And such differences were constant even after researchers took into account how much pain the patients were having, said lead study author Dr. Timothy Platts-Mills, an assistant professor of emergency medicine at the University of North Carolina at Chapel Hill School of Medicine.

Of those older patients reporting severe pain, 67 percent received pain medication, compared to 79 percent of middle aged patients with severe pain.

“We’re not exactly sure why this happens,” said Platts-Mills in a news release. “It may be because physicians are more concerned about potential side effects in this population.

Emergency departments (EDs) are a significant source of acute care for older adults, with more than 20 million emergency department visits each year by patients 65 and older. Nearly half of these medical visits are for the treatment and evaluation of pain.

Platts-Mills and colleagues conducted a secondary analysis of data collected from U.S. emergency departments between 2003 and 2009 in order to test the hypothesis that older adults who come to the ED with a primary complaint of pain are less likely to receive pain medication than younger patients.

Results indicate 49 percent of patients 75 and older received an analgesic like ibuprofen, morphine or oxycodone, compared to 68.3 percent of patients  who were middle-aged patients. Also, 34.8 percent of the elderly patients received an opioid like oxycodone or  morphine compared to 49.3 percent of the middle-aged patients.

These differences remained even after the results were adjusted for race/ethnicity, sex, pain severity and other factors. Elderly patients were 19.6 percent less likely to receive an analgesic and 14.6 percent less likely to receive an opioid than middle-aged patients.

Platt-Mills said the gap in pain management for older patients shows the need for medical professionals to understand the best ways to manage pain and recognize the barriers to doing this.

“All patients, regardless of age, deserve to have relief from pain, especially when it is severe,” Platt-Mills said in a news release. “Our group is actively investigating the side effects of commonly used pain medication and the impact of pain on functional outcomes after injury in older adults.

”

The study’s authors say more research is needed to understand the long-term impact of acute pain management for older patients in the emergency department, to find new methods to minimize adverse effects from pain medications, and to explore the role of non-pharmacologic pain management for the elderly.

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

Clostridium difficile is a bacterium that causes infection and leads to diarrhea. It is most often related to antibiotic use during medical treatment.  A major cause of illness and increasing health care costs among patients in hospitals, C. difficile infections have increased dramatically in recent years. There are approximately 500,000 cases in the United States annually and approximately 15,000 deaths each year, according to the U.S. Centers for Disease Control & Prevention.

Almost 25 percent of patients will have a recurrence of C. difficile infection, and a proportion will be resistant to antibiotics. C. difficile is especially dangerous for patients who have weakened immune systems such as the elderly and those who suffer with Inflammatory Bowel Disease.

Therapies for this difficult-to-treat subpopulation include antibiotics, probiotics, toxin-binding medications, active vaccination, intravenous immunoglobon, and fecal microbiota transplant, for which the evidence has been mounting as an effective rescue for recurrent and resistant cases of C. difficile associated diarrhea.

The first study included 77 patients from New York, Rhode Island, Okalahoma, California and Washington who previously had a colonoscopic fecal microbiota transplant at least three months ago for recurrent C. difficile infection.

Researchers found that FMT had a 91 percent success rate with 70 out of 77 patients who were on average elderly, debilitated and had undergone multiple failed treatments, including antibiotic and probiotic therapies.

Additionally, in six of the remaining seven patients, a single two-week course of vancomycin or a two-week vancomycin course plus one further FMT resulted in a cure in 98 percent of the patients.

Many of the patients who were followed in this study had been ill for quite a long time,  said Dr. Mark Mellow, of INTERGRIS Baptist Medical Center in Oklahoma. “Once they underwent the fecal microbiota transplant, their response to the treatment was quick and their symptoms improved on average in about six days.”

These patients had been ill on average for 11 months, but after the FMT procedure patients continued to improve, according to Dr. Mellow and his fellow investigators. And without additional antibiotic treatment, the patients did not have a recurrence of C. difficile infection during follow-up which averaged 17 months.

