Archives for October 2016

Falls and Older Adults

(National Institutes of Health) Many people have a friend or relative who has fallen. The person may have slipped while walking or felt dizzy when standing up from a chair and fallen. Maybe you’ve fallen yourself.

If you or an older person you know has fallen, you’re not alone. More than one in three people age 65 years or older falls each year. The risk of falling — and fall-related problems — rises with age.

Falls Lead to Fractures, Trauma

Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths.

Fractures caused by falls can lead to hospital stays and disability. Most often, fall-related fractures are in the person’s hip, pelvis, spine, arm, hand, or ankle.

Hip fractures are one of the most serious types of fall injury. They are a leading cause of injury and loss of independence, among older adults. Most healthy, independent older adults who are hospitalized for a broken hip are able to return home or live on their own after treatment and rehabilitation. Most of those who cannot return to independent living after such injuries had physical or mental disabilities before the fracture. Many of them will need long-term care.

Fear of Falling

Many older adults are afraid of falling. This fear becomes more common as people age, even among those who haven’t fallen. It may lead older people to avoid activities such as walking, shopping, or taking part in social activities.

If you’re worried about falling, talk with your doctor or another health care provider. Your doctor may refer you to a physical therapist. Physical therapy can help you improve your balance and walking and help build your walking confidence. Getting rid of your fear of falling can help you to stay active, maintain your physical health, and prevent future falls.

Tell Your Doctor If You Fall

If you fall, be sure to discuss the fall with your doctor, even if you aren’t hurt. Many underlying causes of falls can be treated or corrected. For example, falls can be a sign of a new medical problem that needs attention, such as diabetes or changes in blood pressure, particularly drops in blood pressure on standing up. They can also be a sign of problems with your medications or eyesight that can be corrected. After a fall, your doctor may suggest changes in your medication or your eyewear prescription. He or she may also suggest physical therapy, use of a walking aid, or other steps to help prevent future falls. These steps can also make you more confident in your abilities.

Ways to Prevent Falls

Exercise to improve your balance and strengthen your muscles helps to prevent falls. Not wearing bifocal or multifocal glasses when you walk, especially on stairs, will make you less likely to fall. You can also make your home safer by removing loose rugs, adding handrails to stairs and hallways, and making sure you have adequate lighting in dark areas.

Falls are not an inevitable part of life, even as a person gets older. You can take action to prevent falls. Your doctor or other health care providers can help you decide what changes will help.

Causes and Risk Factors

Many Possible Causes

Falls don’t “just happen,” and people don’t fall because they get older. Often, more than one underlying cause or risk factor is involved in a fall. A risk factor is something that increases a person’s risk or susceptibility to a medical problem or disease.

As the number of risk factors rises, so does the risk of falling. Many falls are linked to a person’s physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person’s home or community environment.

Risk Factors

Scientists have linked a number of personal risk factors to falling.

  • Muscle weakness, especially in the legs, is one of the most important risk factors. Older people with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance.
  • Your balance and your gait — how you walk — are other key factors. Older adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or other medical conditions and their treatments.
  • Blood pressure that drops too much when you get up from lying down or sitting can increase your chance of falling. This condition — called postural hypotension — might result from dehydration, or certain medications. It might also be linked to diabetes, neurological conditions such as Parkinson’s disease, or an infection.
  • Some people with postural hypotension feel dizzy when their blood pressure drops. Other people don’t feel dizzy, even if their blood pressure drops a lot when they get up.
  • Your reflexes may also be slower than when you were younger. The increased amount of time it takes you to react may make it harder to catch your balance if you start to fall.
  • Foot problems that cause painful feet, and wearing unsafe footwear can increase your chance of falling. Backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles are examples of unsafe footwear that could cause a fall.
  • Sensory problems can cause falls, too. If your senses don’t work well, you might be less aware of your environment. For instance, having numbness in your feet may mean you don’t sense where you are stepping.
  • Not seeing well can also result in falls. One reason is that it may take a while for your eyes to adjust to see clearly when you move between darkness and light.
  • Other vision problems contributing to falls include poor depth perception, cataracts, and glaucoma. Wearing multi-focal glasses while walking or having poor lighting around your home can also lead to falls.
  • Confusion, even for a short while, can sometimes lead to falls. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes to help you before trying to get up and walk around.
  • Some medications can increase a person’s risk of falling because they cause side effects like dizziness or confusion. The health problems for which the person takes the medications may also contribute to the risk of falls.
  • The more medications you take the more likely you are to fall. People who take four or more prescription drugs have a greater risk of falling than do people who take fewer drugs. You should check with your doctor if you think your medications are causing dizziness or unsteadiness. Your doctor can tell you which drugs, including over-the-counter medicines, might cause problems. Do not change your medications on your own.

