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Editor's Choice

Photograph of Dr Lambrinoudaki
Irene Lambrinoudaki
Editor in Chief, Gynecology / Endocrinology

Photograph of Dr Flicker
Leon Flicker
Editor in Chief, Aging

The Editor's Choice is a new feature of Maturitas. It summarises for the public the most important research published in the journal on midlife and ageing and the papers are openly available.

There are complex relationships between physical activity, sleep duration and cognitive performance as we age. In this issue of Maturitas, Falck and colleagues report a study based on the Canadian Longitudinal Study on Aging that explores these relationships. The study is large and in over 20,000 people the authors have explored associations between total sleep time (TST), physical activity (PA) and cognitive performance. The association between PA and cognitive performance was robust across both sexes and all age groups. On the other hand, TST had complex relationships with cognitive performance based on age and sex. This is not surprising as TST has many determinants associated with ageing, some of which may also affect cognition. As the authors point out TST and sleep disturbance may have multiple causes and both increased and decreased TST may have negative consequences on cognition with ageing. This is an area that requires more research, specifically targeting interventions that may assist with TST and in turn cognitive performance.

Early surgical menopause caused by bilateral oophorectomy has been associated with adverse metabolic changes and increased risk of cardiovascular disease later in life. However, the trajectories of changes over time and the preventive effect of estrogen therapy during the first years after oophorectomy are not well known. The present study aimed to assess the effects of bilateral oophorectomy on body weight, body composition, lipid profile and blood pressure over 10 years in 3 groups of women: 1) women with bilateral oophorectomy who received estrogen therapy (163), 2) women with bilateral oophorectomy who did not receive estrogen therapy (n=107) and 3) referent women (n=270). The results of the study showed that weight and BMI increased, while HDL-c cholesterol decreased significantly, primarily during the first 4-5 years after oophorectomy in women not on estrogen therapy, compared to the referent women. Women who received estrogen therapy after oophorectomy were comparable to the referent women with regard to weight and BMI, while HDL-c increased over time. The results of this study show that adverse cardiometabolic changes are apparent soon after early surgical menopause. These changes are preventable by estrogen therapy.

Sarcopenia has gained increased attention in recent years. Whether sarcopenia has a major single biologic basis or is the manifestation of multiple age-related diseases is still unclear. Sarcopenia is characterised by low muscle mass and function. Recent work suggests that muscle strength is the more powerful predictor of deleterious outcomes as opposed to muscle mass. In this issue of Maturitas, Piovesan and colleagues report a cross-sectional study exploring the associations of indicators of sleep impairment and disorders, with grip strength. They found that objective short and long sleep durations were associated with lower muscle strength. Increased night-time wakefulness and severe obstructive apnea were also associated with lower muscle strength. The cross-sectional nature of the study limits the ability to determine the direction of causality, with the possibility that lower muscle strength leads to sleep impairment. However, this study does provide some insights into the pathogenesis of lower muscle strength in older people.

Premature ovarian insufficiency (POI), resulting in the cessation of menses before the age of 40 years, affects 1-2% of the general female population. If left untreated, this condition is associated with considerable physical and psychological morbidity; yet women with POI are frequently underdiagnosed and inadequately treated. The study by Blümel et al investigates all-cause, cardiovascular and cancer mortality in a cohort of midlife women attending a preventive health care facility, who were followed for 30 years. The baseline prevalence of POI was 6.7%. In the adjusted model, women with POI had 60% higher all-cause mortality compared to women with normal age at menopause. The excess mortality was mainly attributed to cardiovascular disease, while cancer mortality was not affected by the age at menopause. POI was the 3rd risk factor associated with mortality after diabetes and hypertension. These findings highlight the importance of prompt diagnosis and early implementation of preventive measures in women with POI.

During the life course, hypertension is a major risk factor for morbidity and death. However, for people in their eight decade and beyond, the association between blood pressure with deleterious outcomes is not so clear-cut. In this edition of Maturitas, Rouch and colleagues examine the association of baseline blood pressure with incident frailty as a secondary analysis of the Multidomain Alzheimer Preventive Trial. Frailty is now defined as the loss of physiological redundancy and was measured in this study using a phenotypical model based on the work of Fried et al. Hypertension was not associated with the onset of frailty but low blood pressure was associated with an increased hazard of frailty of 1.43, 95% CI [1.07–1.92]. This association seemed to be independent of anti-hypertensive treatment. At present we do not understand the full implications of these findings. Other studies have demonstrated greater mortality and morbidity in those people with low blood pressure. The authors rightly advise caution and the need to individualise approaches in treating hypertension in older people.

Premature ovarian insufficiency is associated with increased cardiovascular morbidity and mortality. The prompt diagnosis and institution of hormone replacement therapy (HRT) is of high importance to decrease the burden of the disease. The optimal HRT regimen for this young population regarding the cardiovascular system has yet to be demonstrated.

Most RCTs evaluating the effect of different HRT regimens on cardiovascular parameters have been performed in older women. This RCT randomized 57 women with POF in good health status (mean age 35y, normal BMI, non-smokers, not on antihypertensive medication) into 1) 50mcg of transdermal estradiol + 200 micronized progesterone (t-E2+MP) or 2) 50mcg of transdermal estradiol + 10mg medroxyprogesterone acetate (t-E2+MPA).

Changes in hemodynamic parameters and arterial stiffness were assessed at baseline and after 12 months. Arterial stiffness did not change in either treatment arm. Women on t-E2+MP demonstrated a significant improvement in cardiac output and a reduction in diastolic blood pressure. These parameters remained unchanged in women on t-E2+MPA. The results of this RCT highlight the importance of individualizing HRT regimens in women with POF.

In this issue, Veronese and colleagues explored the association of urinary incontinence with subsequent quality of life. Using the data collected from Waves 2 to 7 of the English Longitudinal Study of Ageing (ELSA) they were able to measure self reported urinary incontinence and quality of life at baseline and then subsequent changes in quality of life over time. One of the advantages of this study is that ELSA is broadly representative of the general population. Initially there was no obvious association of urinary incontinence with quality of life but over the subsequent ten years the deterioration in quality of life was found to be greater in those with urinary incontinence than in those without. This association was particularly pronounced in people with a longer duration of urinary incontinence and in men. This study highlights the importance of decreasing risk of urinary incontinence for the general well being of older people.

Estrogens have a beneficial effect on arterial compliance and carbohydrate metabolism both through direct effects on target organs and through indirect effects on body composition. Postmenopausal estrogen loss results in increases in body fat mass, insulin resistance and arterial stiffness. This study evaluated the association between the reproductive lifespan (years from menarche to menopause) and the incidence of type 2 diabetes and hypertension. The researchers evaluated 6357 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) who were 45-50 years at entry and were followed up for 20 years. Compared to women with a normal reproductive lifespan (38-40 years), women with a short reproductive lifespan (<35 years) had 30% higher risk of incident type 2 diabetes and 100% higher risk of incident hypertension. These risks were particularly prominent in obese women, indicating an interaction of obesity with short reproductive lifespan. This study highlights the importance of maintaining healthy body weight at midlife to prevent diabetes and hypertension especially in women with a short reproductive lifespan, like women with early menopause.

More and more older women are experiencing a longevity dividend but the quality of these extra years has been under increasing scrutiny. Virtually everyone wants these extra years to be of high quality but the typical experience is still unclear. In this edition of Maturitas, Rahman and colleagues describe the transitions to chronic disease and disability in a large cohort of Australian women born in the period 1921-1926. By 2016, two-thirds of the women had died with less than 4% dying without disease or disability. At age 70–75, the predicted length of life without disease and disability was 7.7 years, life with only chronic disease was 4.4 years and life with disability was 3.8 years.

Those reporting chronic diseases were 2.7 fold more likely to experience a state of disability than those who did not report chronic illnesses. Other factors such as difficulties managing on available income, not completing secondary school and being overweight or obese were associated with an increased risk of developing disability.”

Hysterectomy is one of the most frequently performed gynecological procedures. In premenopausal women, hysterectomy without bilateral salpingo - oophorectomy (BSO) may also result in premature menopause, by disrupting blood supply to the ovaries. Early ovarian estrogen depletion caused by hysterectomy may have an adverse effect on cardiovascular outcomes. The investigators of this study sought to answer this question by comparing the incidence of coronary heart disease between 8,642 hysterectomized and 34,568 non-hysterectomized women during 11 years of follow up, using the national cohort from the Korean National Health Insurance Service. Women who had been hysterectomized before 50 years of age had 19% higher risk of incident coronary heart disease, compared to non – hysterectomized women, while the risk was non – significant for older women. This association was independent of confounders like age, BMI, lifestyle factors, income or region of residence. This study highlights the importance of the timing of hysterectomy for future cardiovascular health and has implications for clinical decision making.