Results from a meta-analysis by researchers at the University of Toledo Medical Center also provided further evidence of the effectiveness of fecal microbiota transplantation.

Researchers reviewed the cases of 148 patients who had received fecal transplants for C. difficile infection.  Follow-up ranged from 10 days to 62 months after the transplant, with an average follow-up of 1 year.

The fecal transplant procedure had an overall success rate of 85.4 percent, according to researchers, who also concluded that the procedure was a safe and effective treatment option for C. difficile infection.

“While the concept of fecal transplantation may sound unpleasant to some, patient acceptance of this treatment is growing, especially when they have been suffering for months with recurrent C. difficile,” said Dr. Mellow.  “When we asked patients in our study about their choice of treatment if their infection recurred, 53 percent said fecal transplant would be their first choice for treatment.”

With the fecal transplantation’s growing success rate for C.Difficile, researchers have started to explore the effectiveness of this procedure for other serious conditions, such as Inflammatory Bowel Disease.  In this separate study, researchers reported successful treatment of severe mixed Inflammatory Bowel Disease, using recurrent fecal microbiota
transplants in three patient cases.

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

That is what surgeons have concluded after conducting the first study of long-term outcomes from a series of clinical trials of patients 60 and over who were treated with the new form of stem cell transplantation. This kinder and gentler form of donor cell stem cell transplantation was developed at Fred Hutchinson Cancer Research Center.

“Age is no longer a barrier to allogeneic transplant,” said Dr. Mohamed Sorror, an assistant member of the Hutchinson Center’s Clinical Research Division and study  author.

The study involved 372 patients ages 60 to 75 who were enrolled in prospective clinical trials between 1998 and 2008 at 18 collaborating U.S. and European cancer centers known as the “Seattle Consortium.

Researchers found that the five-year rates of overall and disease-progression-free survival among mini-transplant patients were 35 percent and 32 percent, respectively.

Patients in three age groups – 60 to 64, 65 to 69 and 70 to 75 – had comparable survival rates, which showed  that age does play a role in how patients tolerate the mini-transplant procedure.

The two factors that affected survival among older patients were a higher degree of  cancer aggressiveness and  increased medical problems unrelated to cancer. Those patients not impacted by those two factors had a five-year survival rate of 69 percent, compared to 23 percent, regardless of age.

While a long-term survival rate of only a third of these older patients may seem low, researchers say these patients all would have died of their diseases within a matter of months without a transplant.

“The majority of patients were referred for a transplant after they had exhausted all forms of conventional therapy,” said Sorror, who works in the research group led by Dr. Rainer Storb, who developed the mini-transplant.

The study’s authors say these results are very encouraging considering the poor outcomes with non-transplantation treatments, especially for patients with fludarabine-refractory CLL (chronic lymphocytic leukemia), high-risk AML (acute myeloid leukemia),  or progressive lymphoma.

The mini-transplant, known in medical circles as nonmyeloablative transplantation, was developed by researchers at the Hutchinson Center for patients who are older and medically sicker who otherwise could not tolerate the standard, more-toxic, high-dose regimens used to prepare patients for transplantation.

Traditional transplants use high doses of total-body irradiation and potent chemotherapy to destroy leukemic cells, and are typically not performed on those over 60. The intense treatment destroys the blood and immune system and is fatal unless the patient is rescued by transplantation of donor bone marrow or stem cells isolated from peripheral blood.

The mini-transplant depends on the ability of donor immune cells to target and destroy the cancer – without high-dose chemotherapy and radiation. Instead, low-dose radiation and chemotherapy suppress the immune system rather than destroy it. This assists the body in accepting the donor stem cells, which then attack the cancer cells – called the graft-vs.-leukemia effect – and rebuild the body’s immune system.

The study also examined rates of relapse, the toxicity of treatment to internal organs, hospitalization, acute and chronic graft-vs.-host disease (GVHD) which is the most common side effect of transplantation.