What a Fall Might Mean

Be sure to talk with your doctor if you fall, as well. A fall could be a sign of a new medical problem that needs attention, such as an infection or a cardiovascular disorder. It could also suggest that a treatment for a chronic ailment, such as Parkinson’s disease or dementia, needs to be changed.

Most Falls Happen at Home

Although falls can happen anywhere, well over half of all falls happen at home. Falls at home often happen while a person is doing normal daily activities. Some of these falls are caused by factors in the person’s living environment. For instance, a slick floor or a poorly lit stairway may lead to a fall.

Other factors that can lead to falls at home include

  • loose rugs
  • clutter on the floor or stairs
  • carrying heavy or bulky things up or down stairs
  • not having stair railings
  • not having grab bars in the bathroom

Simple changes can help make your home safer.

Fall Proofing Your Home

Simple Changes for Home Safety

Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. Many falls could be prevented by making simple changes in your living areas, as well as personal and lifestyle changes.

Take steps to “fall proof” your home, both inside and outdoors. To make your home safer, you can

  • remove or avoid safety hazards
  • improve lighting
  • install handrails and grab bars
  • move items to make them easier to reach.

Tips to “Fall Proof” Your Home

  • An important step toward preventing falls at home is to remove anything that could cause you to trip or slip while walking. Tripping on clutter, small furniture, pet bowls, electrical or phone cords, or other things can cause you to fall. Slipping on rugs or slick floors can also cause falls.
  • Arrange furniture to give you plenty of room to walk freely. Also remove items from stairs, hallways, and pathways.
  • Be sure that carpets are secured to the floor and stairs. Remove throw rugs, use non-slip rugs, or attach rugs to the floor with double-sided tape.
  • Put non-slip strips on floors and steps. Put non-slip strips or a rubber mat on the floor of your bathtub or shower, as well. You can buy these items at a home center or hardware store.
  • At home and elsewhere, try to avoid wet floors and clean up spills right away. Use only non-skid wax on waxed floors at home.
  • Be careful when walking outdoors, and avoid going out alone on ice or snow. A simple slip on a slick sidewalk, a curb, or icy stairs could result in a serious injury.
  • During the winter, ask someone to spread sand or salt on icy surfaces. Be sure to wear boots with good traction if you must go out when it snows. Better yet, don’t take chances walking on icy or slippery surfaces.
  • Poor lighting — inside and outdoors — can increase your risk of falls. Make sure you have enough lighting in each room, at entrances, and on outdoor walkways. Use light bulbs that have the highest wattage recommended for the fixture.
  • Good lighting on stairways is especially important. Light switches at both the top and bottom of stairs can help.
  • Place a lamp within easy reach of your bed. Put night lights in the bathroom, hallways, bedroom, and kitchen. Also keep a flashlight by your bed in case the power is out and you need to get up.
  • Have handrails installed on both sides of stairs and walkways. If you must carry something while walking up or down stairs, hold the item in one hand and use the handrail with the other. When you’re carrying something, be sure you can see where your feet are stepping.
  • Properly placed grab bars in your tub and shower, and next to the toilet, can help you avoid falls, too. Have grab bars installed, and use them every time you get in and out of the tub or shower. Be sure the grab bars are securely attached to the wall.
  • You might find it helpful to rearrange often-used items in your home to make them more accessible. Store food boxes, cans, dishes, clothing, and other everyday items within easy reach. This simple change could prevent a fall that might come from standing on a stool to get to an item.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care providers can assess your home’s safety and advise you about making changes to prevent falls.

Devices to Help Prevent Falls

Appropriate use of assistive devices can prevent harmful falls. These devices may include canes, walkers, and reachers. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely. Talk with your doctor about having a physical therapist or occupational therapist assess your device needs.


A cane or walker may help you feel more stable when you walk. Different types of canes are available. Some have grips made of foam or that fit the shape of your hand. Many canes can be adjusted, but some cannot.

A physical therapist can advise you about which cane to choose. Be sure the length fits you well. Your elbow should be slightly bent. A cane that’s too short may make you unsteady. A cane that’s too long is harder to use. If you use a cane, be sure to learn how to walk with it the right way. A physical therapist can help.


If you’re at risk of falling, your physical therapist might suggest using a walker. A walker will help you stay balanced by giving you a wide base of support. Be sure to choose a walker that fits you and gives a level of stability that is best for you.

Different types of walkers are available. Some walkers have two wheels so the walker shouldn’t roll away from you. These walkers work well if you need to put weight on the walker when you move. Other walkers have four wheels and brakes for going down inclines.

You can add a basket, tray, or pouch to some walkers to carry items. These accessories will make it more convenient to use the walker.

