Doctors too often prescribe too many or the wrong prescriptions to elderly people, according a report in the medical journal The Lancet.

More research is necessary to change this tendency, say the authors of one report. Many elderly are prescribed drugs that are inappropriate for them, and in many cases the drugs are overused or underused, the article said. To ensure appropriate prescribing of drugs to the elderly, care should be provided by a multidisciplinary team, said Dr. Anne Spinewine of the Universite Catholique de Louvain, in Brussels.

Older patients also are at high-risk for having drug interactions, and more research is necessary to document these interactions, experts said in a second article in The Lancet.
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July 25, 2007

Effect of Omega-3 Fatty Acid Supplementation on the Arachidonic Acid: Eicosapentaenoic Acid Ratio

The serum arachidonic acid:eicosapentaenoic acid (AA:EPA) ratio is a biochemical marker of coronary artery disease (CAD) risk, as well as a tool to measure omega-3 fatty acid supplementation response.^[1] This prospective study measured how supplemental fish oil capsules (containing omega-3 fatty acids) affected the baseline AA:EPA ratio in CAD patients and healthy patients. Thirty CAD patients and 30 healthy patients received the 1.5-g capsules daily for 4 weeks, followed by 3 g per day for another 4 weeks. In addition to measuring the AA:EPA ratios, the authors documented patients' lipid profiles, high-sensitivity C-reactive protein (hs-CRP), and blood glucose levels as secondary outcomes.

The authors concluded that omega-3 fatty acids reduced AA:EPA ratios in both healthy and CAD patients. Triglyceride levels in healthy subjects decreased 20% with 1.5 g/day of omega-3 fatty acids, and decreased 32% with 3 g/day; however, triglyceride levels did not improve among CAD patients. In addition, omega-3 fatty acids did not affect hs-CRP or blood glucose levels in either group.

In this study, fish oil capsules containing omega-3 fatty acids effectively lowered the AA:EPA ratio in both healthy and CAD patients. Several studies have found that lowering the AA:EPA ratio improved CAD outcomes, including the Study on Prevention of Coronary Atherosclerosis by Intervention with Marine Omega-3 Fatty Acids (SCIMO), the Lyon Diet Heart Study, and the Physician's Health Study.^[1-3] Specifically, the Lyon Diet Heart Study found that a 30% reduction in the AA:EPA ratio was associated with a 70% reduction in the risk for myocardial infarction.^[2]

The US Food and Drug Administration recently approved a prescription form of omega-3 fatty acids as an adjunct to treatment of very high (≥ 500 mg/dL) triglyceride levels.^[4] In this study, triglyceride levels in the CAD patients did not decrease after receiving omega-3 fatty acids. However, the study did not reveal whether any of the CAD participants had "very" high triglyceride levels. A larger and longer prospective study including CAD patients with documented "high" triglyceride levels may demonstrate lipid profile effects from omega-3 fatty acids.
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July 24, 2007

Study: High-intensity walking offers best results for older adults

High-intensity walking yields greater health benefits for older people than moderate-intensity walking, according to Japanese researchers.

Researchers from Shinshu University Graduate School of Medicine in Matsumoto, Japan, found that those older adults who are engaged in high-intensity walking training showed greater improvements in blood pressure, thigh muscle strength, and exercise capacity than those who didn't walk or those who walked at a moderate pace. The study defined moderately paced walking as 6 kilometers or 3.7 miles per hour.

While moderately paced walking is recommended for middle-aged and older people, it may not be intense enough to improve aerobic exercise capacity. Study results were published in the July issue of the Mayo Clinic Proceedings.
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July 23, 2007

Study: Waning sense of smell may portend dementia

Assessing older people's sense of smell may assist in determining their risk for impending dementia or Alzheimer's disease, according to a new study.

Of the nearly 600 study participants, who had average age of 80, those who were found to have difficulty identifying familiar odors at study onset developed mild cognitive impairment on follow-up, according to researchers at Rush University Medical Center, Chicago. The study subjects who made four errors on the odor identification test were 50% more likely to develop mild cognitive impairment than a person making just one error, investigators said.

Researchers used a 12-item "scratch and sniff" test to assess the seniors' ability recognize familiar odors. They followed participants for up to five years to reassess for incidence of cognitive impairment.

Study results were published in the Archives of General Psychiatry.
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Elderly ignore summer heat warnings, study finds

Many people aged 70 and older don't take the precautions they should during episodes of extreme summer heat, a new study suggests.

As heat waves grip most of the country this summer, many older Americans fail to take the protective measures that could save their lives when heat advisories are issued, according to researchers at Kent State University in Ohio. Only half of people aged 65 years of age or older surveyed said they changed their behavior in response to heat warnings issued by officials. However, almost 90% claimed to be aware of the warnings, researchers said.

Nearly 3,500 Americans died from heat-related causes between 1999 and 2003, according to data from the U.S. Centers for Disease Control and Prevention. The study was published in the International Journal of Biometeorology.
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July 7, 2007

Study data suggest cardiovascular risks with short-term use of Vioxx

The Wall Street Journal reported that data from a yet-to-be published study suggest that increased cardiovascular risks associated with Merck & Co.'s Vioxx started immediately after patients began treatment with the compound. Merck has argued in lawsuits over the COX-2 inhibitor that patients were not at increased risk for cardiovascular events until they had taken the drug for at least 18 months.

According to a copy of the VICTOR study reviewed by the newspaper, half of the patients who experienced cardiovascular events while taking Vioxx did so within 12 months of treatment initiation. Additionally, the risk of heart attack and stroke went away within 14 days of stopping treatment, the newspaper reported. The study is believed to have been accepted for publication by the NEJM, the report added.

Kent Jarrell, an outside spokesman for Merck, told Bloomberg News that the data in the study were presented at a scientific meeting last year, and that "at that time, it was noted that there were limitations in it related to the premature termination of the study, together with the fact that events were collected after patients'' were informed of their treatment group. Jarrell noted that the company plans to "wait until publication of the study before going into detail about what the data show or do not show."

Merck outside counsel, Ted Mayer, added that "the reported findings with respect to confirmed thrombotic events in short-term use are not supported by the data found in the other available large placebo studies with Vioxx." The drugmaker is currently facing more than 27 000 lawsuits over the COX-2 inhibitor.
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July 5, 2007

Study: Antidepressants may increase fracture risks

Certain drugs commonly used to treat depression may increase bone loss in the elderly, thereby putting them at greater risk for fractures, according to a new study published in the Archives of Internal Medicine.

The loss of bone density was associated with a class of antidepressant medications known as selective serotonin reuptake inhibitors. The class includes the drugs Prozac and Zoloft.