Health and Disability

The special issue presents seven papers by noted experts, who discuss the policy changes, new diagnostic classifications, and latest research driving change in the mental health care of older adults. Topics include:

• Changes in the healthcare landscape, including nine "key initiatives" that provide opportunities for assessing and treating older adults with mental health disorders, as well as for funding outcomes-based research. Emerging technologies such as telehealth, smartphone health apps, and social media may provide new approaches to improving outcomes while reducing costs.
• New diagnostic criteria, based on the recently revised DSM-5. These include the new diagnosis of "hoarding disorder"; a newly defined category of neurocognitive disorders that includes "major neurocognitive disorder" (replacing the term dementia), "mild neurocognitive disorder," (replacing mild cognitive impairment), and delirium; and other diagnostic criteria changes that will increase the accuracy of assessment of common mood disorders.
• Age-related differences in the prevalence and characteristics of anxiety disorders. These symptom differences--along with the effects of accompanying medical disorders--may contribute to the challenges of assessing anxiety in older adults.
• New approaches to the problem of depression in later life. A palliative care approach has gained increasing support among caregivers who treat terminal disorders in the elderly. Instead of emphasizing the aggressive search for curative treatments, palliative care prioritizes quality of life, a change in focus that often leads to longer survival as well as greater comfort.
• The many and varied causes of psychosis--often related to underlying medical or neurological conditions. New evidence on the appropriate use of antipsychotic medications in older patients with neurocognitive, psychotic, or mood disorders is summarized as well.
• An in-depth focus on the new DSM-5 category of "mild neurocognitive disorder." While more research is needed to clarify this new diagnostic category, it reflects the growing emphasis on early recognition and treatment of cognitive impairment.
• Management of behavior changes and neuropsychiatric symptoms in older adults with Alzheimer's diseaseor other neurocognitive disorders. Alternatives to antipsychotic medications, including nondrug approaches, may provide urgently needed new treatments. 

For the study, the researchers performed neurological examinations on a group of 52 women who had been diagnosed with episodic migraine, experiencing an average of 5.6 headache days per month. Alongside them, the researchers also examined 36 women as control participants who did not have headaches.

Mast cells play a key role in the disease process in allergies: As a reaction towards an allergen - for example pollen or dust mites - they release big amounts of substances that initiate an inflammatory process. Study leader Hideaki Morita and his team discovered that mast cells are not only "bad guys", but also have a "good side" (see figure): They release the substance interleukin-2 that induces the production of certain immune cells called T-regulatory (Treg) cells. Treg cells can suppress the allergic inflammatory process in the airways induced by interleukin-10.

It is already known for some time that Treg cells can subdue an excessive immune response and the resultinginflammation. For example, injections with Treg cells prevented autoimmune diseases in mice. However, for Treg cell treatments one needs a large amount of these cells, which is not easy to realise. In the blood, there are just a few of them, and in vitro they are difficult to produce. Using mast cells, Treg cells could be easily produced in the laboratory in large quantities. "The mechanism that we discovered, could be the basis for a new way to handle allergies," says Hideaki Morita.

People with health insurance are more likely to have their high cholesterol, diabetes, and high blood pressurecorrectly diagnosed - and to have these chronic conditions under control - than similar uninsured people, according to a new study led by researchers at Harvard T.H. Chan School of Public Health.

Using these results and 10-year Affordable Care Act (ACA) enrollment projections from the Congressional Budget Office (CBO), the researchers developed an estimate of the number of Americans who might benefit from improved diagnosis and treatment of chronic disease through the expansion of health insurance coverage. They estimated that if the number of nonelderly Americans without health insurance were reduced by half, as the CBO projects, there would be 1.5 million newly insured individuals diagnosed with one or more of these conditions, and 659,000 newly insured individuals able to achieve control of at least one condition.

"These effects constitute a major positive outcome from the ACA," said senior author Joshua Salomon, professor of global health. "Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most important chronic illnesses affecting the U.S. population."