The Genitourinary syndrome of menopause is common and distressing to many women. Local estrogen has been standard therapy for some time but many women are unable to use this treatment. Vaginal laser therapy has recently been suggested as an alternative therapy but the evidence for efficacy is not clear-cut. In this volume of Maturitas, Mension and colleagues report a systematic review of the available evidence, including both trials and observational data. Ten randomized trials were found but none of these studies included more than 88 participants. There were larger numbers of participants studied in observational studies, but the scientific quality of these studies was not robust. There was some improvement noted on subjective measures. However, this evidence needs to be bolstered with more randomized trials, with longer term outcomes that include objective measures. Only then will clinicians be confident in recommending this treatment.

Anti-Müllerian hormone (AMH) is used to assess ovarian reserve in assisted reproduction and epidemiologically is a strong predictor of the onset of menopause. In this study, the researchers examined prospectively the association of premenopausal AMH levels measured between 1996-1997 in 1619 women participating in the Nurses’ Health Study2 with age at menopause and how reproductive factors affected this association. The results showed that a longer duration of breastfeeding was associated with higher AMH levels, even after adjustment for parity. Longer and exclusive breastfeeding was associated with higher age at menopause independently of parity, an association mediated by AMH levels. The results of this study highlight the possible protective of breastfeeding on ovarian reserve.

Diabetes is a public health problem, as its prevalence increases worldwide among both genders. Given its chronic nature, secondary prevention should be the goal of diabetes management. Diet is a modifiable risk factor of both incident diabetes and diabetes complications. Ghaemi et al aimed in this study to investigate the effect of the Mediterranean diet on the incidence of macro and microvascular complications of diabetes. The study was conducted prospectively among 22,187 patients with diabetes participating in the National Program for Prevention and Control of Diabetes in Iran. The investigators concluded that diabetics who were adherent to the Mediterranean diet had lower incidence of microvascular complications, like diabetic retinopathy, nephropathy and neuropathy, as well as lower incidence of cardiovascular disease. The findings of these study denote the importance of a healthy diet in preventing end-organ damage in men and women with diabetes.

Recently the importance of physical activity for the health of cancer survivors has been recognized. Benefits have not only included increased physical fitness but also better mental health and quality of life. The major challenge is to increase the uptake of these findings into clinical practice. Many of the trials of interventions have been performed with breast cancer survivors and in this month’s issue of Maturitas, Pudkasam and colleagues have reviewed the available evidence on improving adherence to physical activity in this group of patients. They found that self-monitoring coupled with motivational improvement strategies were most effective in improving adherence to physical activity recommendations. It seems a simple step tracker may assist individuals to self-monitor, increasing the response to various motivation improvement techniques. It is highly likely that this evidence can be applied to other clinical situations where increased physical activity may provide support to people recovering from major illnesses.

Frailty is a leading cause of death in older people. Measures and strategies to prevent frailty are of high clinical relevance. Social participation and interaction have been suggested to protect against chronic disease in aging people. In this context, the authors of this study evaluated prospectively the effect of social participation on the onset of physical frailty in 6,959 community dwelling older adults who were followed up for two years. The researchers found that playing group games, participating in the activities of sports clubs in a regular basis or participating in voluntary activities occasionally reduced the development of frailty by 30-50%. The results of this study highlight the importance of social participation as a preventive measure of frailty and can guide health care providers in the counseling of their patients.

Hypertension is a major cause of cardiovascular disease morbidity and mortality in women after menopause. Compered to men, awareness is lower and treatment of hypertension is often inadequate in women. The identification of risk factors and preventive measures for hypertension in women at midlife has major clinical implications. Physical activity prevents, while sleep disturbances augment the development of hypertension. It is unknown, however, how these two parameters jointly affect the incidence of hypertension. In this context, the investigators of this study followed prospectively 5,300 mid-age participants of the Australian Longitudinal Study on Women’s Health with a mean age of 55 years who were free of hypertension at baseline. Participants were categorized according to levels of sleeping difficulties and physical activity. After 9 years of follow-up, 22% of the population had developed hypertension. Inactive women with >2 sleeping difficulties had 44% higher odds of developing hypertension compared to active women with no sleeping difficulties. On the other hand, sleeping difficulties were not associated with hypertension among physically active women. The results of this study highlight the protective effect of physical activity against the increased risk of hypertension in women with sleeping difficulties.

The nexus between bone and lipid metabolism has been recently described but the pathological importance in human disease is still uncertain. The role of bone marrow adipocytes is still to be determined, and is likely to play a key role in energy metabolism and modulation of the function of other cells. In this edition of Maturitas an interesting observation from a cohort of postmenopausal women drawn from Northern Spain has supported the potential importance of lipid metabolism on bones. The authors measured the atherogenic index of plasma (AIP) defined as the logarithm of the ratio of the molar concentration of triglycerides to high-density lipoprotein cholesterol. The AIC is associated with metabolic disorders such as diabetes and metabolic syndrome. They then went on to examine the association of the AIC against a measure of bone microarchitecture, the trabecular bone score (TBS). They found that AIP was negatively correlated to TBS values after adjustment for age and a variety of other potential confounders including bone mineral density. This study highlights the importance of the interplay between risk associated with abnormal lipid profile and fracture risks in the postmenopausal population.

Falls constitute a major cause of morbidity and mortality in the geriatric population. Strategies to prevent falls in older people are therefore of major clinical relevance. Exercise is an effective intervention to prevent falls. Poor adherence, however, often decreases the effectiveness of exercise intervention. Knowing the baseline predictors of poor adherence can guide better targeting of modifiable factors. Jennifer Davis et al undertook a “case-mix” approach to identify baseline risk factors which could predict poor adherence to an exercise intervention for secondary falls prevention in the intervention arm of an RCT over 12 months. The researchers concluded that the baseline cognitive profile as well as the functional status of participants predicted the pattern of longitudinal adherence trajectory. The findings of this study may contribute to the individualization of fall prevention strategies.

Hip fractures occur predominantly in older people because of decreased strength of bone and increased propensity to fall. There are many risk factors for falling and simple tests to evaluate falls risk are often used to help streamline the selection of individuals for interventions. The short physical performance battery (SPPB) is one of these simple batteries that combines tests of walking speed , balance and repeated chair stands. Using the China Health and Retirement Longitudinal Study, Zhong et al studied 5,958 people over the age of 60 and followed them for 4 years. The overall score on the SPPB was associated with risk of hip fracture but after adjustment for factors including body mass index, falls and chronic diseases, repeated chair stands appeared to be the most important factor in predicting hip fractures. Taking into account cognitive functioning did not appear to alter these findings. This highlights the observation that specific tests of lower extremity strength and to a less extent balance, are required to evaluate hip fracture risk.

The contribution of environmental factors to health and disease is increasingly being recognized. The reproductive system is particularly susceptible to exogenous influences. In this context, the investigators undertook a multi-center study across Europe to evaluate the association of exposure to ultra-violet radiation (UVR) with serum sex hormone levels in 580 community dwelling postmenopausal women. The results of the study showed that increased UVR exposure was associated with decreased 17-β estradiol levels, as well as increased follicle stimulating hormone and luteinizing hormone levels. The associations were independent of age, BMI, smoking, season of blood sampling, investigation center or vitamin D levels. Low postmenopausal estrogen levels have been associated with chronic disease, like osteoporosis. If proven causative, the results of this study point out the importance of modifiable risk factors such as UVR exposure for women’s post-reproductive health.

It is known that the presence of a maternal history of hip fracture increases the risk of hip fracture in their offspring. It is likely that this risk is mediated by both common environmental and genetic factors, although these have been difficult to elucidate. In this month’s edition of Maturitas, the presence of in utero factors, and in particular gestational diabetes, was found to increase the risk of all fractures and hip fractures in women. The mechanism for this increased risk was difficult to explain as there was no apparent association with an increased rate of falls or decrease in bone mineral density as measured by ultrasound measures at the calcaneus. This novel observation does raise the potential importance of exposures in utero for outcomes thought to be conditions of older age.