Five years after the transplants, almost 66 percent of patients who were affected by chronic GVHD had complete resolution of their symptoms and were able to discontinue immunosuppressive medications after a median time of  two and half years from the initial diagnosis. And 50 percent of the patients never required hospitalization after transplant.

Noting that 20 percent of the U.S. population will be 65 or older by the year 2030, researchers say an increase of up to 77 percent in the number of newly diagnosed blood cancers among this population are expected to occur in the next two decades.

Researchers say they plan to further study the reasons behind the low referral rate of older patients to transplant  and how mini-transplant outcomes compare to those of conventional therapies.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

Researchers found that patients who talk with their physicians about end-of-life care and have an advance directive in their medical record have similar survival rates as patients who do not have these discussions and documents.

The study included 356 patients admitted at three different hospitals who had low or medium risks of dying within one year. Patients were followed from 2003 to 2009.

During the study, there were no differences in survival for patients who had an end-of-life discussion and those who had not; there also were no survival differences for those who had a living will in their medical record and those who did not.

“Our findings are reassuring. They support health care providers, who can initiate these discussions, and policy makers, who seek to reimburse these time consuming discussions,” said lead researcher Dr. Stacy M. Fischer, of the University of Colorado School of Medicine. “Most importantly, our findings are reassuring for patients and families who desire these discussions with their health care providers.”

“The term ‘death panels’ has sparked considerable controversy recently. It has undermined the efforts of clinicians who provide end-of-life care by scaring patients into thinking that their lives may be cut short for their families’ or society’s best interest,” said Fischer. “We hope our study provides data to help inform the national debate about advance directives for key stakeholders; health care providers, policy makers, and patients and families.”

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

The researchers found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent rate of hospitalization within 30 days of biopsy compared to a 2.9 percent hospitalization rate among a control group of men who did not have a prostate biopsy.

More than 1 million prostate biopsy procedures are performed each year in the United States to diagnose and monitor prostate cancer, which is the second most common cause of cancer death among men.

Researchers from Johns Hopkins University say that prostate biopsies should only be performed with strict adherence to medical guidelines, and after all potential risks and benefits have been reviewed with patients. They emphasize that this new data should serve as a reminder to physicians to carefully weigh the risks and benefits of biopsy for individual patients and take all precautions to prevent infections and other complications.

The Johns Hopkins team’s findings are the result of the largest analysis ever performed of Medicare records of American men age 65 and older who underwent prostate biopsies in the last two decades.

They found that having a prostate biopsy makes patients more than twice as likely to need hospitalization after the procedure. Those hospitalized had a range of complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders.

Overall, mortality rates in men undergoing prostate biopsies did not increase. However, men hospitalized with biopsy-related infections had a 12-fold higher risk of death compared to men who did not have a biopsy.

“Prostate biopsy is an essential procedure for detecting prostate cancers,” says Dr. Edward Schaeffer, a Johns Hopkins urologist and oncologist and the study’s senior investigator. “Coupled with appropriate screening, prostate biopsies save lives. However, it is important for men to be aware of the possible risks of prostate biopsies, which are often described as simple outpatient procedures.”

In their study, the researchers examined the frequency of biopsy related complications that required hospitalization in more than 17,400 men age 65 and older from 1991 to 2007. They compared these rates to a cohort of 134,977 men during the same time period with similar characteristics who did not undergo a prostate biopsy. The researchers only looked at hospital admissions, not men whose complications were treated in an emergency department or outpatient setting.

While the rate of hospitalization following prostate biopsy has declined steadily since 1991, the researchers found that the rate of hospitalization during the time period was still two-fold higher among the men who had a biopsy (6.9 percent compared to 2.9 percent).