If you use a walker, be sure it’s the right type for you. Also, learn to use it properly. A physical therapist can help you select the right walker and show you how to use it. Four-wheeled walkers can be used if you don’t need to put your weight on the walker for balance. Those with two tips and two wheels can roll, depending on where you place your weight. Walkers with tips only are quite common and will not roll.


A reacher, or grabber, can also help prevent falls. This simple tool lets you take lightweight items from high shelves and other places and pick up objects from the floor so you do not have to bend over. Use a reacher rather than standing on a stool to get something from above or bending down to pick up something from the floor.

Portable Phones

Another helpful device is a portable telephone. Carry the phone with you from room to room. When it rings, you won’t have to rush to answer it. Not rushing could avert a harmful fall. Never rush to answer the phone or door.

Maintaining Bone Health

Why Bone Health Is Important

Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help prevent fractures by maintaining the strength of your bones.

Having healthy bones won’t prevent a fall. If you fall, though, having healthy bones can prevent hip or other fractures that may lead to a hospital or nursing home stay, disability, or even death.

Osteoporosis makes bones thin and more likely to break. It is a major reason for fractures in women past menopause. It also affects older men. If bones are fragile, even a minor fall can cause fractures.

Getting Enough Calcium

At any age, you can take steps to keep your bones strong. Be sure to consume adequate amounts of calcium and vitamin D. Women over age 50 should consume 1,200 mg of calcium daily. Men between the ages of 51 and 70 should consume 1,000 mg of calcium a day, and men over 70 should consume 1,200 mg per day. This can be done by eating calcium-rich foods and taking calcium supplements.

Good dietary sources of calcium include

  • dairy products such as low-fat milk, yogurt, and cheese
  • orange juice, cereals, and other foods fortified with calcium
  • dark green, leafy vegetables such as broccoli, collard greens, and bok choy
  • sardines, salmon with bones, soybeans, tofu, and nuts such as almonds.

Getting Enough Vitamin D

Vitamin D helps your body absorb calcium. Exposure to sunlight causes your body to make vitamin D. Many older people don’t get enough vitamin D this way, though. Eating foods with vitamin D and taking supplements can help.

As you grow older, your need for vitamin D increases. People ages 51 to 70 should consume at least 600 international units (IU) of vitamin D daily. People over age 70 should consume at least 800 IUs daily.

Herring, sardines, salmon, tuna, liver, eggs, and fortified milk and foods are good sources of vitamin D. Vitamin D supplements may also be needed. Talk with your doctor about how much vitamin D you need. Taking too much may be harmful.

Other Ways to Maintain Bone Health

  • Physical Activity. Physical activity is another way to keep your bones strong. Try to get a total of at least 30 minutes of physical activity a day. Find time for activities like walking, dancing, stair climbing, gardening, and weight-lifting.
  • Bone Density Test. Talk with your doctor about having a bone density test. This safe, painless test assesses your bone health and risk of future fractures. Medicare and many private insurers cover this test for eligible people. Women over age 65 and all men over 70 should have a bone density test.
  • Medications. Your doctor can also advise you about whether you should consider taking prescription medications to improve bone health. These medications can slow bone loss, improve bone density, and lessen the risk of fractures.

Quitting Smoking, Limiting Alcohol

Other ways to maintain bone health include quitting smoking and limiting alcohol use. Smoking and heavy alcohol use can decrease bone mass and increase the chance of fractures. Also, maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

You’re never too old to improve your bone health. A diet that includes enough calcium and vitamin D, and physical activity can help prevent bone loss and fractures. You can also have your bone density tested and ask your doctor about supplements or other medicines to strengthen your bones if needed.

If You Fall

Whether you’re at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible. Take several deep breaths to try to relax.

fallenHow to Get Up From A Fall

  1. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
  2. Decide if you’re hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.
  3. If you think you can get up safely without help, roll over onto your side.
  4. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
  5. Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor.
  6. From this kneeling position, slowly rise and turn your body to sit in the chair.

If you’re hurt or can’t get up on your own, ask someone for help or call 911. If you’re alone, try to get into a comfortable position and wait for help to arrive.

Consider Emergency Response Devices

If you have problems with balance or dizziness, be sure to discuss these with your doctor. If you are often alone, and at increased risk of falling, consider getting a personal emergency response system. This service, which works through your telephone line, provides a button or bracelet to wear at all times in your home.

If you fall or need emergency assistance for any reason, a push of the button will alert the service. Emergency medical services will be called. There is a fee for medical monitoring services, but it may be worth the cost.

Carrying a portable phone with you as you move about your house could make it easier to call someone if you need assistance. You might also put a telephone in a place that you can reach from the floor in case you fall and need help.

