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• GeroNurseOnline Now Offers Continuing Education Contact Hours
• Nutrition and Physical Activity Program Materials Available
• CDC Reports U.S. Physical Activity Levels
• With Training, Exercise Efficiency Improved More in the Older Than Young People
• Blood Pressure Treatment for Elderly Falls Short
• Abdominal Obesity is an Independent Risk Factor for Chronic Heart Failure in Older People
• Natural History of Depression in the Oldest Old: Population-based Prospective Study

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GeroNurseOnline Now Offers Continuing Education Contact Hours 

In February 2006, the Web site GeroNurseOnline.org began a new continuing education (CE) feature in which contact hours may be earned in a variety of geriatric content areas. Twenty-five topics are slated to be included in the CE feature, including nutrition and aging, urinary incontinence, sexuality issues in aging, and substance abuse. GeroNurseOnline is a sophisticated resource that brings best practices in care of older adults directly to nurses who wish to learn more about geriatric syndromes and their possible causes and treatments and to translate that knowledge for the immediate benefit of their patients. To receive contact hours toward CE credit, nurses must review the subject matter on GeroNurseOnline, print out and take a posttest, and fill out an evaluation of the process. They then mail the posttest and evaluation with a $15 per topic fee to the John A. Hartford Institute for Geriatric Nursing, which administers the Web site. For 3 or more topics, the cost is $12 per topic. Each GeroNurseOnline topic earns 1 contact hour and should take 50 minutes to complete. After successful completion of the posttest and evaluation, test takers receive a certificate documenting their CE contact hours. For more information, please contact Yamilee Bazile at yamilee.bazile@nyu.edu or (212) 998-5152. CE contact hours through GeroNurseOnline are provided through the New York University Center for Continuing Education in Nursing, which is approved by the New York States Nurses Association Council on Continuing Education. GeroNurseOnline is a component of the Nurse Competence in Aging initiative, a 5-year initiative funded by the Atlantic Philanthropies (USA) Inc. and awarded to the American Nurses Association (ANA) through the American Nurses Foundation. It represents a strategic alliance between ANA, the American Nurses Credentialing Center, and the John A. Hartford Foundation Institute for Geriatric Nursing at NYU College of Nursing.

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Nutrition and Physical Activity Program Materials Available 

The Administration on Aging has added information to its You Can! Campaign Web site, Eat Better & Move More, a 12-week nutrition and exercise program for older adults. The site contains details about the program and the 10 mini-grant awardees who piloted the project. The National Resource Center on Nutrition, Physical Activity and Aging at Florida International University developed the program in cooperation with Administration on Aging. See http://www.aoa.gov/youcan/EBMM/ebmm.asp.

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CDC Reports U.S. Physical Activity Levels 

A recently released report from the Centers for Disease Control and Prevention (CDC) showed that in 2003, only 45.9% of adults over age 18 met the U.S. government’s recommendation of at least 30 minutes of moderate exercise 5 days a week. For the full story, see Medline Plus: http://www.nlm.nih.gov/medlineplus/news/fullstory_28395.html.

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With Training, Exercise Efficiency Improved More in the Older Than Young People 

Older age is associated with decreased exercise efficiency and an increase in the oxygen cost of exercise, which contribute to a decreased exercise capacity. These age-related changes are reversed with exercise training, which improves efficiency to a greater degree in the elderly than in the young. A recent study examined the effects of age, gender, and training on exercise efficiency, defined as the W/Vo₂ relationship. Sixty-one healthy, sedentary young and older adult men and women underwent exercise testing at baseline and after 3 to 6 months of supervised exercise training. At baseline, older age was associated with a 42% lower peak Vo₂ (mL/kg/min, P < .0001), 11% higher work Vo₂/W (P = .02), and 8% lower efficiency than those of younger subjects (P = .03). With training, however, exercise efficiency improved more in the older subjects than the young (+30% vs 2%, P < .0001). Source: J Am Coll Cardiol 2006;47:1058-9.