Diabetes is a widely prevalent chronic disease associated with multimorbidity and a high socioeconomic burden. Diabetes is positively associated with some types of cancer, such as kidney cancer, however, it is not known whether this is a direct association or it is mediated by obesity or hypertension. The IOWA study is a large population-based study conducted in 36,975 postmenopausal women who were followed up for 25 years. During the study period, 245 cases of incident kidney cancer occurred. Diabetes was positively associated with the incidence of kidney cancer, an effect which was partly explained by risk factors including age, obesity or hypertension. However, among non-obese women and women with low waist circumference, time-dependent diabetes was an independent risk factor of incident kidney cancer [HRs (95% CIs): 1.82 (1.10, 3.00) among women with BMI < 30 kg/m2 and 2.18 (1.08, 4.38) among women with a waist circumference <34.6 in.]. This study strengthens the hypothesis that diabetes is associated with kidney cancer risk independently of its comorbidities.

Handgrip strength has been increasingly recognized as a reliable marker of muscle strength which is easily measured in the clinical setting. Functional measurements of sarcopenia, such as handgrip strength, have gained popularity over the time- and resource consuming structural measurements of muscle mass. The authors of this study have measured hand grip strength in 509 consecutive patients aged 65 years or older with a diagnosis of fragility hip fracture admitted to a tertiary care hospital over one year. The mean age of the patients were 85 years and 66.6% of them had reduced handgrip strength at baseline. At one year of observation, patients with reduced handgrip strength had a significant decline in walking ability (32.7% vs 10.9%) and a higher mortality rate (30.4% vs 8.8%). The study demonstrates the ability of handgrip strength to predict functional disability and mortality after a hip fracture in older patients and highlights the significance of an easy-to-use clinical measure of muscle function in predicting adverse outcomes.

Osteoporosis and Sarcopenia are common and disabling conditions of older people, and the clinical methods to detect their presence and treatment, well established. Recently a new syndrome has been described, osteosarcopenia, where both these condition occur concurrently in an individual, greatly increasing the risk of fractures and other deleterious consequences. The pathophysiology of the two underlying conditions forming osteosarcopenia has many similarities. In particular physical inactivity, the hormonal milieu, humoral factors and inflammatory process may have substantial effects on the development of osteosarcopenia. The identification of osteosarcopenia is relatively straightforward by modern diagnostic techniques. As Kirk and colleagues point out the condition is best avoided by a combination of physical activity and adequate nutrition. Further research is required to identify specific biomarkers and pharmacological intervention for the condition of osteosarcopenia.

Postmenopausal osteoporosis is one of the most prevalent chronic diseases of midlife and beyond which is associated with high morbidity and mortality. Osteoporotic fractures are to a considerable extend preventable, making therefore screening and early intervention mandatory. Several scientific societies have issued guidelines for the prevention and management of postmenopausal osteoporosis. The authors of this publication have performed a critical appraisal of available systematic reviews and meta-analyses, guidelines and recommendations published the previous 10 years. This manuscript provides clear answers to the most frequent questions arising in the clinical practice during assessment of bone health in postmenopausal women.

Sarcopenia is defined as an age-associated loss of skeletal muscle function and muscle mass. It is common in older people but a precise and widely accepted definition has currently eluded us. In 2019, The European Working Group on Sarcopenia in Older People (EWGSOP2) updated the original definition and highlighted the primacy of reduced muscle strength. Sarcopenia is still defined by low muscle strength and mass but severe sarcopenia is defined by the coexistence of poor physical performance, most commonly by reduced gait speed. Petermann-Rocha and colleagues tested the prognostic value of the different attributes of sarcopenia against the outcomes of cardiovascular and respiratory diseases, and cause specific and all cause mortality. The measure of poor physical performance, slow gait speed had the strongest association with deleterious outcomes. The importance of physical performance as well muscle strength and mass in the assessment and management of older people with presumed sarcopenia has been highlighted.

COVID-19 pandemic has had a major impact on people’s life and has influenced medical practice and priorities. Managing the menopause has become a secondary issue while many women infected by the new corona virus are on estrogen / progestogen therapy, either for contraception or for the management of menopausal symptoms. COVID-19 is associated with a systemic inflammatory response and a pro-coagulant state. Clinical guidance, therefore, on the management of infected women on systemic estrogen / progestogen treatment is urgently needed. The paper by Ramírez et al presents clinical practice algorithms guiding physicians how to modify estrogen treatment in the context of the new corona virus infection, according to the severity of the disease. The guidelines presented here will help clinicians not familiar with hormonal treatment to serve their patients in the best way during the pandemic.

The COVID-19 epidemic has continued to march on. By May 26 approximately 350,000 people worldwide have had deaths attributed to COVID-19. In the absence of an effective vaccine or treatment, public health measures that include quarantine of high risk individuals and proven cases have been used to control the epidemic. Spatial distancing, sometimes called social distancing, has been used to decrease the spread of the virus. In this edition of Maturitas Mesa Vieira and colleagues have highlighted the potential risks associated with the reliance on spatial distancing. These include the reduction in the mental health of individuals, particularly from disadvantaged groups and the breakdown of social and professional networks that can encourage the spread of misinformation and prejudice. Perhaps the most insidious of the problems is the diminution of routine healthcare, services upon which many older people are reliant. This interference in healthcare may be as damaging to vulnerable groups as the virus itself.

Primary hyperparathyroidism has become a common clinical entity following the easy access to measurements of serum calcium. While in older times the disease was diagnosed late in its natural course, nowadays many patients are asymptomatic and hyperparathyroidism is discovered accidentally on the basis of an elevated serum calcium. The most definite and effective management of primary hyperparathyroidism is parathyroidectomy. However, many older patients are poor candidates for surgery due to comorbidities and many physicians choose to follow their patients conservatively. In this study the researchers present their findings on the conservative management of 182 patients with primary hyperparathyroidism with a mean age at diagnosis of 73 years, who were followed up for an average of 11 years. Although the majority of them had formal indication for surgery, patients who were followed conservatively had no difference in levels of urine calcium, glomerular filtration rate, nephrolithiasis or the frequency of fractures, compared to patients who underwent parathyroidectomy. The results of this study are reassuring for the conservative management of primary hyperparathyroidism.

Two of the common problems facing older people are osteoporosis, a loss of bone mass and quality that predisposes to fracture, and sarcopenia, a loss of muscle mass and function. Both conditions are heavily age dependent and predispose to long term disability and death. The two conditions may often coexist producing a syndrome called osteosarcopenia. Physical inactivity and poor nutrition are potent risk factors for osteosarcopenia. Obesity may predispose to osteosarcopenia, by its association with an infiltration of fat within both muscle and bone tissues. In this issue of Maturitas, Bae has reported a cross-sectional study of post-menopausal women exploring various body composition factors utilising data from the Korea National Health and Nutrition Examination Survey. Increased fruit intake was associated with a dramatically decreased risk of osteosarcopenic obesity. The mechanisms for this association are not clear but if such effects can be confirmed in longitudinal studies then there is even more reason to advocate for an increase in fruit intake for older women.

Osteoporosis is one of the most prevalent chronic diseases worldwide. Case finding and the decision to treat are still demanding tasks in the clinical setting. BMD and risk calculating algorithms, although helpful as screening tools, still miss a considerable proportion of people at risk of fracture. This study analyzed 14,429 participants from the 2009-2011 Korean National Health and Nutritional Examination Survey who were 20 years or older, aiming to investigate the association of low muscle mass with osteoporosis. The investigators observed a significant association of low muscle mass with osteoporosis of both lumbar spine and femoral neck, which was evident in both genders and across most age strata. The association was not affected by covariates like smoking or drinking, physical activity, comorbidity, use of supplements or menopausal status. This study provides evidence on an important risk factor of osteoporosis, which is not accounted for in the routine clinical setting.

There are conflicting studies about the effects of age on body composition variables throughout the lifespan. In this population based longitudinal study of women across ages 40 to 79 years, several interesting observations were made. Firstly, lean mass continues to increase in the fifth decade of life, suggesting that the decline in muscle mass occurs comparatively later in life. Total fat mass and abdominopelvic fat started to decline in the sixth decade, somewhat earlier than expected. Arm lean mass commenced to decline in the sixth decade whereas leg lean mass declined only in the seventh decade. The arm lean mass decline seemed to be greater in magnitude than in the legs. These findings may have important implications for timing of risk factor evaluation and the design of diet and exercise programs for women throughout the life-course.

Age at menarche is an emerging gender-specific risk factor of cardiovascular disease in later life. The investigators of the European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) Study have looked at the association of age at menarche and incident heart failure in 28,504 women aged 20-70 years at baseline, who were followed up for 15.2 years. The study showed that earlier age at menarche was associated with an increased risk of heart failure. Each year of older age at menarche was associated with a 5% lower risk of heart failure. Adiposity, hypertension, prevalent coronary heart disease and diabetes mediated the association. Age at menarche may serve as an indicator of future cardiovascular health in the clinical setting.