Tell Your Doctor

Be sure to discuss any fall with your doctor. Write down when, where, and how you fell so you can discuss the details with your doctor. The doctor can assess whether a medical issue or other cause of the fall needs to be addressed. Knowing the cause can help you plan to prevent future falls.

After a fall, your doctor might refer you to other health care providers who can help prevent future falls. A physical therapist can help with gait, balance, strength training, and walking aids. An occupational therapist can suggest changes in your home that may lower your risk of falls.

Addressing the Fear of Falling

Many older people who have fallen are afraid of falling again. Even if a fall doesn’t cause injury, the fear of falling again might prevent you from doing activities you enjoy or need to do. Fear of falling also might cause you to stay at home away from your friends, family, and others.

Your muscles and bones can weaken over time without the physical activity that comes with doing daily tasks or exercise. As a result, you could become more — not less — likely to fall.

If you’re worried about falling, talk with your doctor or another health care provider. Your doctor may refer you to a physical therapist. Physical therapy can help you improve your balance and walking and help build your walking confidence. Getting rid of your fear of falling can help you to stay active, maintain your physical health, and prevent future falls.



Topics to Discuss Now with Your Aging Parents

(Administration on Aging) Face the Facts – Financial, legal, health care, and long-term care issues affect families, not just individuals. Aging parents may not understand how estate planning can affect their own financial status as well as that of their children.

The Eldercare Locator produced this guide to help families “face the facts” about important topics to discuss with aging parents. It addresses key areas of concern, suggested questions to ask, and ways in which families might initiate conversations.

Key Considerations

  1. Determine what benefits are provided by Social Security and any pensions. Then, determine whether your parents are eligible for other financial programs.
  2. Ensure that each family member has a living will. Make sure you know the location of all insurance policies, wills, trust documents, investment and banking records, and tax returns.
  3. Investigate what type of long-term care insurance coverage might be best for your parents. Note that premiums are usually lower when policies are purchased at younger ages.
  4. Identify community services that can help your parents maintain independence for as long as possible. Learn what housing options are available to meet their changing needs.

Financial Organization

Your parent may already be receiving or eligible for a variety of financial resources. Social Security is the federal program that provides retirees a regular income based on work history as well as benefits to workers with disabilities. Long-time workers usually have pensions that are retirement compensation plans either fully managed by the employer, or involve employee contributions, such as a Tax-Deferred Annuity (TDA) or Individual Retirement Account (IRA). Some people have “lost” a pension they earned, while others forget about a retirement account set up many years prior. Low-income individuals with disabilities or age 65 and older may also be eligible for monthly cash benefits through Supplemental Security Income (SSI).

What type of retirement income do they receive?
Are pension savings from all jobs being collected?
Is there a need to apply for SSI benefits?
Who can access important financial information in case of emergency?
Where do your parents keep these important documents?

Legal Preparation

Wills and power of attorney may not be topics your relatives want to discuss; however, these issues need to be addressed to make sure that assets are properly taken care of and that medical treatment preferences are known. A will directs how a person wants property to be distributed after death and appoints a trusted person to be the executor. A durable power of attorney provides written authorization for a person you name to act on your behalf for whatever financial or health care purpose you spell out. An advance directive is a legal document that provides directions for your health care if you are unable to speak for yourself.

Do your parents have a will?
Are their important legal documents up to date?
What other legal matters are you concerned about?
Have your parents executed a durable power of attorney or considered whom they want to make financial or health decisions if they are unable to do so?

Health Insurance

Health care is a high-cost necessity, so it is crucial to know what is available and what your parents are eligible to receive. Most adults over age 65 are covered by Medicare, the federal health insurance program that helps pay medical expenses for older Americans and younger people with disabilities. However, Medicare does not cover all needs, such as long-term care, including nursing homes. Medicare Supplement Insurance (also called Medigap) might be necessary to cover additional health costs.

Medicaid, on the other hand, is the federal and state insurance program that helps pay the health care costs of low-income individuals of any age. Long-term care insurance is available through the private market to assist individuals to cover the cost of long-term care services such as home health and nursing home care.

As health statuses change, are your parents prepared to meet their long-term care needs?
Do they have proper health insurance coverage (not too much or too little)?
Are they comfortably able to pay for prescription drugs and other out-of pocket health costs?
Who are their doctors and how can they be contacted, if necessary?
Where are their insurance cards, Medicare information, and other important health documents?

Community Services

One of the most useful things that adult children can do for their parents is to provide information about resources that help maintain and enhance independence. Services like home modification are available to help reduce the risk of accidents and make daily activities more comfortable to perform.

