Editor's view |
Editor's view
Editor, Age and Ageing
Doctors have traditionally given advice to their patients about smoking and alcohol consumption, but this may have previously been regarded as less relevant in older than younger people, because of their shorter life expectancy. Two papers in this issue investigate aspects of smoking and alcohol consumption in older people. A Systematic Review (p. 505) examined the relationship between alcohol intake and cognitive function, cognitive decline and dementia in older people. Although there was considerable heterogeneity in the studies reviewed, meta-analysis suggested that small amounts of alcohol may be protective against dementia and Alzheimer's disease, but not against vascular dementia or cognitive decline. The evidence for the beneficial effect of alcohol was strongest for wine, but the authors acknowledge that this is not conclusive. An accompanying Editorial (p. 493) highlights our responsibility to ensure that future research provides well-defined and evidence-based measures of alcohol consumption in relationship to harm or benefit.
Another Editorial (p. 490) on smoking cessation comments that until recently, there was thought to be no reason for an older smoker to stop, but underlines that there is growing evidence that this is incorrect, as it may improve physical and mental function, general health and life expectancy. This Editorial accompanies a Research Paper (p. 521) investigating the effect of executive cognitive function on smoking cessation in community dwelling older people in the US. This found that older people with impaired executive cognitive function were less likely to have stopped smoking than cognitively intact subjects. The Editorial suggests that people with mild to moderate cognitive impairment may benefit from stopping smoking, but highlights that these individuals need to be identified and that evidence-based cessation strategies are required for this large and growing part of the population.
This issue contains a Review Article on genital dermatoses in older men (p. 500), which is illustrated by graphic clinical photographs of Zoon's balanitis, lichen sclerosus, extramammary Paget's disease and penile cancer. This reviews the clinical features, diagnosis and treatment of the common genital dermatoses in older men, which range from infectious to inflammatory and neoplastic dermatoses. The paper highlights that dematological conditions of the male genitalia can affect sexual and urinary function, both of which may be important to older men. The review also suggests that although penile cancer is rare, it is preventable and may be curable if diagnosed early.
Fragility fractures are an important cause of excess mortality, morbidity and health and social service expenditure in older people. The risk of fracture is higher in older people living in residential and nursing homes than in community dwelling people of the same age, reflecting their greater risk of falling and lower bone density. The challenge is how to identify residents of care and nursing homes at highest risk of fracture. A prospective study reported in this issue (p. 536) examined clinical risk factors for fracture in over 2,000 older people living in intermediate care facilities or nursing homes in Australia. The authors report that living in an intermediate care facility, poor balance, impaired cognitive function, polypharmacy, low body weight and longer leg length were all associated with an increased risk of fracture. They then developed a fracture risk index, using these clinical risk factors with appropriate weighting. Individuals with a high score on this index were at sixfold greater risk of fracture than those with a low score. If this fracture risk index can be validated in other populations of older people living in residential and nursing homes, the next step will be to develop and implement appropriate strategies for the prevention of fractures.
A Research letter (p. 595) from Germany reports the findings of a prospective study of 118 consecutive patients aged above 80 years, who underwent endoscopic retrograde cholangio-pancreatography (ERCP), 73% of which were performed for biliary obstruction. The most frequently performed procedures were biliary or pancreatic sphincterotomy and common bile duct or pancreatic duct stenting, with only 6% of patients undergoing a purely diagnostic procedure. Complications of ERCP occurred in 9.3% of patients, which included pancreatitis and post-sphincterotomy bleeding, but there was no associated mortality. Although the paper reports the experience from just one centre, it suggests that. ERCP is performed in older people mainly to treat biliary obstruction and it carries a low complication rate.
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