ABSTRACT
Vaccine response declines with age, but currently recommended vaccines are safe and effective in reducing, if not preventing, disease altogether. Over the last decade, advancements in vaccine immunogenicity, either by increasing dose or conjugating vaccines to protein, have resulted in more immunogenic vaccines that also seem more effective in reducing clinical disease both for influenza and pneumococcus. Meanwhile, there is a resurgence in incident pertussis, exceeding prevalence from five decades ago, adding older adults to a recommended target vaccination group. This article discusses currently available vaccines, in the context of current epidemiology and recommendations, for older adults.
Subject(s)
Infection Control/methods , Vaccination/methods , Vaccines, Conjugate/pharmacology , Aged , HumansABSTRACT
The clinical phenomenon of early evening disruptive behavior also called "Sundowning" in elderly patients has been largely reported in the medical literature without a consistent diagnosis and criteria to define this phenomenon. The current understandings of sundowning are incomplete and current treatment strategies have relied heavily on use of antipsychotic medications, despite side effects and limited evidence to justify their use. A comprehensive understanding of the biogenesis of this phenomenon and mechanistic changes from oxidative pathways may provide novel information on completing the sundowning puzzle. Future studies could examine the utility of natural factors in reviving neuronal energy loss and altering the oxidative pathways might be safe and additional options in development of treatment models for this behavioral disorder.
Subject(s)
Aging , Antipsychotic Agents/pharmacology , Dementia/complications , Psychomotor Agitation , Sunlight , Adaptation, Physiological , Aged , Aging/physiology , Aging/psychology , Biological Phenomena , Humans , Oxidative Stress/physiology , Psychomotor Agitation/etiology , Psychomotor Agitation/metabolism , Psychomotor Agitation/therapyABSTRACT
BACKGROUND: Markers of collagen turnover have not been well studied in the context of cardiovascular disease in patients with chronic kidney disease (CKD). We investigated the associations between serum markers of collagen turnover [N-terminal procollagen type 3 propeptide (PIIINP) and carboxy-terminal telopeptide (C1TP)] and both pulse wave velocity (PWV) and left ventricular mass index (LVMI) in a CKD cohort. METHODS: The study included 242 patients (mean age 60 ± 15 years, 53% males, 80% Caucasian, CKD Stages 3-5) from the Renal Research Institute (RRI)-CKD Study. Serum PIIINP and C1TP levels were analyzed by radioimmunoassay. PWV was obtained by applanation tonometry from carotid and femoral pressure wave contours. LVMI was measured by echocardiography. Statistical analyses included Pearson's correlations and multiple linear regression. RESULTS: Both PIIINP and C1TP values were significantly higher in more advanced stages of CKD (P < 0.05). A positive correlation was demonstrated between PWV and LVMI (r = 0.25, P = 0.0018), persisting after adjustment for potential confounders (partial r = 0.27, P = 0.0009). PIIINP correlated with PWV (r = 0.16, p = 0.029) and LVMI (r = 0.16, P = 0.0018), while C1TP correlated with LVMI (r = 0.18, P = 0.013) but not with PWV (r = 0.12, P = 0.09). In multivariable analysis adjusting for race, diabetes, estimated glomerular filtration rate (eGFR) and renin-angiotensin-aldosterone system inhibitors, only PWV (ß = 0.45, P = 0.0017) but not LVMI (P = 0.09) remained significantly associated with serum PIIINP. CONCLUSIONS: Our results demonstrate the association of PIIINP (but not C1TP), a circulating biomarker of collagen synthesis with arterial stiffness (but not with LVMI) in a CKD cohort, independent of eGFR. This suggests that altered collagen turnover may play a role in the pathogenesis of arterial stiffness in CKD.
Subject(s)
Arteries/physiopathology , Biomarkers/metabolism , Collagen/metabolism , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/etiology , Kidney Failure, Chronic/complications , Vascular Stiffness , Academies and Institutes , Cohort Studies , Female , Follow-Up Studies , Glomerular Filtration Rate , Humans , Hypertrophy, Left Ventricular/metabolism , Kidney Failure, Chronic/metabolism , Male , Middle Aged , Peptide Fragments/metabolism , Procollagen/metabolism , Prognosis , Prospective StudiesABSTRACT
Depression in heart failure recently has become a topic of great interest because of the high prevalence of the diseases and their tendency to worsen medical prognosis. This article reviews the epidemiology of depression in heart failure and provides the necessary knowledge and insight for understanding the complex burden of the disease in terms of mortality, morbidity, health-care costs and impact on quality of life (QOL). Early detection and treatment of this comorbid association is important for patients to improve QOL and regain function. The article also highlights the wide heterogeneity in the prevalence of depression in heart failure across the various studies done and emphasizes the need for future research to address these gaps.
