Active social lives keep elderly 'sharp'

``Policymakers should support the development of social policies and programs that promote social engagement among older citizens,'' suggest Dr. Shari Bassuk and colleagues at the Harvard School of Public Health in Boston, Massachusetts. Their study is published in the August 3rd issue of the Annals of Internal Medicine.

Numerous animal and human studies have suggested that social interaction helps maintain and even improve healthy brain function.

In their study, Bassuk's team followed the mental function of over 2,800 elderly New England residents between 1982-1994. Participants were periodically interviewed to assess their level of mental functioning, as well as the quality of their social lives (i.e. contact with spouse, family members, friends, group activities).

According to the investigators, risks of significant mental decline ``were approximately twice as great in the most (socially-) disengaged respondents (those reporting no social ties) than in the most engaged respondents (those with five or more ties).'' They add that no one type of social connection -- be it spouse, family, or friend -- was more protective than another when it came to preserving mental health.

Changes in intellectual function were not tied to levels of emotional support received from family and friends, the authors point out. Instead, socialization seemed to protect neurological health by providing the elderly with ``an active, reciprocal connection between persons and their communities.''

How might socialization slow age-related declines in mental function? First, the stimulating 'give-and-take' of interpersonal relationships may reduce daily stress. Stress increases levels of certain hormones that can damage areas of the brain important to memory and other intellectual processes, the authors explain. They believe that by reducing stress, socialization may help protect the brain against this type of hormonal damage.

Elderly individuals with active social lives may gain greater self-esteem, as well. According to Bassuk's team, this self-esteem may lead them to take better care of themselves, reducing risks for disease-related intellectual decline.

Based on these findings, the authors suggest that healthcare professionals, caregivers, and policymakers should provide the elderly with the means of ``maximiz(ing) opportunities for social interaction.'' Possible interventions include delayed retirement, part-time work programs, volunteer programs, improved transportation, and well-designed living spaces that encourage all of us to intermingle on a daily basis.

SOURCE: Annals of Internal Medicine 1999;131:165-173.

Exercise for low back pain offers long-term gains

But according to a report published in the July 31st issue of the British Medical Journal, patients with low back pain who participate in just a few weeks of exercise classes may reap benefits that include less distressing pain and a greater level of normal activity, even one year later.

Dr. Jennifer Klaber Moffett and colleagues from the University of York and the University of London, both in the UK, studied 187 adult men and women who had complained of low back pain for 1 to 6 months. Each patient was assigned either to a ''control'' group that received no treatment other than that provided by their general practitioner, or to a progressive exercise program that included stretching and strengthening exercises, relaxation, and education about back care. These patients attended eight 1-hour classes over a 4-week period.

After 6 weeks, the exercise group reported less distressing pain and less disability than the other group. At 6 months, the differences between the two groups were even greater, and at 1 year, greater still. By the end of 1 year, 64% of the exercise group had improved at least 3 points on the 24-point disability questionnaire, compared with 35% of the non-exercise group.

In addition, during the 1-year follow-up period, patients who took the exercise classes tended to make less use of healthcare resources than those in the control group, and missed significantly less work -- 378 days compared to the other group's 607.

In an interview with Reuters Health, Moffett emphasized that ``people need to overcome their fear of damaging their backs through movement and physical activity. The back does not like static postures but it does like movement.''

Moffett added, ``We need to start exercise at a low level and gradually build up the amount we do. It's not about a cure -- it's about learning to cope and getting on with life in spite of back pain. When people focus less on the pain, they usually do better.''

SOURCE: British Medical Journal 1999;319:279-283.

Dieting may erode bone mineral density

The findings may have ``widespread implications,'' explain researchers led by Dr. Loran Salamone of the University of Pittsburgh, since ``about 50% of American women consume weight-reduction diets at some point.'' Their findings are published in the July issue of the American Journal of Clinical Nutrition.

Salamone's team points out that the bone mineral density (BMD) of heavier women tends to be greater than the bone density of thin women, and ``heavier women tend to have a lower risk of osteoporosis and related fractures than do slender women.''

The authors theorized that weight-reducing diets might have an impact on bone density. To test this idea, they compared the bone density of 115 premenopausal women placed on an 18-month low-fat diet with that of 121 non-dieters. Dieters lost an average of 7 pounds while on the diet.