There was also a steady rise in the rate of serious infection-related complications. At the onset of the study in 1991, fewer than 0.5 percent of men were admitted to the hospital because of an infection diagnosed following a prostate biopsy. This rate remained stable until 2000, when rates of infection-related complications began to increase to more than 1.2 percent in 2007.

“Antibiotics are routinely given to men at the time of biopsy, and the fact that infections serious enough to cause hospital admissions have been on the rise makes us think that these types of complications are occurring because of a steady increase in antimicrobial resistance rates in America,” said Schaeffer, who is also an associate professor at the Johns Hopkins University School of Medicine.

“Based on these findings, we believe that more needs to be done to reduce potential complications,” said co-author H. Ballentine Carter, M.D., professor of urology and oncology at the Johns Hopkins University School of Medicine. “It is important for urologists to determine if a biopsy is appropriate for an individual patient and also if the patient is at increased risk for a biopsy- related complication.”

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

These burdensome transitions include moving to a different facility in the last three days of life or repeat hospitalizations for expected complications of dementia in the last 90 days of life.

“Such patterns of transitions are burdensome, particularly since the overwhelming majority of family members state the main goal of care is comfort,” said study co-author Joan Teno, professor of health policy and practice at the Warren Alpert Medical School of Brown University and a palliative care physician, in a news release.  “These transitions reflect the inefficiency of our health care system. Similar outcomes could be achieved by keeping these patients in the nursing home setting.”

An important reason for the prevalence of burdensome transitions might be embedded in the way Medicare pays nursing homes, said Brown health economist and lead author Pedro Gozalo.

Nursing homes can earn higher payments for patients who have been transferred to a hospital for three days and they may qualify for skilled nursing services paid by Medicare rather than Medicaid upon their return. The current incentives under Medicare and Medicaid encourage nursing homes to send patients to the hospital, he said.

What makes the transitions burdensome, especially for patients with cognitive impairment, Teno said, is that they are often unnecessary, raise the risk of medical errors, and interrupt continuity of care for patients who can experience significant stress and disorientation when they are suddenly removed from familiar surroundings and people. When the patients become upset, their families experience more stress.

Because these financial incentives, market conditions, and the culture of end-of-life care vary by state, so do the rates of burdensome transitions.

The authors, who also include researchers from Harvard University and Dartmouth College, found that the overall percentage of patients experiencing at least one burdensome transition was 19 percent. State-level rates varied from 2.1 percent in Alaska to 37.5 percent in Louisiana. Blacks and Hispanics were also more likely than whites to experience burdensome transitions, the authors found.

“These burdensome transitions are not only bad for the patient, they also drain the federal treasury, hastening the day when the Medicare trust fund runs out of money,” said economist Jonathan Skinner from Dartmouth College, a co-author on the study.

To reach these conclusions, the team analyzed federal databases of nursing home and Medicare records accumulated between 2000 and 2007. In all, they found 474,829 patients who were older than 66, had advanced cognitive impairment, and lived in a nursing home 120 days before their death.

Of these, 90,228 residents experienced at least one burdensome transition, defined as either a transfer in the last three days of life, returning to a different nursing home than the one they lived in before they went to the hospital, or multiple hospitalizations in the last 90 days of life.

Often these hospitalizations occur even though the condition prompting the hospitalization — pneumonia, urinary tract infection, or dehydration — could easily be treated in a properly equipped and staffed nursing home.

These variations were particularly wide across different geographic areas. In McAllen, Texas, 24.1 percent of patients had multiple hospitalizations for urinary tract infections, pneumonia or dehydration, compared to only 0.7 percent of patients in Grand Junction, Colo.

The regional rate of burdensome transitions also correlates with other indicators of poor end-of-life care, Gozalo noted. Compared to patients living in the health care markets with the lowest rates of burdensome transitions, those who lived in the regions with the highest rates were three times more likely to have a feeding tube inserted, more than twice as likely to be in the intensive care unit in the last 30 days of life, and more than twice as likely to have developed an advanced pressure ulcer.