Hand-grip strength is a feasible and reliable indicator that can be easily measured as a surrogate marker for muscle strength, especially of the upper limbs. The association between low hand-grip strength and increased osteoporotic fracture risk has been reported among the elderly. The researchers therefore investigated the association between hand-grip strength and site-specific risks of major osteoporotic fracture in 1342 postmenopausal women aged 50 years or more at baseline who were followed up for 15 years. They found that hand-grip strength is specifically associated with the risk of distal forearm fractures within 10 years and clinical vertebral fractures within 15 years or more in postmenopausal women. Thus clinicians should consider measuring hand-grip strength in the assessment of postmenopausal women.

The study examined associations of parental ages at childbirth with healthy survival to age 90 years among older using a racially and ethnically diverse sub-cohort of 8,983 postmenopausal women from the larger Women’s Health Initiative population, recruited during 1993–1998 and followed for up to 25 years up till 2018.

Women were aged on average 71.3 years ( range 65-79) at baseline. There was no significant association of maternal age at childbirth with healthy survival to age 90 or death before age 90. Women born to fathers aged older than 35 years compared with 30–34 years at their births were more likely to achieve healthy than usual survival . There was no association of paternal age at childbirth with death before age 90.

This large study suggests that being born to older fathers was associated with healthy survival to age 90 among women who had survived to ages 65–79 years at study baseline. There was no association of maternal age at childbirth with healthy survival to age 90 among these older women.

The association between frailty, mortality and sex is complex. Therefore, the researchers prospectively evaluated sex differences in frailty and mortality in an international cohort of older people admitted to hospital in Europe and Australia. Altogether, 1140 hospitalized patients (mean age=84.2 years; 694 women=60.9%) were included.

The study found that hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the ‘male-female health-survival paradox’ to acutely ill patient groups.

Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort, reduced mobility falls and fracture. This review concludes that safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. The authors conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people especially as the population is aging.

The European population is estimated at 515 million inhabitants, of which 19% is currently aged 65 years and older. This is expected to increase to 29% in 2060. Longevity often brings health-related issues which include which protein-energy malnutrition (PEM). The condition is associated with delayed recovery from disease, poorer quality of life and increased risk of morbidity and mortality. The authors therefore carried out a systematic review and meta-analysis to assess the prevalence of protein-energy malnutrition risk in European older adults. They found that 23% of European older adults are at high risk of malnutrition. The risk of malnutrition was lowest in the community and highest in the hospital setting. People aged over 80 years, women and those with comorbidities have a higher risk of malnutrition. The high risk of malnutrition is of concern and should be taken on board by health policy makers especially in the age of austerity.

Measurement of serum testosterone (T) level is of utmost importance for the evaluation of hypogonadism in men and androgen excess in women. This timely review details the pitfalls in measuring T levels in both genders. Thus most of the available immunoassays lack the required accuracy when dealing with T concentrations at the lower end of the normal range for men and across the entire range for women. Consequently, there is no universally accepted lower T threshold for healthy adult men and most immunoassays fail to detect states of mild androgen excess in women. Mass spectrometry is considered the gold-standard method for T measurement; however, due to its complexity and cost, it has not been widely adopted. To increase accuracy, T in men should be measured with a fasting morning sample and repeated if the level is found to be low; in women, measurement must be performed at the follicular phase of the cycle. In both cases, borderline results may be clarified by the assessment of free testosterone (fT). Since most fT assays are unreliable, calculated surrogates should be used instead. Thus collaborative efforts have been undertaken, with rigorous internal and external quality controls and the establishment of reference methods, to harmonise commercial assays.

Increasing evidence suggests a bidirectional relationship exists between levels of health literacy (HL) and cognitive impairment in later life. However, it is unclear whether low levels of HL can lead to a higher risk of dementia. This systematic review explored prospective cohort studies to find out whether HL is a risk factor for incident dementia in older adults. The review found a statistically significant positive association between total literacy scores and the post-mortem amount of plaques and tangles suggestive of Alzheimer’s disease. Thus low levels of HL might lead to higher future dementia risk. Primary health care professionals might wish consider individual’s HL when planning and implementing dementia risk reduction in order to improve its long-term effectiveness.

Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. However not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit.

The authors of this review examines how to deal with diagnoses that are no longer clinically relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.

The parent-child relationship is critical for human development. The authors therefore investigated whether childhood experiences of poor-quality parenting (characterized as decreased parental care and increased parental overprotection) are associated with women’s reproductive timing and lifespan.

They analysed data obtained from 2383 women aged 55–89 years from the English Longitudinal Study of Ageing (ELSA). They found that increasing maternal and paternal overprotection were associated with later menarche (≥16 years). Maternal and paternal overprotection were also inversely associated with age at natural menopause. Further, increasing paternal overprotection was associated with a shorter reproductive lifespan (≤33 years). To conclude women who experienced poor-quality parenting in childhood might be at increased risk of an unfavourable reproductive health profile and a shorter reproductive lifespan.

Intimate partner violence (IPV) against women is a significant public health issue globally. It has serious physical and psychological health consequences as well huge economic and social costs. This narrative review explores IPV in women aged ≥45 years. It finds that IPV is commonly experienced by older women (lifetime prevalence 16.5%–54.5%), but that their age and life transitions mean that they may experience abuse differently to younger women. They also face unique barriers to accessing help, such as disability and dependence on their partners. The author recommend commissioning services that are specifically tailored to meet their needs. Professionals working in frontline services where older women are commonly seen should be trained to identify and respond to IPV appropriately.

There are over 4.2 million women in employment aged between 50 and 64 in the UK. This means that a significant proportion of mid-aged and older women workers will be going through the menopause and might experience symptoms whilst in employment. About 70-80% have hot flushes and night sweats and for some they can be very troublesome and adversely impact at work. Yet, there is a general lack of awareness and communication about menopause in work settings.

This timely research developed and evaluated a 30-min online training for managers, in order to improve menopause-related knowledge, attitudes and confidence in having supportive discussions with women experiencing menopausal symptoms at work. The study found that a brief menopause awareness training may be a feasible and effective way to help managers become more knowledgeable about menopause-related problems and more confident in discussing and exploring solutions with their staff.

The results are encouraging and will hopefully break taboos about discussing menopause in the workplace.

Cardiovascular disease is the leading cause of death in women throughout the United States and Europe. While one in thirty-one women will die from breast cancer, one in approximately two to three women will die from heart disease or stroke. However many women do not identify cardiovascular disease as a primary threat. Despite efforts to raise awareness, sex-specific risk factors are still poorly recognized. These risk factors include adverse pregnancy outcomes, autoimmune diseases, depression, and cancer treatments. The incidence of cardiovascular events rises dramatically during a woman’s midlife, around 55 years, and make the menopause a unique time period during which preventative screening and measures can significantly reduce the risk of death. The authors of this must-read review conclude that healthcare providers should identify risk factors and provide education and counseling about healthy lifestyle changes at this time.

The review examines scientific evidence about the potential health benefits of olive oil consumption. While most olive oil is produced in Mediterranean countries , some comes from other regions of the world, including Australia and the USA. There are several olive oil subtypes (i.e. extra virgin olive oil, virgin olive oil, refined olive oil, and pomace oil) which potentially have different effects upon human health. The health benefits depend on chemical composition, in particular polyphenol content, which may vary according to the different subtypes and the variety of olive used. The authors conclude that olive oil consumption is beneficial for human health, and particularly for the prevention of cardiovascular diseases, breast cancer, and type 2 diabetes. However more research is needed on the merits of different types of olive oil.

Bilateral oophorectomy results in immediate menopause. It is therefore important to find out why women have their ovaries removed for non cancer reasons. The authors therefore looked at the the association of personal, reproductive, and familial characteristics with bilateral oophorectomy performed for benign indications in 1653 US women between 1998 and 2007.

They found that infertility was more common in women who underwent bilateral oophorectomy. The women also weighed more than those who did not undergo the procedure, had a higher body mass index and were younger at menarche. The associations were more pronounced for women who underwent the bilateral oophorectomy before the age of 46. This information collected over 20 years may help inform decision-making about oophorectomy in the future.

The challenges in meeting current and future social care needs and expectations are of paramount importance in an ageing society. Continued rises in the need for long-term care are projected. In Britain and other Western societies, the majority of older people needing help and care with activities of daily living receive this informally from family either from their spouse or partner or their adult children .