There are many community resources that provide related information or services. Find out about support available through Area Agencies on Aging (AAAs) and local providers by contacting the Eldercare Locator at 1-800-677-1116 or

Are there home repairs or modifications, such as bathtub railings or an emergency response system, that could help your parents?
Do they need assistance with housekeeping, shopping, or personal care?
If they become homebound, would they need home-delivered meals?
Do they need transportation? If so, what services are available?

Conversation Approaches

Prepare to be open, honest, and non-argumentative when discussing these topics with your loved ones. Consider preparing by doing research about the topics you want to review. Below are some approaches you can take, depending on the personality of the care recipient.

  • Direct: If the care recipient is a ‘no-nonsense’ personality, openly express your concerns and ask for information you need to address specific situations that might arise.
  • Educational: For the relative who needs a delicate push, you might begin by sharing the experience of another caregiver and how it made you realize the need to discuss issues that could help your whole family in the future.
  • Expert: For the relative who refuses to talk about personal issues or tends to accuse others of taking control, seek to make them the expert by asking for their advice about a particular issue. “What type of long-term care plan should I look into?” “Can you recommend someone to help me prepare my will?” This strategy is non-threatening and could lead them to share personal details or let you know where they stand on a subject.



Administration on Aging


10 Warning Signs an Older Loved One May Need Assistance

( Changes in physical and mental abilities that may occur with age can be difficult to detect— for older adults and their family members, friends, and caregivers too.

To help in determining when an older adult may need assistance in the home, the Eldercare Locator has compiled a list of 10 warning signs.

Any one of the following behaviors may indicate the need to take action. It is also important to inform the older adult’s physician of these physical or psychological behavior changes.

Has your loved one:

  1. Changed eating habits, resulting in losing weight, having no appetite, or missing meals?
  2. Neglected personal hygiene, including wearing dirty clothes and having body odor, bad breath, neglected nails and teeth, or sores on the skin?
  3. Neglected their home, with a noticeable change in cleanliness and sanitation?
  4. Exhibited inappropriate behavior, such as being unusually loud, quiet, paranoid, or agitated, or making phone calls at all hours?
  5. Changed relationship patterns, causing friends and neighbors to express concerns?
  6. Had physical problems, such as burns or injury marks, which may result from general weakness, forgetfulness, or misuse of alcohol or prescribed medications?
  7. Decreased or stopped participating in activities that were once important to them, such as bridge or a book club, dining with friends, or attending religious services?
  8. Exhibited forgetfulness, resulting in unopened mail, piling of newspapers, not filling their prescriptions, or missing appointments?
  9. Mishandled finances, such as not paying bills, losing money, paying bills twice or more, or hiding money?
  10. Made unusual purchases, such as buying more than one subscription to the same magazine, entering an unusually large number of contests, or increasing purchases from television advertisements?

Through the Eldercare Locator, older adults and their loved ones can get connected with information on local aging resources that offer assistance for aging in place, enabling older adults to continue living independently in their homes and communities.

For additional information on programs and services for older adults and their caregivers in your area, contact the Eldercare Locator at 800-677-1116 or


Copyright © 2016 Administration on Aging


Cognitive Function Improvements After Resistance Training in Older Adults with Mild Cognitive Impairment

J Am Geriatr Soc 2016.Version of Record online: 24 OCT 2016. DOI: 10.1111/jgs.14542

Mediation of Cognitive Function Improvements by Strength Gains After Resistance Training in Older Adults with Mild Cognitive Impairment: Outcomes of the Study of Mental and Resistance Training

Yorgi Mavros PhD, Nicola Gates PhD, Guy C. Wilson MS, Nidhi Jain MPH, Jacinda Meiklejohn BS, Henry Brodaty DSc, Wei Wen PhD, Nalin Singh MB BS, Bernhard T. Baune PhD, Chao Suo PhD,  Michael K. Baker PhD, Nasim Foroughi PhD, Yi Wang Ph, Perminder S. Sachdev PhD, Michael Valenzuela PhD and Maria A. Fiatarone Singh MD



To determine whether improvements in aerobic capacity (VO2peak) and strength after progressive resistance training (PRT) mediate improvements in cognitive function.


Randomized, double-blind, double-sham, controlled trial.


University research facility.


Community-dwelling older adults (aged ≥55) with mild cognitive impairment (MCI) (N = 100).


PRT and cognitive training (CT), 2 to 3 days per week for 6 months.


Alzheimer’s Disease Assessment Scale–cognitive subscale (ADAS-Cog); global, executive, and memory domains; peak strength (1 repetition maximum); and VO2peak.