The investigators report that ``diet- and exercise-induced weight loss was associated with a 2-fold greater rate of loss in hip BMD.'' A similar but less significant association was noted for spine bone mineral density.

Exercise has been shown to be protective of bone density. However, Salamone and colleagues found that while exercise slowed bone loss in the spines of dieting women, it did not appear to protect the bones of the hip.

How might dieting reduce bone density? Reductions in weight lead to a decrease in the stress put on bones, the authors write. This 'lightening of load' might trigger a proportional thinning of bone structure, they explain.

In a related statement, Salamone explained that ``women need to evaluate the risks and benefits of their weight-reduction program.'' Exercise can help, and Salamone believes ``the ideal program is one that achieves weight loss while maintaining skeletal integrity.''

SOURCE: American Journal of Clinical Nutrition 1999;70:97-103.

Walking improves mental processing

Executive control functions -- such as the ability to plan, coordinate, schedule, as well as selectively focus on information in the environment and ignore extraneous information -- typically show the largest decline with normal aging, lead researcher Dr. Arthur F. Kramer of the University of Illinois at Urbana-Champaign told Reuters Health.

Kramer and colleagues report their findings on the benefits of increasing aerobic fitness on specific brain functions in a letter in the July 29th issue of the journal Nature. ``The nice result of our study is that a person who has not been physically active during his or her younger years still can benefit from walking,'' Kramer said in a University press release.

Briefly, Kramer and colleagues randomly assigned 124 previously sedentary adults, aged 60 to 75, to either 6 months of aerobic walking or 6 months of anaerobic stretching and toning. The walkers started with 15 minutes of walking 3 days a week and then gradually increased to about 45 minutes of walking 3 days a week. The anaerobic stretchers met for 1 hour 3 times a week to stretch and tone their muscles.

At the end of the study period, significant differences between the aerobic walkers and the anaerobic stretchers and toners emerged. The walkers performed substantially better on several tasks requiring executive control processes compared with the stretchers and toners. For example, following training, subjects in the aerobic walking group were able to switch between tasks more quickly than subjects in the anaerobic toning group and they had reduced reaction times on a ``stopping test'' and were less distractible. ``The people who did toning and stretching certainly improved in physical fitness, but they didn't improve in cardiorespiratory fitness or mental fitness,'' Kramer told Reuters Health.

In addition, the aerobic walkers showed significant improvement in oxygen consumption compared with the anaerobic stretchers and toners. Oxygen consumption scores were equal among subjects in the two groups before randomization to walking or stretching/toning.

In the interview with Reuters Health, Kramer said a ''reasonable explanation'' for the results is that improved oxygenation of tissue through increased cardiorespiratory fitness translated into improved brain-blood flow, specifically to the frontal and prefrontal areas of the brain that control executive control processes.

SOURCE: Nature 1999;400:418-419.

Nutritional assessment reduces hospital costs

Elia M. Mears, director of laboratory services at the Leonard J. Chabert Medical Center in Houma, Louisiana, said that the Center's readmission rate was reduced by about 4% following implementation of a nutritional assessment program. Addressing the patients nutritional needs both before and during hospital stays helped reduce the facility's costs by about $6 million during the first year of the nutritional assessment program, Mears added.

Denise L. Geiger, administrative director and clinical chemist at John T. Mather Memorial Hospital in Port Jefferson, New York, told meeting attendees that clinical nutritional assessment of 350 patients entering that facility's emergency room identified more than half as malnourished. Thirty percent of these patients showed nutritional improvement after therapy.

Nutritional assessment involves obtaining a thorough medical and dietary history of the patient as well as clinical testing of the patient's prealbumin and albumin levels. Albumin is a type of protein found in body tissues and fluids. ``Comparing the two tests shows whether the patient is chronically malnourished or if the malnourishment is a recent event,'' Geiger told Reuters Health in a telephone interview from the meeting.

In 1998, the laboratory at the John T. Mather Memorial Hospital performed 12,000 prealbumin tests at a cost of approximately $36,000. However, Geiger said this testing resulted in improved care to the patient.

``Spending more in laboratory costs reduces patient care costs downstream,'' she explained.

Both Geiger and Mears advocate a multidisciplinary nutrition support team approach once the patient's nutritional needs have been established. This approach results in a good nutritional plan and continued monitoring of the patient's nutritional status. ``This is especially important for elderly, surgical, and intensive care unit patients,'' Mears commented.

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