The researchers asked 2135 participants aged 68–69 of the UK MRC National Survey of Health and Development about care expectations. The survey is a population-based birth cohort study set in mainland Britain. The outcome was who, besides the partner or spouse, is expected to provide for the future care needs, coded as adult children, other relatives, friends/neighbours, paid/professional care, or no one.

91% had an adult child, of whom 74% expected them to provide care if needed, and 11% expected formal care. The latter rose to 33% of those with no adult children. Geographical distance to adult children (over 25 miles) was strongly correlated with expectations but, independently of this, lack of someone to help in a crisis from midlife onwards and low social contact were associated with expecting formal care. Strategies need to be devised to reduce barriers to residential mobility. The researchers highlighted the cost of moving house. In addition children may have their relationships, employment, pay and pensions affected having to care for a parent, which is likely to affect their own health and quality of life. Thus employers need to be sensitive to the needs of their staff outside the workplace.

This state-of the-art review looks at the threat to human health of plastic pollution. It has been estimated that 250 million tonnes of plastic will be present in the seas and oceans by 2025. Plastic pollution arises mainly from large items or macroplastics such as bottles, cartons, food wrappings, plastic straws and cosmetic products. Macroplastics can be degraded into into microplastics (MPs; < 5 mm), found as fibres and fragments and nanoplastics (NPs; particles < 0.1 µm; 100 nm); both of which are currently of concern as potential hazards to human health as they enter the food chain.

Absorption across the gastrointestinal tract is relatively low, especially for MPs, which appear to have little toxicity. However, NPs are more readily absorbed and may accumulate in the brain and liver. Studies using nanoparticles of other materials suggest that toxicity could potentially affect the central nervous system and the reproductive system. Reassuringly, although it is not completely impossible, the authors conclude that this would be unlikely unless exposure levels were very high and absorption continuous.

Recently, there has been wide interest on the role of the fat-soluble vitamin K on physical functioning. Present in green leafy vegetables, algae and plant oils, Vitamin K1 is the primary source of vitamin K. Vitamin K2 comes in lower quantities and is present in meat, eggs, fermented dairy products and in limited amounts it can be formed by bacteria in the gut from vitamin K1.

The study examined the association between vitamin K status and physical functioning over 13 years in the Longitudinal Aging Study Amsterdam of 633 people aged 55-65 years. Half of the sample were women. Low vitamin K status was found to be associated with lower handgrip strength, smaller calf circumference, and, in women only, with poorer functional performance score. A low vitamin K status was however not related to the 13-year decline in these measures. The researchers concluded that studies are needed to determine whether vitamin K rich foods or vitamin K supplements could improve physical functioning in those with vitamin K insufficiency.

Experienced more by women, perceived stress (PS) is a defensive reaction against threatening environmental conditions, which is associated with activation of the sympathetic nervous system. This status cannot be maintained for long periods, as the parasympathetic system restores equilibrium. PS is experienced as a negative sensation and is associated with adverse health consequences, including increased cardiovascular risks, hypertension, cancer, social adversity, metabolic syndrome risk and insomnia. Physical activity and programmed exercise have been widely recommended to reduce PS, however experts disagree. This meta-analysis was therefore undertaken to assess the evidence provided by randomized controlled trials. It found that there is no evidence that programmed exercise, over 6-12 months, can modify PS in middle-aged and old women. Therefore, it cannot be recommended as a first-line approach for this purpose.

Lifestyle modifications that may reduce menopausal symptoms have generated much interest. This cross-sectional study investigated menopausal symptoms and dietary pattern. This survey found that in perimenopausal women, vegans reported less bothersome vasomotor (p<0.01) and physical symptoms (p<0.01) than omnivores. For both symptom types, more vegetables and less flesh food were associated with less bothersome symptoms (p values<0.05). These results are consistent with other studies demonstrating reduced menopausal symptoms in those consuming greater quantities of plant based foods and less meat and is a potential option for women who do not wish to take medicines.

Women with BRCA1/2 mutations are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) before the menopause to reduce the risk of ovarian cancer. Premenopausal RRSO results in sudden estrogen decline and onset of menopausal symptoms. This study investigated the severity and duration of subjective menopausal symptoms after premenopausal RRSO. Symptoms persisted for many years after surgery with 66% having moderate to severe symptoms 10 years after surgery. Thus followup of these women should extend for many years.

The relationship between meat intake and breast cancer risk is attracting attention. The researchers looked at the relationship of the risk of breast cancer (BC) to meat intake, preference regarding degree of cooking (‘doneness’) and cooking methods, using data from a population-based Spanish case-control study.

1006 Histologically confirmed incident BC cases and 1370 controls aged 23- 85 years were recruited in 10 Spanish provinces. The study found that high total intake of meat was associated with increased BC risk in postmenopausal women. Similar results were found for processed/cured meat and this association was particularly strong for triple-negative tumours. Intakes of well-done and stewed red meat were associated with increased BC risk. Pan-fried/bread-coated fried white meat, but not doneness preference, was associated with an increased BC risk for all women, with a stronger association for premenopausal women.

This study provides support for the importance of diet in breast cancer prevention.

Hip fracture is an important public health problem in the elderly, as it is one of the main causes of morbidity, mortality and related health-care expenditures in older people. It is more common in women than in men. This study looked at gender and cognitive impairment and risk of hip fracture in nearly 5,000 people aged over 55 in a 16-year follow-up study. During that time, 50 men (2.5%) and 225 women (8.4%) suffered a hip fracture. They found that increased hip fracture risk was associated with “mild” stages of cognitive impairment in men, but not in women.

The results in this study add to the relevance of detecting mild stages of cognitive impairment, at least in men.

There is increasing interest in the use of dietary strategies before or simultaneously with lipid-lowering agents in people with abnormal cholesterol levels. The authors review the various options and conclude that changing diet should be the first line, but a tailored approach is needed. Thus low carbohydrate (low GI) diets and mono- and polyunsaturated fatty acids are recommended in people with high triglycerides or low HDL-cholesterol levels. Losing weight and exercise are also beneficial. Plant sterols, soy protein, red yeast rice and reduced intake of saturated and trans fatty acids are recommended in those with high cholesterol levels.

With respect to the potential cardiovascular benefit of these dietary interventions, there is currently good evidence for efficacy of the Mediterranean diet. Thus the management of dyslipidaemias should not involve lipid-lowering agents alone and a more holistic approach is required.

Unexpected benefits of vitamin D in health and disease, beyond bone health, are attracting increasing attention. Vitamin D deficiency has been associated with cognitive decline and dementia in older adults. Given the long prodromal stage of dementia, the authors investigated the association between midlife vitamin D levels and cognition 10 years later in 170 Australian women. They found that at baseline, women aged 55-67 years with vitamin D levels greater that 25nmol/L maintained better executive functioning in late-life, in particular, improved mental flexibility and psychomotor speed. This study provides new information to help inform clinical practice and interventions, given a clear age-window in midlife where giving vitamin D supplements to deficient women may protect cognitive function in late-life.

Handgrip strength, a simple bedside measure, has been shown to be a proxy for muscle strength. Most of the epidemiological data on the link between handgrip strength and various health outcomes have been primarily assessed in the oldest old age-group. In this study of 947 people over 65 a greater decline in handgrip strength was observed with increasing age in men than in women. Furthermore handgrip strength was inversely associated with impaired activities of daily living. Moreover greater handgrip strength was linked to reduced reliance on support services. The authors concluded that preserving handgrip strength is likely to facilitate independent living, as evidenced by the reduced need for both formal and informal support and a greater ability to manage daily living activities with increasing handgrip strength.

As treatments for cancer become more effective, the number of long term survivors is increasing.. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. Similar trends have been found in Europe. Understanding the long-term health and psychosocial issues faced by cancer survivors is therefore of growing importance This special issue in Maturitas on health and wellbeing after cancer comprises review and research articles, as well as management recommendations. The papers are wide ranging and cover: long-term health issues; cancer follow-up care and management; the effects of diet and lifestyle; sexual problems; screening for familial risk; and tumor biology and the effects of chemotherapeutic agents.

Breast cancer is the most common cancer in women worldwide and more than 6 million women worldwide are living with a past diagnosis of the disease. Most survive their illness, and management of the long-term consequences of treatment has become a priority in cancer care. Menopausal symptoms affect most breast cancer survivors and may significantly impair quality of life. The authors describe a multidisciplinary model to evaluate and manage these women using a patient-focused approach. Thus clinics should include gynecologists, endocrinologists, GPs, a psychologist and a clinical nurse specialist. Benefits of this model are clear. They include improved coordination of patient care, education, communication and evidence-based decision making.