PRT increased upper (standardized mean difference (SMD) = 0.69, 95% confidence interval = 0.47, 0.91), lower (SMD = 0.94, 95% CI = 0.69–1.20) and whole-body (SMD = 0.84, 95% CI = 0.62–1.05) strength and percentage change in VO2peak (8.0%, 95% CI = 2.2–13.8) significantly more than sham exercise. Higher strength scores, but not greater VO2peak, were significantly associated with improvements in cognition (P < .05). Greater lower body strength significantly mediated the effect of PRT on ADAS-Cog improvements (indirect effect: β = −0.64, 95% CI = −1.38 to −0.004; direct effect: β = −0.37, 95% CI = −1.51–0.78) and global domain (indirect effect: β = 0.12, 95% CI = 0.02–0.22; direct effect: β = −0.003, 95% CI = −0.17–0.16) but not for executive domain (indirect effect: β = 0.11, 95% CI = −0.04–0.26; direct effect: β = 0.03, 95% CI = −0.17–0.23).


High-intensity PRT results in significant improvements in cognitive function, muscle strength, and aerobic capacity in older adults with MCI. Strength gains, but not aerobic capacity changes, mediate the cognitive benefits of PRT. Future investigations are warranted to determine the physiological mechanisms linking strength gains and cognitive benefits.


© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society


Increasing Muscle Strength Can Improve Brain Function

(University of Sydney) Increased muscle strength leads to improved brain function in adults with Mild Cognitive Impairment (MCI), new results from a recent trial led by the University of Sydney has revealed.

With 135 million people forecast to suffer from dementia in 2050, the study’s findings–published in the Journal of American Geriatrics today–have implications for the type and intensity of exercise that is recommended for our growing ageing population.

Mild Cognitive Impairment defines people who have noticeably reduced cognitive abilities such as reduced memory but are still able to live independently, and is a precursor to Alzheimer’s disease.

Findings from the Study of Mental and Resistance Training (SMART) trial show, for the first time, a positive causal link between muscle adaptations to progressive resistance training and the functioning of the brain among those over 55 with MCI.

The trial was conducted in collaboration with the Centre for Healthy Brain Ageing (CHeBA) at University of New South Wales and the University of Adelaide.

“What we found in this follow up study is that the improvement in cognition function was related to their muscle strength gains” said lead author Dr Yorgi Mavros, from the Faculty of Health Sciences, at University of Sydney.

“The stronger people became, the greater the benefit for their brain.”

SMART was a randomised, double-blind trial involving 100 community-dwelling adults with MCI, aged between 55 and 86. They were divided into four groups doing either:

  • Resistance exercise and computerised cognitive training;
  • Resistance exercise and a placebo computerised training (watching nature videos);
  • Brain training and a placebo exercise program (seated stretching/calisthenics); or
  • Placebo physical exercise and placebo cognitive training.

Participants doing resistance exercise prescribed weight lifting sessions twice week for six months, working to at least 80 per cent of their peak strength. As they got stronger, the amount of weight they lifted on each machine was increased to maintain the intensity at 80 per cent of their peak strength.

The primary outcomes of a paper published in 2014 found these participants’ global cognition improved significantly after the resistance training, as measured by tests including the Alzheimer’s disease Assessment Scale-Cognitive scale. The cognitive training and placebo activities did not have this benefit. The benefits persisted even 12 months after the supervised exercise sessions ended.

“The more we can get people doing resistance training like weight lifting, the more likely we are to have a healthier ageing population,” said Dr Mavros.

“The key however is to make sure you are doing it frequently, at least twice a week, and at a high intensity so that you are maximising your strength gains. This will give you the maximum benefit for your brain.”

These new findings reinforce research from the SMART trial published earlier this year, whereby MRI scans showed an increase in the size of specific areas of the brain among those who took part in the weight training program. These brain changes were linked to the cognitive improvements after weight lifting.

“The next step now is to determine if the increases in muscle strength are also related to increases in brain size that we saw,” said senior author Professor Maria Fiatarone Singh, geriatrician at University of Sydney.

“In addition, we want to find the underlying messenger that links muscle strength, brain growth, and cognitive performance, and determine the optimal way to prescribe exercise to maximise these effects.”


The SMART trial was funded by Australia’s National Health and Medical Research Council. It was conducted in collaboration with the Centre for Healthy Brain Ageing (CHeBA) at UNSW and the University of Adelaide.



Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: Outcomes of the study of mental and resistance training, Yorgi Mavros et al., Journal of the American Geriatrics Society, doi: 10.1111/jgs.14542, published online 24 October 2016, abstract.

Copyright © 2016 by the American Association for the Advancement of Science (AAAS)


Additional Benefit of Omega-3 Fatty Acids for Clearance of Metabolites from Brain

(Federation of American Societies for Experimental Biology) New research published online in The FASEB Journal suggests that omega-3 polyunsaturated fatty acids, which are found in fish oil, could improve the function of the glymphatic system, which facilitates the clearance of waste from the brain, and promote the clearance of metabolites including amyloid-β peptides, a primary culprit in Alzheimer’s disease.