The study appears in the September 2015 issue of Health Affairs.

Because of their partnership with a nursing home, fourth graders did several service-learning projects involving residents. This blog post features their research on their intergenerational experiences and older adult stereotypes. Pre-test and post-test survey questions were included. Before visiting, students recorded what their expectations were about nursing homes and the residents who lived there. They indicated that they thought residents would be boring, slow, and trying to get into their "business." These were only a few of the negative stereotypes they had already developed about this population.

Students also participated in several lessons on aging, stereotypes, and eldercare. Among other topics, they learned about dementia, potential healthcare careers, and win-win benefits of service. A better understanding of caregiving and acceptance of peoples' differences became evident in their discussions. This extensive preparation enhanced their confidence in interacting with residents later.

Fourth graders were amazed at how their opinions changed when they answered the same survey questions after returning to school and reflecting on their nursing home experiences. One girl exclaimed, "That 80-year-old lady said she used to be a really good basketball player!" A boy wearing eyeglasses happily shared that a resident told him she used to get called "four-eyed" sometimes just like he did, but she never let that stop her from doing her best. Students mastered how to record, analyze, and disseminate research data presented later to staff, parents, community, the school district, and at the NYLC National Service-Learning Conference.

'Dysautonomia,' is an umbrella term used to describe a number of different medical conditions that cause a malfunction of a person''s autonomic nervous system. The autonomic nervous system controls the automatic functions of a person's body that we do not consciously think about such as blood pressure, heart rate, digestion, constriction and dilation of the pupils, temperature control and kidney function. People living with different forms of dysautonomia have difficulty regulating these systems, something that may result in lightheadedness, unstable blood pressure, fainting, malnutrition, abnormal heart rates or even death in severe instances.

Dysautonomia is fairly common; more than 70 million people around the world live with different forms of dysautonomia. People of any gender, race, or age may be affected. There is currently no cure for any form of dysautonomia, although research is being pursued to develop better treatments and hopefully one day – a cure for each form of dysautonomia. Even with the high prevalence of dysautonomia, the majority of people take years to receive a diagnosis because of a lack of awareness among medical personnel and the public at large. Some different forms of dysautonomia include the following.

Haemophilia A is a rare genetic disorder that prevents blood clotting. Patients receive lifesaving infusions of clotting factors, but development of inhibitors in many of those being treated interferes with efforts to control their bleeding.

With the market for haemophilia medications expected to grow to $11 billion next year, Roche's ACE910 drug is closely watched because it could change the way the disease is treated.

"FDA has granted breakthrough therapy designation for ACE910, recognising an unmet need for patients with inhibitors and the promise of these early data," Sandra Hornung, Roche's chief medical officer, said in a statement.

In older patients with arthritis and no history of cardiovascular disease, chronic use of any non-steroidal anti-inflammatory drug appears safe from a cardiovascular and gastrointestinal stand-point, and regular, non-selective NSAIDs such as ibuprofen and diclofenac appear just as safe as the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib according to results the SCOT trial.

"We found no difference between nsNSAIDs and celecoxib, with low cardiovascular and upper gastrointestinal adverse event rates overall," he commented. "In our view, it seems unlikely that another trial of nsNSAIDs versus COX2 inhibitors in subjects free from cardiovascular disease will ever be done due to the low event rates in this population."

The trial included primary care patients aged 60 years and more who were free from known cardiovascular disease and taking chronic nsNSAIDs for their osteoarthritis or rheumatoid arthritis.

The study examined 490 patients  (with a total of 916 dental implants) who were treated with dental implants between January 2007 and January 2013, 51 of which were using SSRIs. Out of the 94 implants on these 51 SSRI users, 10 implants failed, as opposed to 38 dental implants out of the group of 784 nonusers. In the end, the failure rates for SSRI non-users came to 4.6%, while SSRI users had a failure rate of 10.6%.  The study concluded that treatment with SSRIs was associated with an increased risk of failure in osseointegrated implants.