People are concerned about the side effects of medicines and drug-induced diabetes is one of them. Unfortunately the risk is underestimated. Diabetes may be induced by: hormonal therapies, especially glucocorticoids and androgen blockers; cardiovascular drugs such as statins, beta-blockers and diuretics; antipsychotics, including clozapine, olanzapine and quetiapine; and antiretrovirals (protease inhibitors and non-reverse transcriptase inhibitors). There is little information on the long-term effects on microvascular complications as clinical trials have not been long enough and have not focused on these endpoints. The good news is that drug-induced diabetes is potentially reversible.
Overall management includes awareness of a drug’s diabetogenic potential, underlying diabetes risk, benefits and risks of continuing versus discontinuing the drug, plus a consideration of drug duration and dose. While diabetes and its severity can be identified and controlled, the likelihood of future diabetes complications frequently cannot. This, balanced against the predicted benefit of the drug, results in clinical uncertainty.

The impact of the gut microbiome on health has become a rapidly growing and exciting area of research over the last 10 years. One of the principal regulators of circulating estrogens is the gut microbiome. This review examines the role of the gut microbiome in estrogen-modulated disease. The authors conclude that novel estrogen modulation methods through microbiome alteration and/or phytoestrogen consumption may provide an alternative to current treatment of estrogen-mediated conditions and disease. Modulation of the gut microbiome and metabolic profile as a means of treating estrogen-driven disease through surgical (bariatric surgery), fecal microbiome transfer, nutraceutical (genistein) and pharmaceutical (metformin) methods also shows promise.

With an aging workforce and rising employment rates for women throughout Europe, increasing numbers of women will be working during their menopause transition and postmenopause. While the menopause may cause no significant problems for many women, for some it is known to present considerable difficulties in both their personal and working lives. This online survey found that women want employers and managers to have more knowledge and awareness about the menopause. They also want employers and managers to be better able to talk about it and to be able to agree appropriate work adjustments. Finally women want employers and managers to provide staff training and to develop supportive policies.The results of this study have clear implications for communication about menopause at work and for employer-level policy and practice.

Solutions are needed to satisfy care demands of older adults to live independently. Wearable technology (wearables) is one approach that offers a viable means for monitoring the health of older adults in free-living environments. Gait has been presented as a relevant (bio)marker in ageing and pathological studies, with objective assessment using wearables. This review concludes that wearables can play active roles for independent living in older adults by providing clinically relevant gait estimations. Additionally, more accurate automated fall detection could lessen fall risk. However, diverse and sporadic innovation have generated many wearable (and algorithm) combinations which need further evaluation. There is therefore a need for consolidation on the use of wearables in older people to fully assess their role in supporting independent living.

  • Being overweight or obese is associated with harboring a gut microbial community not capable of metabolizing the soy isoflavone daidzein to O-desmethylangolensin in peri- and post-menopausal women

    Lindsey M. Miller, Johanna W. Lampe, Katherine M. Newton, Gabrielle Gundersen, Sharon Fuller, Susan D. Reed, Cara L. Frankenfeld
    Maturitas, Vol. 99

The Office for National Statistics reported 61,686 deaths with dementia listed on the death certificate in England and Wales in 2015 overtaking heart disease, previously the leading cause of death. This was widely reported in UK media, but what do the figures mean? John Starr points out in his editorial that there are drivers to increase identification of dementia both in primary and secondary care.
Also another trend which may also have affected rates of dementia being recorded on death certificates is the decreasing proportion of people dying in acute hospitals rather than at home. People who have been diagnosed with dementia are more likely to have this stated on their death certificate if they die at home rather than in an acute hospital. Combined these trends boost numbers of recorded dementia deaths.
Thus it is uncertain whether dementia rates are really increasing and careful population-representative studies need to be undertaken.

The Office for National Statistics reported 61,686 deaths with dementia listed on the death certificate in England and Wales in 2015 overtaking heart disease, previously the leading cause of death. This was widely reported in UK media, but what do the figures mean? John Starr points out in his editorial that there are drivers to increase identification of dementia both in primary and secondary care.
Also another trend which may also have affected rates of dementia being recorded on death certificates is the decreasing proportion of people dying in acute hospitals rather than at home. People who have been diagnosed with dementia are more likely to have this stated on their death certificate if they die at home rather than in an acute hospital. Combined these trends boost numbers of recorded dementia deaths.
Thus it is uncertain whether dementia rates are really increasing and careful population-representative studies need to be undertaken.

  • Gender differences in the incidence of and risk factors for hip fracture: A 16-year longitudinal study in a southern European population

    Elena Lobo, Guillermo Marcos, Javier Santabárbara, Helena Salvador-Rosés, Luis Lobo-Escolar, Concepción De la Cámara, Alberto Aso, Antonio Lobo-Escolar and the ZARADEMP Workgroup
    Maturitas, Vol. 97

Hip fractures are a major public health concern, particularly among older people. The present study followed up 4803 Southern European men and women aged over 55 for 16 years. They found that women are three times more likely than men to fracture a hip, and that risk factors differ for men and women. Illiteracy and depression increase the risks of fracture in women, while smoking and disability raise the risk in men. Dementia did not increase the risk of hip, but being married or having a partner reduced the risk for men and women.

Type 2 diabetes is a global epidemic, and the prevalence and incidence of type 1 diabetes are increasing. While the negative effects of diabetes on kidneys, nerves, and vessels are well established, less is known about reproductive function. The authors reviewed the literature on diabetes and ovarian aging. They found that women with type 1 diabetes appear more likely to have ovarian dysfunction, manifested by delayed menses, menstrual irregularities, and possibly earlier menopause. Studies of women with type 2 diabetes are inconsistent but suggest increased anovulation and earlier menopause. The mechanisms are uncertain but women and their health professionals should be aware of the effects of diabetes on reproductive function.

Depression is more common in women than in men. The authors studied changes in negative mood and depressive symptoms over 20 years in women enrolled in the Melbourne Women’s Midlife Health Project. The study found that negative mood significantly declined across twenty years, as women transitioned from mid-life (50 years) to late-life (70 years). Depressive symptoms also significantly reduced for women between the ages of 60 years and 70 years. When the mean age of the women was 60 years 22.6% reported mild or moderate symptoms of depression compared to 15.5% of women with an average age of 70 years. Women should find these results reassuring.

  • Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use

    Pauliina Tuomikoski, Veikko Salomaa, Aki Havulinna, Juhani Airaksinen, Matti Ketonen, Heli Koukkunen, Olavi Ukkola, Y. Antero Kesäniemi, Heli Lyytinen, Olavi Ylikorkala, Tomi S. Mikkola
    Maturitas, Vol. 94

The effects of menopausal hormone therapy (MHT) on heart disease are debated. The researchers looked at the effect MHT on mortality in acute coronary syndrome (ACS) in Finnish women. They found that ACS death in MHT ever-users were smaller compared to non-users. Of women with MHT ever use, 42% died within one year as compared with 52% of non-users. Most deaths (84%) occurred within 28 days after ACS, and in this group 36% of women with ever use of MHT and 30% of women with ≥5 year MHT use died as compared to 43% of the non-users. Age ≤60 or >60 years at the time of MHT initiation was accompanied with similar reductions in ACS mortality risk. Health professionals and women should be aware of this new information when deciding whether to take MHT.

Populations are aging worldwide. Aging is a complex process that affects the majority of body systems resulting in a gradual loss of function that when significant translates into greater risk for health problems and disability in later life. Thus the overall burden of medical and social care is increasing. It is now widely acknowledged that multidisciplinary approaches are necessary to enhance health in later life. This special issue of Maturitas focuses on aging and anti-aging with an emphasis on understanding the process of aging, the implications of aging on disease and management to improve health and functioning in old age. Collectively, the articles included in this special issue of Maturitas address an exciting research area.

Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. Delirious patients have longer hospital stays as well as increased morbidity and mortality. Delirium has an overall prevalence of 15% among hospitalized older adults although this is considerably higher in certain patient populations, such as those undergoing major surgical procedures. Community prevalence is lower although prevalence in newly admitted nursing home residents is similar to hospital-based populations and estimated at around 16%. Delirium is frequently under-diagnosed and can go unrecognized in 32–66% of individuals. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. This useful review looks at managing risk factors to try and reduce delirium both in primary and secondary care.

On average, 30–40% of women aged in their 40s and 50s experience hot flushes and night sweats (vasomotor symptoms). Depending on frequency, duration and severity, these symptoms can have a major impact on a woman’s overall quality of life, productivity and social relations.