Ultimately, Teno said, all of these problems are signs of care gone awry. The best care for a patient with advanced cognitive impairment near the end of life is often to maximize comfort. The burdens of hospitalization usually outweigh the benefits.

“Our research calls for efforts to reform health care payment that create incentives to improve advance care planning and care coordination,” Gozalo said. “Current reform efforts like accountable care organizations that bundle both the hospital and post-acute care payments could begin to address some of these perverse incentives. We need financial incentives to make sure that people are getting the right care in the right place at the right time.”

For more on end-of-life care, see the library of articles by Daytona Beach nursing  home injury attorney.

Visual information helps us to coordinate our movements so that we can successfully navigate our surroundings. In fall-prone older adults, however, the ability to collect visual information is compromised, and this group is not slowing down to compensate for this effect.

The researchers, Fiona Newell of Trinity College in Dublin and colleagues conducted an experiment comparing three groups: older adults who had fallen at least once in the past 12 months, older adults who had not fallen, and younger adults.

The participants completed a walking course that consisted of an invisible equilateral triangle. One side of the triangle was a mat with sensors that recorded the gait of the participants.

Researchers also tested the subjects’ ability to navigate this unmarked course. After following the course under normal conditions, the participants then attempted to walk the course again wearing safety goggles wrapped with masking tape. The tape blurred the participants’ vision but still allowed light in.

Blurred vision took its toll on the performance of all three groups, but especially the fall-prone older adults. When the vision of the other two groups was reduced, they reduced their walking speed. They were compensating for their impairment by proceeding more slowly.

The fall-prone group, however, did not walk more slowly. They also made more errors in returning to the starting point of the course.

Performance in older adults has generally been found to be less than that of younger adults in tasks involving the use of spatial memory to guide movement, researchers say.

In this study, the fall-prone older adults displayed an overreliance on visual information for spatial cognition, but at the same time they did not adjust their behavior to compensate for their lack of visual information.

The findings suggest that the ability to collect and process the visual information needed to navigate the surrounding environment is more severely impaired in fall-prone older adults than in older adults who have not fallen.

The results of this study was published in the current issue of the journal “Insight: Research and Practice in Visual Impairment and Blindness.”

For more on elderly health issues, see the library of articles by Daytona Beach nursing home injury attorney.

The World Alzheimer Report 2011, released by Alzheimer’s Disease International (ADI), shows that there are interventions that are effective in the early stages of Alzheimer’s disease, some of which may be more effective when started earlier, and that there is a strong economic argument in favor of earlier diagnosis and timely intervention.

To prepare the report, titled “The Benefits of Early Diagnosis and Intervention,” ADI commissioned a team of researchers led by Prof. Martin Prince at the Institute of Psychiatry, King’s College London, to undertake the first-ever, comprehensive, systematic review of all of the evidence on early diagnosis and early intervention for dementia.

According to the World Alzheimer Report 2009, the number of people with dementia is forecast to nearly double every 20 years — from 36 million in 2010 to 115 million in 2050. According to the World Alzheimer Report 2010, the costs associated with dementia totaled US $604 billion, about 1% of global GDP.

Currently, the great majority of people with dementia receive a diagnosis late in the course of the disease, if at all, resulting in a substantial “treatment gap.” This greatly limits their access to valuable information, treatment, care, and support and compounds problems for all involved — patients, families, carers, communities and health systems.

“There is no single way to close the treatment gap worldwide,” said Prof. Prince, the main author of the report. “What is clear is that every country needs a national dementia strategy that promotes early diagnosis and a continuum of care thereafter. Primary care services, specialist diagnostic and treatment centers and community-based services all have a part to play, but to differing degrees depending upon resources.”

“Failure to diagnose Alzheimer’s in a timely manner represents a tragic missed opportunity to improve the quality of life for millions of people,” said Dr. Daisy Acosta, Chairman of ADI. “It only adds to an already massive global health, social, and fiscal challenge — one we hope to see in the spotlight at next week’s United Nations Summit on Non-Communicable Diseases.”