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Blood Pressure Treatment for Elderly Falls Short 

According to a 2006 Framingham Heart Study with 2317 male and 2979 female subjects, far too many people aged ≥80 have high blood pressure and receive poor treatment for it, needlessly suffering such deadly consequences as heart attacks and strokes. Nearly two thirds of the participants ≥80 had high blood pressure, yet just 38% of men and 23% of women were treated sufficiently to reduce their blood pressure to a target level of 140/90 or below. Blood pressure creeps up with age for many reasons, including hormonal changes, hardening of the arteries, and aging kidneys that do not clear fluid from the blood as efficiently as they once did. Many doctors have long believed that increased blood pressure was necessary to sustain aging organs. The study showed how risky this is. Nearly 25% of older study participants with severe high blood pressure had strokes, heart attacks, or other serious cardiovascular problems. Treatment guidelines advise using more than 1 drug to boost potency and minimize side effects. Doctors also can combine a diuretic that siphons fluid out of the blood with 1 or more drugs that relax arteries and lighten the heart’s workload. Despite the guidelines, almost two thirds of the older patients were receiving only 1 drug. “If there’s anything we’ve learned in the past decade, it’s that it is going to require two medications for the vast majority of people with hypertension to get to goal,” says lead researcher Donald Lloyd-Jones of the Northwestern University School of Medicine.

One medicine that should be considered, Lloyd-Jones says, is an inexpensive, generic thiazide diuretic. Despite their low cost and demonstrated effectiveness, thiazides were prescribed to just 23% of men and 38% of women in the study. The diuretic “has gotten something of a bad reputation,” Lloyd-Jones says. “It may accelerate the onset of diabetes and, if not used carefully, precipitate a gout attack in someone who has gout. But compared with having a stroke, those are manageable side effects.”

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Abdominal Obesity is an Independent Risk Factor for Chronic Heart Failure in Older People 

To examine whether total and abdominal adiposity are risk factors for the development of chronic heart failure (CHF), 2,435 well-functioning community-dwelling older adults aged 70 to 79 were studied in a prospective, longitudinal cohort: The Health, Aging and Body Composition study. Body composition using dual energy X-ray absorptiometry (visceral adipose tissue area using computed tomography) adjudicated CHF. Of the 1081 men and 1354 women without coronary heart disease or CHF at baseline, there were 166 confirmed diagnoses of CHF during the 6.1 ± 1.4–year follow-up (M ± SD).

After adjustment for age, race, sex, site, education, smoking, and chronic obstructive pulmonary disorder, all adiposity variables (body mass index [BMI], adipose tissue mass, percentage body fat, waist-to-thigh ratio, waist circumference, and visceral and subcutaneous abdominal adipose tissue) were significant predictors of the development of CHF. In a model that included waist circumference and BMI, waist circumference was associated with incident CHF (hazard ratio [HR] = 1.27, 95% confidence interval [CI] = 1.04–1.54 per SD increase, P = .02), but BMI was not (HR = 1.08, 95% CI = 0.86–1.35). When waist circumference and percentage fat were included together, both variables were significant predictors of CHF (waist: HR = 1.17, 95% CI = 1.00–1.36 per SD increase, P = .05; percentage fat: HR = 1.47, 95% CI = 1.16–1.87 per SD increase, P = .002). Stepwise adjustment for inflammation, hypertension, insulin resistance, and diabetes mellitus did not decrease the relative risk of a greater waist circumference for the development of CHF. Source: J Am Geriatr Soc 2006;54:413-20.

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Natural History of Depression in the Oldest Old: Population-based Prospective Study 

Despite its negative consequences, little is known about the natural history of depression in the oldest old. To study the incidence, course, and predictors of depression in the general population of the oldest old, the prospective population-based Leiden 85-Plus Study involved 500 people from their 85th to their 89th birthdays. Depressive symptoms were assessed annually with the 15-item Geriatric Depression Scale, using a cutoff of 4 points.

During a mean follow-up of 3.9 years, the annual risk for the emergence of depression was 6.8%. Poor daily functioning and institutionalization predicted depression. Among the 77 participants with depression at baseline (prevalence 15%) the annual remission rate was 14%. In more than half of the participants with a remission of depression, a relapse of depression was observed during follow-up. No predictors of remission could be identified. The researchers concluded that among the oldest old, depression is frequent and highly persistent. More active case finding and treatment would be potentially rewarding. Source: Br J Psychiatry 2006;188:65-9.