Between 20 and 40% of women in more economically developed countries have a hysterectomy by the time they are 60 years old, and this surgery remains one of the most common gynaecological procedures performed worldwide. While it is well known that removal of both ovaries at the time of hysterectomy often leads to severe vasomotor symptoms, the effect of hysterectomy with ovarian conservation is less clear.

This longitudinal study assessed the associations of menopausal symptom patterns in women with a hysterectomy with ovarian conservation (n = 1129) versus women without a hysterectomy (n = 4977) over 17 years.

The study found that women with a hysterectomy had twice the odds of experiencing persistent (i.e. constant) hot flushes and night sweats over an extended time period compared to women without a hysterectomy. Thus women who have a hysterectomy before the age of 50 years have a higher risk of experiencing both hot flushes and night sweats that persist for well over a decade. This higher risk was not explained by differences in lifestyle or socioeconomic factors.

In today's society, many women will be working throughout their menopausal transition. The researchers undertook a cross-sectional study comparingthe work ability of a sample of otherwise healthy employed Dutch women (n = 205) with that of a sample of first-time attendees of a menopause clinic (n = 60); both groups were aged 44–60 years. They found that over three-quarters of symptomatic menopausal women reported serious problems in dealing with the physical and mental demands of their work (recorded as low work ability); hence these women might be at risk of prolonged sickness absence from work.

The number of long term survivors of breast cancer has significantly increased thanks to therapeutic advances. For example five year survival rates are now estimated at 98% for patients with early-stage disease. However, the downside of these new therapeutic regimens is the increased incidence of late side effects, especially cardiotoxicity. Breast cancer treatment is currently focused on tumor characteristics. Unfortunately, there is still a lack of awareness for the need and possible benefits of cardiac monitoring. As most women with breast cancer are expected to survive their disease, new evidence-based surveillance strategies targeted to individual women’s risk of cardiovascular disease as well are needed to improve quality of life and long-term prognosis.

Medical tourism is a particular form of patient mobility, where patients travel across borders or to overseas destination to receive treatments including fertility, cosmetic, dental, transplantation and elective surgery. There has been much media coverage—of individual patients, of unusual places, of life-saving and life-changing treatments, and medical mishaps and the risks travellers face. The review concludes that the body of literature focusing on medical tourism as a trade in health services indicates that further research investigating levels of such trade is needed. Data on costs and benefits of medical tourism are rare and this limits accurate assessments of its effects to inform policy decision-making.

As populations are aging the health or retirees is of increasing importance. The authors looked at 21,608 Australians aged 55–69. They found that retirement is associated with physical dysfunction over time. Retirement is not associated with psychological distress among women, but retirement is associated with psychological distress among men who have a high level of physical dysfunction.

The authors examined if diabetes and duration of diabetes are direct or indirect causes of depression in later life. They studied 5462 men aged 70–89 years. Diabetes was associated with increased odds risk of ever and current depression (OR = 1.94, 95%CI = 1.15, 2.48). The association between duration of diabetes and risk of current depression was ‘J-shaped’. Frailty mediated some of the association between diabetes and depression, although other unmeasured factors are also likely to play a role. The introduction of strategies that are effective at decreasing diabetes-related complications may therefore also contribute to decrease the risk of depression among older men.

Large numbers of women transition through the menopause while in paid employment. Symptoms associated with menopause may cause difficulties for working women, especially if untreated, yet employers are practically silent on this potentially costly issue. This review summarises existing research on the underexplored topic of menopause in the workplace, and synthesises recommendations for employers. Principal recommendations for employers to best support menopausal women as part of a holistic approach to employee health and well-being include risk assessments to make suitable adjustments to the physical and psychosocial work environment, provision of information and support, and training for line managers.

Age-related macular degeneration (AMD) is a common condition. The authors investigated the independent association between AMD and risk of ischemic heart disease (IHD), stroke, and cardiovascular (CVD) mortality, and all-cause mortality over 15 years in 3654 Australians over the age of 49 at baseline. They found that late AMD independently predicted all-cause mortality in men and stroke mortality in women, over 15 years. Although underlying mechanisms are unclear, these findings indicate that late AMD is a marker of biological aging.

As the population ages, there are increasing numbers of people with dementia and they do not receive good quality palliative care, even though dementia is increasingly recognized to be a terminal condition. The authors review the literature and conclude that that we need to improve dementia care overall. It is an argument against the over-emphasis on early diagnosis. The care of people with dementia needs to cover the full course of the condition. Good quality, person-centred dementia care, which will include adequate liaison with end-of-life specialists when the time is right is needed.

  • Practice points in gynecardiology: Abnormal uterine bleeding in premenopausal women taking oral anticoagulant or antiplatelet therapy

    Angela H.E.M. Maas, Mia von Euler, Marlies Y. Bongers, Herbert J.A. Rolden, Janneke P.C. Grutters, Lian Ulrich, and others
    Maturitas, Vol. 82, Issue 4

A growing number of premenopausal women are currently using antithrombotic and/or (dual) antiplatelet therapy for various cardiovascular indications. These may induce or exacerbate abnormal uterine bleeding and more awareness and knowledge among prescribers is required. Heavy and irregular menstrual bleeding is common in women in their forties and may have a variety of underlying causes that require different treatment options. Thus using anticoagulants in premenopausal women demands specific expertise and close collaboration between cardiovascular physicians and gynecologists.

Cells, termed oogonial stem cells, have been isolated from adult rodent and human ovaries. The potential implications of oogonial stem cells for fertility maintenance, preservation and restoration are considerable. While these cells have generated follicles capable of producing healthy offspring in rodents, there is no evidence that they contribute to the primordial follicle pool under physiological conditions in humans. This review examines their interactions with ovarian somatic cells which will be important to understand their function, and therapeutic potential.

Eating disorders (EDs) are serious illnesses that can endanger the physical health and often the lives of sufferers and affect their psychosocial functioning. EDs are usually thought of as problems afflicting teenagers. However, the incidence in older women has increased in recent decades. These cases may represent either late-onset disease or, more likely, a continuation of a lifelong disorder. The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health. The main risk factors for developing long-term consequences are the degree of weight loss and the chronicity of the illness. Most of the cardiac, neurological, pulmonary, gastric, haematological and dermatological complications of EDs are reversible with weight restoration. EDs are serious illnesses and they should never be neglected or treated only as a manifestation of the fashion for dieting or a woman's wish to achieve an imposed standard feminine figure.

The health benefits of regular exercise are well recognised. However, in most clinical practices, midlife and older women patients are not offered specific exercise guidance Although most aging women know the benefits of engaging in a regular exercise program, many do not establish a regular routine. The authors provide simple guidelines on how women can commence an exercise routine which they can incorporate into their lifestyle.

Urinary incontinence has a detrimental impact on quality of life and overall health perception. Mishra and colleagues therefore examined the association of depressive symptoms with subsequent urinary incontinence symptoms among young women. Data were obtained from a cohort of 5391 young women (born 1973–1978) from the Australian Longitudinal Study on Women's Health. They found that women with depressive symptoms or a history of depression were more likely to report subsequent urinary incontinence. The authors therefore recommend that health professionals should consider a current or history of depression in women with urinary incontinence.

Hot flashes are common menopausal symptoms. Theoretically while vitamin D could improve hot flashes, calcium could make them worse. The Women's Health Initiative Calcium/Vitamin D Supplementation Trial (CaD), randomized women to elemental calcium carbonate 1000 mg with vitamin D 400 IU daily or placebo. There was no difference in menopause-related symptoms after mean follow up of 5.7 years in the 17,101 women randomized to CaD compared to the 17,056 women given placebo. Similarly, there was no difference between sleep disturbance, emotional well-being, or energy/fatigue at follow-up in those who were randomized to CaD supplementation compared to those taking the placebo.

Grandparents are popular childcare providers as they are less expensive than formal childcare. The aim of the study was to find out the effects on cognition in women aged between 65 and 75. The researchers found that minding grandchildren predicted higher cognitive performance overall; however, participants who minded grandchildren for more than one day per week performed worse than those who minded grandchildren for one day per week. Thus grandparents should not be overburdened.

