 1.11).&lt;/p&gt;
&lt;p&gt;Self-reported sedentary lifestyle doubled the mortality risk for women across all BMI categories (HR 2.08, 95% CI 1.79 to 2.41). In contrast, sedentary lifestyle increased the mortality risk for men by 28% (HR 1.28, 95% CI 1.14 to 1.44).&lt;/p&gt;
&lt;p&gt;Separate analyses involving common causes of death, such as cardiovascular disease and cancer, showed similar relationships between BMI and mortality risk.&lt;/p&gt;
&lt;p&gt;&quot;Even after removing the effects of early mortality, those who were overweight were still at lowest risk, a finding consistent with the observation that weight loss in older age groups is associated with greater mortality,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Overweight older people are not at greater mortality risk, and there is little evidence that dieting in this age group confers any benefit,&quot; they added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_281"
                     title="Multiple Benefits Seen for Exercise in Seniors (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/tb/18140?impressionId=1265784923025"
                     
      Regular exercise can help stave off the cognitive and physical impairments of aging that many people dread more than death, a series of new studies found.&lt;br&gt;
&lt;br&gt;Ability to walk and perform other daily tasks, avoidance of major chronic diseases, and overall good quality of life  --  all were more common in people who exercised at least three times a week, according to four studies published in the Jan. 25 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;For example, analysis of some 13,500 participants in the Nurses&apos; Health Study found that the likelihood of &quot;successful survival&quot; (living past 70 in general good physical and mental health) was nearly doubled (OR 1.99, 95% CI 1.66 to 2.38) for those who had been in the highest quintile of overall physical activity 10 to 15 years earlier than for the most sedentary participants.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Even among those in the middle quintile, the chances of successful survival improved by 37% (OR 1.37, 95% CI, 1.13 to 1.65), Qi Sun, MD, ScD, of Harvard School of Public Health, and colleagues reported.&lt;/p&gt;
&lt;p&gt;&quot;The notion that physical activity can promote successful survival rather than simply extend the lifespan may provide particularly strong motivation for initiating activity,&quot; Sun and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Only 1,456 of the Nurses&apos; Health Study Participants qualified as successful survivors when evaluated from 1995 to 2001, meaning they were free of significant cognitive and physical disabilities as well as 10 major chronic conditions that included cancer, major cardiovascular and lung disease, kidney failure, diabetes, and Parkinson&apos;s.&lt;/p&gt;
&lt;p&gt;When initially evaluated at baseline in 1986, these successful survivors walked more (mean 9.5 metabolic-equivalent task [MET) hours per week versus 7.2 hours for other survivors, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and their overall physical activity levels were greater (mean 19.1 MET hours per week versus 14.1 hours, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Major highlights of the three other studies included: &lt;ul&gt; &lt;li&gt;Among women 65 and older in a randomized trial, an increasingly intense, supervised exercise program led to significantly enhanced bone mineral density, reduced falls, and better marks on standard cardiovascular risk factors than a more passive wellness program.&lt;/li&gt; &lt;li&gt;Risk of impaired performance on the six-item Cognitive Impairment Test in a prospective cohort study of about 3,900 people 55 and older was cut nearly in half among people with moderate or high levels of physical activity, relative to those with low levels (odds ratio 0.57 and 0.54, respectively, &lt;em&gt;P&lt;/em&gt;&amp;#8804;0.01).&lt;/li&gt; &lt;li&gt;Another randomized trial found that nursing-home residents 65 and older showed slower declines in health-related quality of life with two different exercise programs than with usual care.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Exercise was not a panacea, however. In the last study, involving 160 patients, it seemed to have little or no effect on psychiatric diagnoses such as dementia and psychosis.&lt;/p&gt;
&lt;p&gt;In the other randomized trial, involving a supervised exercise program with 246 participants, no improvement in cardiovascular disease risk was seen relative to the control group.&lt;/p&gt;
&lt;p&gt;Moreover, the improvements seen with exercise in that study also failed to translate into significant healthcare cost savings, according to the researchers, led by Wolfgang Kemmler, PhD, of the University of Erlangen-Nuremberg in Germany.&lt;/p&gt;
&lt;p&gt;They estimated that the total 18-month cost of healthcare for those in the exercise program averaged about $3,202, compared with $3,948 in the control group (&lt;em&gt;P&lt;/em&gt;=0.20).&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, two gerontologists from the University of Florida in Gainesville, Fla., commented that the most important clinical question about exercise in the elderly remained unanswered by these and earlier studies.&lt;/p&gt;
&lt;p&gt;&quot;While scientific value of these studies cannot be disputed, whether the results can or should be translated into recommendations for preventing disability progression in the broader community of older adults typically seeking care in the outpatient setting is the burning question that remains. This is because most of these studies and other published studies have enrolled younger and generally healthier older people,&quot; wrote Jeff Williamson, MD, MHS, and Marco Pahor, MD.&lt;/p&gt;
&lt;p&gt;&quot;The primary issue is the lack of randomized controlled trials (RCTs) of adequate scope examining the feasibility, safety, and impact of exercise over a long duration (&amp;gt;2 years) in persons who are at highest risk for loss of independence on relevant geriatric outcomes, such as onset of major disability,&quot; they added.&lt;/p&gt;
&lt;p&gt;Williamson and Pahor have planned a clinical trial that they said could begin to provide answers.&lt;/p&gt;
&lt;p&gt;A multicenter study called Lifestyle Interventions and Independence for Elders (LIFE) is set to recruit 1,600 older sedentary people considered at risk to lose substantial mobility. They will be assigned to an exercise program or to receive general health education and will be followed for four years.&lt;/p&gt;
&lt;p&gt;&quot;The LIFE study will provide definitive evidence regarding whether physical activity is effective and practical for preventing major mobility disability,&quot; Williamson and Pahor asserted.&lt;/p&gt;
&lt;p&gt;Meanwhile, the four new &lt;em&gt;Archives&lt;/em&gt; studies &quot;move the scientific enterprise in this area further along the path toward the goal of understanding the full range of important aging-related outcomes for which exercise has a clinically relevant impact,&quot; the editorialists wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study by Sun and colleagues was funded by the National Institutes of Health and the Boston Obesity Nutrition Research Center, along with support from Unilever and the American Heart Association.&lt;/p&gt;&lt;p&gt;The study by Etgen and colleagues was funded by AOK, a health insurer in Germany.&lt;/p&gt;&lt;p&gt;The study by Kemmler and colleagues was funded by Siemens Betriebs Krankenkasse, Behinderten-und-Rehabilitations-Sportverband Bayern, Netzwerk Knochengesundheit e.V., Opfermann Arzneimittel GmbH, Thera-Band, Institute of Sport Science, and Institute of Medical Physics.&lt;/p&gt;&lt;p&gt;The study by Dechamps and colleagues was funded by Conseil Regional d&apos;Aquitaine.&lt;/p&gt;&lt;p&gt;None of the study authors or the editorialists reported any competing financial interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_8_929"
                     title="Active Men Lessen Later Fracture Risk"
                     score="-0.005"
                     href="