To make this discovery, scientists first used transgenic fat-1 mice, which express high endogenous omega-3 polyunsaturated fatty acids (PUFAs) in the brain, to investigate the effect of omega-3 PUFAs on the clearance function of the glymphatic system. Compared to the wild-type mice, the fat-1 mice with enriched endogenous omega-3 PUFAs significantly promote the clearance function of the lymphatic system, including the Aβ clearance from the brain.

Wild-type mice were supplemented with fish oil, which contains high concentrations of omega-3 PUFAs, and found that fish oil-supplemented mice also improved the clearance function of the glymphatic system compared to the control mice without fish oil supplementation. Omega-3 PUFAs help maintain the brain homeostasis, which may provide benefits in a number of neurological diseases, such as Alzheimer’s disease, traumatic brain injury, and sleep impairment, among others.

“These now-famous fatty acids have been the subject of major studies both in academia and industry. Just when we thought we had heard everything, here is something new, and it is provocative indeed,” said Thoru Pederson, Ph.D., Editor-in-Chief of The FASEB Journal.

“This study should not turn attention away from the roles of these substances in maintaining vascular health, but neither should they restrict our view. The brain is an extremely vascularized organ, while we might also bear in mind that omega-3 fatty acids may impact neurons, glia, and astrocytes themselves.”


Journal Reference:

H. Ren, C. Luo, Y. Feng, X. Yao, Z. Shi, F. Liang, J. X. Kang, J.-B. Wan, Z. Pei, H. Su. Omega-3 polyunsaturated fatty acids promote amyloid-  clearance from the brain through mediating the function of the glymphatic system. The FASEB Journal, 2016; DOI: 10.1096/fj.201600896

Copyright © 2016 by the American Association for the Advancement of Science (AAAS)


Alzheimer’s Drug Discovery Foundation Launches Expanded Brain Health and Dementia Prevention Website

(Alzheimer’s Drug Discovery Foundation) Site Features Science-Based Ratings of Options to Improve Brain Health, Help Consumers Make Informed Choices.

The Alzheimer’s Drug Discovery Foundation (ADDF) announced today the relaunch of, its brain health and dementia prevention website. The streamlined, easy-to-navigate site separates fact from fiction and empowers people to make smarter choices for their brain health.

“Americans are spending millions of dollars every year on supplements, drugs, and brain training games in the hope of staving off cognitive decline and dementia,” said Penny Dacks, PhD, director of Aging and Alzheimer’s Prevention at the ADDF.

“Despite this massive investment, people are still unsure about what works and what doesn’t, and even about what is and isn’t safe. We developed to give consumers trustworthy information based on scientific evidence.”

At, neuroscientists from the ADDF review all of the available research and provide clear, unbiased ratings on the potential benefit, supporting evidence, and safety of options to improve brain health and potentially prevent dementia. These options include food and drinks, drugs, and vitamins and supplements. Ratings may be viewed individually, or in a streamlined grid that allows users to compare options. New ratings are included, and previous ratings have been updated to include the latest scientific evidence.

“Science suggests there are steps people can take to lower their odds of getting dementia while other approaches are very unlikely to help. We want people to have the latest evidence on what they can do,” said Dr. Dacks.

Prior to posting, each rating is reviewed by two members of the independent Cognitive Vitality Clinical Advisory Board, which consists of nationally recognized leaders in epidemiology, neurology, geriatrics and gerontology, and related fields.

New Ratings of Supplements Provided
The relaunched site includes new ratings of the active ingredients in widely used supplements, including nicotinamide riboside and apoaequorin, which make brain health claims. Vitamins B6, B12, and folic acid—which are promoted for brain health—are also rated.

“These ratings should be especially helpful to consumers, as nutritional supplements are not required to prove their efficacy or safety in the manner required of pharmaceuticals,” said Howard Fillit, MD, the ADDF’s Founding Executive Director and Chief Science Officer.

Cognitive Vitality Blog Featured features a blog with in-depth articles on potential risks, lifestyle factors, and emerging science that may affect the brain. The relaunched site includes new posts on lifestyle choices and risks that may affect brain health, including hypertension, smoking, and anesthesia, organized into user-friendly categories to help people find exactly what they want.

About Cognitive Vitality is an initiative of the Aging and Alzheimer’s Prevention program at the ADDF, which is directed by Dr. Penny Dacks. It was initially launched in 2014. In addition to ratings and the blog, includes a description of the types of evidence used to develop the ratings, and a list of relevant scientific publications.

