Exercise may reduce injuries from falls in older men

Gill et al in a BMJ article reported findings of potential beneficial effect(s) exercise may have in reducing falls among the elderly.   The authors derived their data from the Lifestyle Interventions and Independence for Elders (LIFE) trial.  The research included 1635 sedentary men and women aged 70-89 years with functional limitations, as defined with a short physical performance battery score (SPPB) equal to or less than 9, but who were able to walk 400 meters. 

The SPPB consists of a battery of tests that combines results from gait speed, standing from a chair and balance as was described by Guralnik etal.  Scores range from 0 (worst performance) to 12 (best performance). Thus SPPB has been used as a predictive tool for assessing possible disability and/or for monitoring of function in older people. 

The participants in the LIFE study were randomly assigned to a structured, moderate intensity physical activity program (n=818) conducted in a center and at home that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching.

The study found that the rate of falling did not differ significantly between those who received health education versus those who were asked to increase their physical activity.  Over two years, 61.2 percent reported at least one fall in the first group, while 60 percent did in the second.  Serious fall injuries, defined as a fall that resulted in a fracture and/or injury that led to a hospital admission, was experienced by 84 (10.3%) in the health education group and 75 (9.2%) of the participants in the physical activity group.

The investigators found the male participants in the exercise group boosted their physical activity, and also had greater improvements in gait, balance and muscle strength comparing to those in the health education group.  This resulted in a 38 percent lower risk of serious fall injuries, a 53 percent lower risk of fall-related fractures, and a 59 percent lower rate of fall injuries requiring hospitalization for the men in the workout group. However, the exercise program did not appear to reduce women’s risk of serious injuries.

Approximately 30 per cent of the elderly fall each year.  In 2010, 2.3 million non-fatal fall injuries were treated in U.S. emergency departments, and more than 662,000 of these patients were admitted to the hospital.  The results of this study are suggestive that even modest interventions in physical activity as those practiced by the participants in this study may result in a reduction in the number of falls and in the associated morbidity and mortality from the resulting injuries.  The sense of security due to enhanced sense of balance may also result in better-quality of life among the elderly.

Decades long decline in Dementia

A study by Satizabal et al published in the NEJM found that dementia rates fell steadily over the past three decades, likely due to declining rates of heart disease.

The study analyzed data collected since 1975 from the Framingham Heart Study and included 5205 persons 60 years of age or older.  The authors compared interactions between epoch and age, sex, apolipoprotein E ε4 status, educational level, as well as the effects of vascular risk factors such as cardiovascular disease on the prevalence of dementia.

The 5-year age-and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma. The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of the disease.

The authors concluded that the incidence of dementia has declined over the course of three decades.

N Engl J Med 2016; 374:523-532

Cancer death rate has fallen in the United States

Each year, the American Cancer Society (ACS) estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival.

The ACS collects and reports data from several registries such as SEER, CDC, NPCR, NACCR and NCHS.  In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Overall cancer incidence trends are stable in women, but declining by 3.1% per year in men (from 2009-2012), much of which is because of recent rapid declines in prostate cancer diagnoses. The cancer death rate has dropped by 23% since 1991, translating to more than 1.7 million deaths averted through 2012. The decline is attributed to decreasing smoking rates and advances in cancer detection, treatment and prevention.

Deaths from lung, breast, prostate, and colon/rectum cancers drove overall declines.  Death rates for female breast cancer have declined 36% from peak rates in 1989, while deaths from prostate and colorectal cancers have each dropped about 50% from their peak. Meanwhile, lung cancer death rates declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females, due to a decline in the use of tobacco.

In spite of this progress, death rates are increasing for cancers of the liver, pancreas, and uterine corpus. Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death because of the dramatic therapeutic advances against leukemia.  

Despite of these remarkable improvements cancer remains the leading cause of death in 21 states, primarily due to exceptionally large reductions in death from heart disease. Accelerating progress against cancer requires novel approaches in diagnosis, treatment and the application of existing cancer control knowledge across all segments of the population

CA: A Cancer J Clin Vol 66, 1, 7-30, Jan-Feb 2016

One-third of all cancers maybe inherited

Muci et al published in JAMA the results of a trial that suggests that approximately one-third of all cancers are due to inherited genes. 

The investigators looked at data from 80 309 monozygotic and 123 382 same-sex dizygotic twin individuals (N = 203 691) within the population-based registers of Denmark, Finland, Norway, and Sweden, who were part of the Nordic Twin Study of Cancer. 

Twins were followed up a median of 32 years between 1943 and 2010. There were 50 990 individuals who died of any cause, and 3804 who emigrated and were lost to follow-up.

The main outcome was incident cancer and time-to-event analyses were used to estimate familial risk.

A total of 27 156 incident cancers were diagnosed in 23 980 individuals, translating to a cumulative incidence of 32%. Cancer was diagnosed in both twins among 1383 monozygotic (2766 individuals) and 1933 dizygotic (2866 individuals) pairs. Of these, 38% of monozygotic and 26% of dizygotic pairs were diagnosed with the same cancer type.

The analysis of data found that overall heritability for cancer was 33 percent among the entire study population, and significantly higher for certain types of cancers.  Significant heritability was found in 58 percent of diagnosed skin melanomas, 57 percent of prostate cancers, 43 percent of non-melanoma skin cancers, 39 percent of ovarian cancers, 38 percent of kidney cancers, 31 percent of breast cancers and 27 percent of uterine cancers.  In the same study researchers identified a set of cancers in which genetics play a very small role. This group includes lung cancer (18 percent), colon cancer (15 percent), rectal cancer (14 percent), and head and neck cancer (9 percent).”

In this long-term follow-up study among Nordic twins, there was significant familial risk for cancer overall and for specific types of cancer.  This information about hereditary risks of cancers may be helpful in patient education and cancer risk counseling.