IMPORTANCE: It is unclear whether levothyroxine treatment provides clinically important benefits in adults aged 80 years and older with subclinical hypothyroidism. OBJECTIVE: To determine the ...association of levothyroxine treatment for subclinical hypothyroidism with thyroid-related quality of life in adults aged 80 years and older. DESIGN, SETTING, AND PARTICIPANTS: Prospectively planned combined analysis of data involving community-dwelling adults aged 80 years and older with subclinical hypothyroidism. Data from a randomized clinical trial were combined with a subgroup of participants aged 80 years and older from a second clinical trial. The trials were conducted between April 2013 and May 2018. Final follow-up was May 4, 2018. EXPOSURES: Participants were randomly assigned to receive levothyroxine (n = 112; 52 participants from the first trial and 60 from the second trial) or placebo (n = 139; 53 participants from the first trial and 86 from the second trial). MAIN OUTCOMES AND MEASURES: Co-primary outcomes were Thyroid-Related Quality of Life Patient-Reported Outcome (ThyPRO) questionnaire scores for the domains of hypothyroid symptoms and tiredness at 1 year (range, 0-100; higher scores indicate worse quality of life; minimal clinically important difference, 9). RESULTS: Of 251 participants (mean age, 85 years; 118 47% women), 105 were included from the first clinical trial and 146 were included from the second clinical trial. A total of 212 participants (84%) completed the study. The hypothyroid symptoms score decreased from 21.7 at baseline to 19.3 at 12 months in the levothyroxine group vs from 19.8 at baseline to 17.4 at 12 months in the placebo group (adjusted between-group difference, 1.3 95% CI, −2.7 to 5.2; P = .53). The tiredness score increased from 25.5 at baseline to 28.2 at 12 months in the levothyroxine group vs from 25.1 at baseline to 28.7 at 12 months in the placebo group (adjusted between-group difference, −0.1 95% CI, −4.5 to 4.3; P = .96). At least 1 adverse event occurred in 33 participants (29.5%) in the levothyroxine group (the most common adverse event was cerebrovascular accident, which occurred in 3 participants 2.2%) and 40 participants (28.8%) in the placebo group (the most common adverse event was pneumonia, which occurred in 4 3.6% participants). CONCLUSIONS AND RELEVANCE: In this prospectively planned analysis of data from 2 clinical trials involving adults aged 80 years and older with subclinical hypothyroidism, treatment with levothyroxine, compared with placebo, was not significantly associated with improvement in hypothyroid symptoms or fatigue. These findings do not support routine use of levothyroxine for treatment of subclinical hypothyroidism in adults aged 80 years and older. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01660126; Netherlands Trial Register: NTR3851
Gut microbiota and aging O'Toole, Paul W.; Jeffery, Ian B.
Science (American Association for the Advancement of Science),
12/2015, Volume:
350, Issue:
6265
Journal Article
Peer reviewed
The potential for the gut microbiota to affect health has a particular relevance for older individuals. This is because the microbiota may modulate aging-related changes in innate immunity, ...sarcopaenia, and cognitive function, all of which are elements of frailty. Both cell culture–dependent and –independent studies show that the gut microbiota of older people differs from that of younger adults. There is no chronological threshold or age at which the composition of the microbiota suddenly alters; rather, changes occur gradually with time. Our detailed analyses have separated the microbiota into groups associated with age, long-term residential care, habitual diet, and degree of retention of a core microbiome. We are beginning to understand how these groups change with aging and how they relate to clinical phenotypes. These data provide a framework for analyzing microbiota-health associations, distinguishing correlation from causation, identifying microbiota interaction with physiological aging processes, and developing microbiota-based health surveillance for older adults.
Centenarians have a decreased susceptibility to ageing-associated illnesses, chronic inflammation and infectious diseases
. Here we show that centenarians have a distinct gut microbiome that is ...enriched in microorganisms that are capable of generating unique secondary bile acids, including various isoforms of lithocholic acid (LCA): iso-, 3-oxo-, allo-, 3-oxoallo- and isoallolithocholic acid. Among these bile acids, the biosynthetic pathway for isoalloLCA had not been described previously. By screening 68 bacterial isolates from the faecal microbiota of a centenarian, we identified Odoribacteraceae strains as effective producers of isoalloLCA both in vitro and in vivo. Furthermore, we found that the enzymes 5α-reductase (5AR) and 3β-hydroxysteroid dehydrogenase (3β-HSDH) were responsible for the production of isoalloLCA. IsoalloLCA exerted potent antimicrobial effects against Gram-positive (but not Gram-negative) multidrug-resistant pathogens, including Clostridioides difficile and Enterococcus faecium. These findings suggest that the metabolism of specific bile acids may be involved in reducing the risk of infection with pathobionts, thereby potentially contributing to the maintenance of intestinal homeostasis.