The new ADI report also reveals the following:

• In high-income countries, only 20-50% of dementia cases are recognized and documented in primary care. In low- and middle-income countries, this proportion could be as low as 10%.
• Failure to diagnose often results from the false belief that dementia is a normal part of aging, and that nothing can be done to help. On the contrary, the new report finds that interventions can make a difference, even in the early stages of the illness.
• Drugs and psychological interventions for people with early-stage dementia can improve cognition, independence, and quality of life. Support and counseling for caregivers can improve mood, reduce strain and delay institutionalization of people with dementia.
• Governments, concerned about the rising costs of long-term care linked to dementia, should “spend now to save later.” Based on a review of economic analyses, the report estimates that earlier diagnosis could yield net savings of up to US$10,000 per patient in high-income countries.

“Over the past year, the research team has reviewed thousands of scientific studies detailing the impact of early diagnosis and treatment, and we have found evidence to suggest real benefits for patients and caregivers,” said Marc Wortmann, Executive Director of ADI. “Earlier diagnosis can also transform the design and execution of clinical trials to test new treatments.

“But first we need to ensure that people have access to the effective interventions that are already proven and available, which means that health systems need to be prepared, trained and skilled to provide timely and accurate diagnoses, communicated sensitively, with appropriate support.” Wortmann said.

To that end, ADI recommends that every country have a national Alzheimer’s/dementia strategy that promotes early diagnosis and intervention. More specifically, governments must:

• Promote basic competency among physicians and other health care professionals in early detection of dementia in primary care services.
• Where feasible, create networks of specialist diagnostic centers to confirm early-stage dementia diagnosis and formulate care management plans.
• In resource-poor settings, apply the World Health Organization’s recently developed guidelines for diagnosis and initial management by non-specialist health workers.
• Publicize the availability of evidence-based interventions that are effective in improving cognitive function, treating depression, improving caregiver mood and delaying institutionalization.
• Increase investment in research — especially randomized control trials to test drugs earlier and over longer periods of time, and to test the efficacy of interventions with particular relevance to early-stage dementia.

Dementia is a syndrome that can be caused by a number of progressive disorders that affect memory, thinking, behavior and the ability to perform everyday activities. Alzheimer’s disease is the most common cause of dementia

September 2011 is the first-ever World Alzheimer’s Month. For more valuable information, see the library of articles by Daytona Beach nursing home injury attorney.

Biomarkers such as changes in brain volume or in cerebrospinal fluid levels of some proteins have helped scientists learn about how Alzheimer’s disease develops and whether treatments for it are effective, according to an article on the study in the September issue of Archives of General Psychiatry..

Behavioral markers such as cognitive changes, genetic risk factors and demographic variables also seem to be associated with the condition. However, the authors write, “despite formidable evidence for the predictive validity of individual biomarkers and behavioral markers, they have rarely been examined in combined models.”

Jesus J. Gomar, Ph.D., from the Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain, and colleagues sought to determine how well different classes of biomarkers and cognitive markers could predict whether patients with mild cognitive impairment (MCI) would develop Alzheimer’s disease. They also wanted to assess whether any of these factors was associated with a disproportionate magnitude of decline.

The longitudinal study used information from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. The study included 116 participants with MCI that converted to Alzheimer’s disease in two years, 204 participants with MCI that did not convert to Alzheimer’s disease and 197 cognitively healthy participants as controls.

The researchers used a variety of neuropsychological tests to assess participants’ cognition and ability to function. They obtained cerebrospinal fluid samples when the study began and at annual visits for two years.

At the beginning of the study, participants gave a blood sample which was examined for the presence of genes associated with Alzheimer’s disease. The researchers also obtained information about participants’ brain volume and cortical thickness from magnetic resonance imaging results included in the ADNI.