About the Alzheimer’s Drug Discovery Foundation
Founded in 1998 by Leonard A. and Ronald S. Lauder, the Alzheimer’s Drug Discovery Foundation (ADDF) is dedicated to rapidly accelerating the discovery of drugs to prevent, treat and cure Alzheimer’s disease. The ADDF is the only public charity solely focused on funding the development of drugs for Alzheimer’s, employing a venture philanthropy model to support research in academia and the biotech industry. Through the generosity of its donors, the ADDF has awarded over $90 million to fund more than 500 Alzheimer’s drug discovery programs and clinical trials in 18 countries. To learn more, please visit:


©2016 Newswise, Inc


Global Rise in Total AD Cases Dwarfs Falling Age-Standardized Rate

(AlzForum) As populations age around the world, the number of deaths due to Alzheimer’s and other dementias is up almost 40 percent since 2005, according to the latest figures in the Global Burden of Disease (GBD) Study 2015.


An Interactive Tool: The GBD Compare tool allows users to query global causes of mortality and morbidity by age, sex, and region. Here, more deaths from dementias (red areas) occur in North America and Europe, while fewer people die with the disease in Africa and Eastern Europe (blue). IHME, University of Washington, 2016. (Accessed Oct., 2016.)

At the same time, a small dip in the age-standardized rate of death could mean that improved vascular and overall health, as well as education, may be tempering that ever so slightly. The report was a collaboration between the Institute for Health Metrics and Evaluation (IHME) and The Lancet, and appears in the October 8 issue of the journal.

In a series of seven papers, the report outlines the causes of death and disability in regions and countries around the world.

“This study gives a sense of the burden of dementia, and how it scales compared to different diseases in the population,” said Eric Larson of the Group Health Research Institute in Seattle. “It’s a global perspective on disease and how it’s changing.”

This is the third report since GBD 2010 and GBD 2013 were published. By detailing the major diseases, injuries, and other health risks that challenge health systems worldwide, GBD authors aim to provide policymakers with up-to-date information. Trends in AD and dementia have remained largely steady over that time, but the data come into sharper focus as new information flows in and researchers find new ways to analyze the data.

In one GBD 2015 paper, first author Haidong Wang at IHME and colleagues reported trends for 249 causes of death in 195 countries between 1980 and 2015. The number of people dying from Alzheimer’s disease and related dementias has risen 38 percent in the last 10 years.

“Globally a lot of [other] causes of death are declining,” said Theo Vos, University of Washington, Seattle, a joint senior author on the paper. He cited deaths due to childhood and infectious diseases as examples.

“But since we have no effective treatments or preventative measures for dementia, and we have an aging global population, Alzheimer’s is becoming much more important in terms of rank order.”

The rising death toll from AD is slightly offset by a 2.7 percent drop in the age-standardized death rate. That method of looking at the data removes the effects of population growth and aging, said Vos.

“This leaves a more level field comparison for the true epidemiological change [in AD].”

A small decrease could reflect improved cardiovascular health, better education, or higher overall health. It fits with declines in prevalence and incidence reported in studies from the United Kingdom, Germany, and United States respectively. However, some data suggest the incidence of dementia is rising in the developing world.

“These data are useful at the ‘global burden’ level; however, it is probably impossible to reconcile the empirical number with epidemiologic data on incidence, survival, and prevalence,” wrote Walter Rocca, Mayo Clinic, Rochester, Minnesota, to Alzforum.

“The trends may be very different by region, and the global numbers are weighted averages of possibly opposing trends.”

In the grand scheme of things, the 2.7 percent reduction suggests that the death rate among prevalent cases of dementia has not changed much, said Vos. Any dip will be far outstripped by increases due to population aging, he said, causing significant strain on health systems worldwide.

A companion paper on which Vos is the first author extends these findings by reporting that AD and other dementias are also becoming a leading cause of disability during life (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016). Among people 75 and older, AD has now made its first appearance among the top 10 causes of disability around the globe.

According to another companion paper, dementias are a growing reason for rising disability-adjusted life-years (DALYs), which reflect the years of healthy life lost due to premature mortality and years lived with disability (GBD 2015 DALYs and HALE Collaborators, 2016). Alzheimer’s and related diseases have caused a 30 percent rise and have become the 29th leading cause of DALYs around the world since 2005, the authors report.

“The paradox of our era is that as health indicators have improved globally, more people are spending more time with functional health loss, and morbidity is increasing in absolute terms,” wrote Kevin Watkins of Save the Children U.K. in London in an accompanying commentary.

“This has far-reaching implications not just for health-system financing and service delivery, but also for economic growth and well-being.”

To allow researchers to explore these data in greater detail, GBD collaborators have created the GBD Compare tool. Users can enter factors they’d like to compare—such as causes of death or disability by age and sex—to explore global trends in disease and disability.


By Gwyneth Dickey Zakaib

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