•To increase a better understanding of the drivers and barriers affecting older consumers’ intention to shop online.•The major factors driving older adults toward online shopping are performance ...expectation and social influence.•The major barriers that keep older adults away from shopping online include value and tradition.
The use of the Internet by older adults is growing at a substantial rate. They are becoming an increasingly important potential market for electronic commerce. However, previous researchers and practitioners have focused mainly on the youth market and paid less attention to issues related to the online behaviors of older consumers. To bridge the gap, the purpose of this study is to increase a better understanding of the drivers and barriers affecting older consumers’ intention to shop online. To this end, this study is developed by integrating the Unified Theory of Acceptance and Use of Technology (UTAUT) and innovation resistance theory. By comparing younger consumers with their older counterparts, in terms of gender the findings indicate that the major factors driving older adults toward online shopping are performance expectation and social influence which is the same with younger. On the other hand, the major barriers include value, risk, and tradition which is different from younger. Consequently, it is notable that older adults show no gender differences in regards to the drivers and barriers.
IntroductionDemographic changes are leading to an ageing population with a disproportionate increase in the oldest old. Stroke is a leading cause of death and disability in Australia and is ...particularly prevalent in the elderly. The Murrumbidgee region has a population profile that is 14 years ahead of national Australia and therefore data from this population portends how stroke may present nationally in the future. Existing research suggests that stroke risk factors, subtype, treatment provided and outcomes differ between younger and older demographic groups. This study seeks to build a profile of the experiences of stroke in the oldest old and compare variables with two younger cohorts to test a number of hypotheses about background, treatment and outcomes.MethodsData was collected retrospectively from the electronic medical records of 100 stroke patients consecutively admitted to the Wagga Wagga Rural Referral Hospital Acute Stroke Unit. They were split into three demographic groups; young old, 65–74 old (75 to 84) and oldest old (85 and older) and comparisons were made of baseline functional status and risk factor profile, stroke type, stroke treatment and outcomes.ResultsOlder people admitted with stroke were more likely to be female with poorer premorbid functional status and higher numbers living in residential care. Atrial fibrillation (p=0.008) and hypertension (p=0.01) were significantly more common with advancing age while rates of smoking (p=0.006) were higher in younger patients. Stroke mechanism was predominantly cardioembolic in older patients and embolic stroke of undetermined source (ESUS) in the youngest group. Stroke severity and stroke treatment did not vary according to age. However, outcomes were poorer with rates of dependency (p=0.03) and residential aged care facility placement (p=0.06) increased among older patients post stroke.ConclusionThese data provide an indication of how stroke may manifest in our ageing population in the future.
PATIENT PORTRAITS Marvaha, Seema
Canadian Medical Association journal (CMAJ),
10/2020, Volume:
192, Issue:
40
Journal Article
Peer reviewed
Marwaha relates the story of Sam Meister, a 97-year-old widower, retired business man and Holocaust survivor. His parents died at Auschwitz and his brother was also killed during the war. At the end ...of the war, he, his only sister and older brother were left. The love of his life was also sent to Auschwitz. He didn't know she was alive until it was liberated. When she came home after the war, they got married right away. He arrived in Halifax in 1948. They were assigned to settle in Winnipeg, but they got off the train early in the big city--Toronto--and lived there ever since. They raised two children and he built three successful businesses.
Summary Background The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, ...disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008. Methods We used data from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged 80–89 years, 90–99 years, and 100–105 years (in total, 19 528 oldest-old participants) were examined; the two cohorts in each pair were born 10 years apart, with the same age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes were investigated: annual death rate, Activities of Daily Living (ADL), physical performance in three tests and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the cohort differences. Findings Controlling for various confounding factors, we noted that annual mortality among oldest-old individuals was substantially reduced between 0·2% and 1·3% in 1998–2008 compared with individuals of the same age born 10 years previously, and that disability according to activities of daily living had significantly reduced annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts increased annually between 0·7% and 2·2% and objective physical performance capacity (standing up from a chair, picking up a book from the floor, and turning around 360°) decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially lower than male mortality among the oldest-old, but that women's functional capacities in activities of daily living, cognition, and physical performance were worse than their male counterparts. Interpretation Advances in medications, lifestyle, and socioeconomics might compress activities of daily living disability, that is, benefits of success, but lifespan extension might expand disability of physical and cognitive functioning as more frail, elderly individuals survive with health problems, that is, costs of success. Funding National Natural Science Foundation of China, National Institute on Aging/National Institutes of Health, United Nations Funds for Population Activities.
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