Analysis of the variables showed that two measures of delayed memory, as well as the cortical thickness of the left middle temporal lobe in the brain, were associated with a higher chance of converting from MCI to Alzheimer’s disease at two years.

A change in participants’ scores on a measure of functional activities appeared to show a larger rate of decline than did changes in biomarkers. In particular, a decline in scores on the Functional Assessment Questionnaire and the Trail Making Test, part B, appeared to predict whether an individual with MCI would develop Alzheimer’s disease within one year.

“Cognitive markers at baseline were more robust predictors of conversion than most biomarkers,” write the authors. “Longitudinal analyses suggested that conversion appeared to be driven less by changes in the neurobiologic trajectory of the disease than by a sharp decline in functional ability and, to a lesser extent, by declines in executive function.”

The researchers add that in clinical practice and in clinical trials, the optimal way to accurately predict conversion to Alzheimer’s disease is to use all available data.

For more on elderly medical issues, see the library of articles by Daytona Beach nursing home injury attorney.

This link between sleep-disordered breathing and an increased risk of cognitive impairment opens up new avenues for research that has a large public impact, the authors say.

“Given the high prevalence and significant morbidity associated with both sleep-disordered breathing and cognitive impairment in older populations, establishing whether a prospective association exists between sleep-disordered breathing and cognition is important,” researchers write in the Aug. 10 issue of JAMA. “This is especially important because effective treatments for sleep-disordered breathing exist.”

Dr. Kristine Yaffe, of the University of California, San Francisco, and colleagues examined the association between prevalent sleep-disordered breathing as measured with polysomnography (monitoring of physiological activity during sleep) and subsequent diagnoses of mild cognitive impairment and dementia.

The study included 298 women without dementia at the beginning of the study (average age, 82.3 years) who had overnight polysomnography measured between January 2002 and April 2004.

Sleep-disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. The apnea-hypopnea index is the number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep.

Cognitive status (normal, dementia, or mild cognitive impairment) was based on data collected between November 2006 and September 2008. Measures of hypoxia, (oxygen deficiency), sleep fragmentation, and sleep duration were investigated as underlying mechanisms for any association between sleep-disordered breathing and cognitive impairment.

Among the 298 women, 35.2 percent met criteria for sleep-disordered breathing. After an average of 4.7 years of follow-up, 35.9 percent of the women developed mild cognitive impairment or dementia (mild cognitive impairment: 20.1 percent; dementia: 15.8 percent). Forty-seven women (44.8 percent) with prevalent sleep-disordered breathing developed mild cognitive impairment or dementia compared with 31.1 percent of those without sleep-disordered breathing.

Analysis of the data indicated that the presence of sleep-disordered breathing was associated with an increased odds of subsequent mild cognitive impairment or dementia.

The researchers also found, after adjusting for various demographic risk factors, that two measures of hypoxia (an oxygen desaturation index of 15 or greater and a high percentage of total sleep time in apnea or hypopnea) were associated with higher incidence of mild cognitive impairment or dementia.

“Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment.” The authors add that their finding that sleep-disordered breathing was associated with an increased risk of cognitive impairment seems to be related primarily to measures of hypoxia.

“Given the high prevalence of both sleep-disordered breathing and cognitive impairment among older adults, the possibility of an association between the two conditions, even a modest one, has the potential for a large public health impact,” the researchers write. “This opens a new avenue for additional research on the risk for development of mild cognitive impairment or dementia and exploration of preventive strategies that target sleep quality including sleep-disordered breathing.”

To fully evaluate the impact of treatment for sleep-disordered breathing in elderly populations, researchers say additional trials with larger sample sizes, longer treatment periods, and more diverse populations are required.

“Our findings suggest a potential role for supplemental oxygen therapy for sleep-disordered breathing in elderly individuals; however, its role requires critical evaluation in intervention studies.”

For more on medical issues, see the library of articles by Daytona Beach nursing home injury attorney.