  • EMAS position statement: The ten point guide to the integral management of menopausal health

    Manuel Neves-e-Castro, Martin Birkhauser, Goran Samsioe, Irene Lambrinoudaki, Santiago Palacios, Rafael Sanchez Borrego, Placido Llaneza, Iuliana Ceausu, Herman Depypere, C. Tamer Erel, Faustino R. Pérez-López, Karin Schenck-Gustafsson, Yvonne T. van der Schouw, Tommaso Simoncini, Florence Tremollieres, Margaret Rees
    Maturitas, Vol. 81, Issue 1

Whole body vibration (WBV) exercise has been promoted as a potentially safe, low-impact alternative to current, conventional modalities in non-compliant, exercise-intolerant or mobility-limited individuals. Application of the vibration modality to the whole body has been reported recently to improve muscle strength, power and velocity, and bone mineral density in sub-populations described as youthful, athletic, healthy and elderly. This review looked at the effects of WBV on balance or functional mobility outcomes in older adults. It found that although there is some evidence for an overall effect of WBV on selected balance and mobility measures, its impact remains inconclusive.

Whole body vibration (WBV) exercise has been promoted as a potentially safe, low-impact alternative to current, conventional modalities in non-compliant, exercise-intolerant or mobility-limited individuals. Application of the vibration modality to the whole body has been reported recently to improve muscle strength, power and velocity, and bone mineral density in sub-populations described as youthful, athletic, healthy and elderly. This review looked at the effects of WBV on balance or functional mobility outcomes in older adults. It found that although there is some evidence for an overall effect of WBV on selected balance and mobility measures, its impact remains inconclusive.

  • Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Effects on risk management decisions & outcome of risk-reducing salpingo-oophorectomy specimens

    Catheleine M.G. van Driel, Geertruida H. de Bock, Henriette J.G. Arts, Aisha S. Sie, Harry Hollema, Jan C. Oosterwijk, Marian J.E. Mourits
    Maturitas, Vol. 80, Issue 3

The authors examined clinical management protocols of women at increased risk for hereditary ovarian cancer referred to a family cancer clinic. Before October 1, 2009 women were offered an annual gynecological exam, transvaginal ultrasound and CA125 testing from the age of 35 years onwards or risk reducing salpingo-oophorectomy (RRSO) from the age of 35 to 40 years for BRCA1 mutation carriers and 40 to 45 years BRCA2 mutation carriers, given that they had completed their child-bearing. After October 1, 2009 the family cancer clinic stopped offering annual testing because of its proven ineffectiveness in reducing morbidity and mortality of ovarian cancer. The researchers found that after stopping annual testing the percentage of women who underwent RRSO within the recommended age range increased from 81 to 95%. This study shows to importance of regularly reviewing clinical protocols as some become obsolete with time.

Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative condition of the central nervous system that affects women up to three times more often than men. The clinical presentation typically involves a constellation of symptoms, with common deficits including optic neuritis, gait ataxia, limb weakness, paralysis, cognitive impairment and fatigue . The disease course often occurs in a relapsing remitting, primary progressive or secondary progressive manner. Low estrogen states such as menopause and the postpartum period favor exacerbations of multiple sclerosis in women with the disease. This review examines the current evidence that estrogen therapy can have a beneficial neuroprotective effect on MS which is very significant for postmenopausal women with the disease.

Female Genital Mutilation (FGM) comprises various procedures which remove or damage the external female genital organs for no medical reason. FGM has no health benefits and is recognised to cause severe short and long term damage to both physical and psychological health. Although FGM is primarily performed in Africa, Asia and the Middle East, migration of FGM practising communities means that the health complications of FGM will have a global impact. The review examines the gynecological, obstetric and psychological consequences of FGM.

Physical activity has been identified as a protective factor against a wide spectrum of diseases, but little is known about the link between older women's health and their professional involvement in sport in the past. This review looked at the available data concerning the influence of physical activity on morbidity and mortality in former female athletes. Physical activity reduces the risk of osteoporosis and is beneficial to the cardiovascular system. Also the risk of breast cancer is decreased. Professional sport, on the other hand, acts negatively on the pelvic floor and is a risk factor for urinary incontinence. In conclusion, regular moderate physical activity is an important health-promoting factor, but the role of professional sports training is still under debate. Many extreme sports can place great strain on women's bodies and can cause serious injuries and damage. Those women who were engaged in sports disciplines with high levels of physical contact have a higher mortality than women who practiced safer sports.

As populations are ageing, people are becoming even more aware and sensitive about their skin getting older and the effects on their appearance. Attention also needs to be drawn to the fact that the relative incidence of some dermatological conditions is age-dependent. In particular, dry skin, cutaneous malignancies and skin injuries are more common in older people. This review describes the functional consequences of skin ageing and discusses the current evidence on how skin health may be maintained and dermatological conditions prevented in an ageing population. It is essential to remember that skin care starts at an early age and use of skin protectors and avoidance behaviour should start in childhood.

This editorial introduces a special issue which explores some of the facets of depression, dementia and cognition in older people. These conditions are common and are amongst the leading cause of years lost due to disability worldwide. Depression affects 1 in every 10 persons older than 60 years and its presence has been associated with deteriorating physical health and function, greater service utilisation, and increased mortality. Available estimates suggest that 36 million people currently live with dementia, and this figure will double by 2030 and more than triple by 2050. The assessment, management and prevention of these conditions pose major challenges to governments, planners and the entire community. It is hoped that the readers of this special issue will notice that the assessment, management and prevention of depression and dementia have evolved over the past 10 years. What is even better is that both conditions continue to be actively researched in all parts of the globe.

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. There is increasing evidence that diet may have a significant role in the development of OAB symptoms. Whilst fluid in-take is known to affect lower urinary tract function the effects of smoking, caffeine, alcohol, vitamins, phytoestrogens, cranberry juice carbonated drinks and artificial sweeteners are less well understood. The authors review the often conflicting evidence and this is a must read before considering pharmacological therapy.

Low back pain is a common symptom in older people. Whilst most cases are thought to be mechanical or idiopathic and benign in nature, its multiple potential causes and concerns regarding missed diagnosis of less common but more serious underlying pathological diagnoses mean many physicians find the assessment, investigation and treatment of chronic low back pain in older adults challenging. This elegant review is a ‘must read’ for all health professionals dealing with older people. It describes the classification of low back pain in older adults, discusses both mechanical and sinister causes of pain, highlights the appropriate use of medical imaging and provides an overview of surgical and non-surgical management.

Osteoarthritis (OA) is the most common form of degenerative joint disease and a major cause of pain and disability. However there are no pharmacological therapies that can restore cartilage. The authors review the status of chondrocyte and mesenchymal stem cell-based therapies. Autologous chondrocyte implantation (ACI) has been used for over two decades. Although chondrocyte-based therapy has the capacity to slow down the progression of OA and delay partial or total joint replacement surgery, currently used procedures are associated with the risk of serious adverse events. Complications of ACI include hypertrophy, disturbed fusion, delamination, and graft failure. Mesenchymal stem cells show promise for use in repairing and rebuilding cartilage. However many hurdles and technical challenges need to be overcome before they can be used in clinical practice.

Working years increasingly extend into the late 60s and may soon include the 70s for some people. Thus the authors examined whether work stress has a cumulative effect in older age, and whether older employees are more vulnerable to certain sources of work stress, such as bullying in the work place, is becoming increasingly relevant. They found that unfavourable working conditions during mid-life and later in life have a negative effect on mental health and cognition in late life. Although bullying increases the incidence of psychiatric illness, such as depression, and post-traumatic stress disorder, older workers may have developed some resilience to the pressures of work stress, including bullying, from their experience and expertise in the workforce. Age-related workplace bullying should be addressed by employers, social workers, human resource administrations, policy makers, and informed by scientific research, for this is a valuable group of individuals who bring numerous strengths to the workforce.

Managing menopausal symptoms following breast cancer treatment is a complex issue. The authors examined the use of cognitive behaviour therapy (CBT). They found that CBT was effective at reducing problem rating at 9 weeks regardless of age, BMI, time since breast cancer diagnosis, menopausal status at time of diagnosis, or type of cancer treatment (radiotherapy or chemotherapy or endocrine treatment). The treatment effect was significantly greater in women not receiving chemotherapy, those with higher levels of psychological distress at baseline and for non-white women. Beliefs about control/coping with hot flushes were the main mediators of improvement in problem rating following CBT. This study suggests that CBT is widely applicable for breast cancer patients who are experiencing treatment related menopausal symptoms, and that CBT works mainly by changing beliefs and improving mood and sleep.

Informal (unpaid) care for older people or those with disability is an increasing feature of modern society. Most carers are middle aged women who then have to juggle caring with the rest of their lives. Not surprisingly this type of care provision is known to lead to high rates of depression, anxiety, hopelessness and poor physical health in the carers. This Australian study looked at the proportion of female carers who experience death thoughts and the factors associated with these thoughts. They found that nearly one in 10 women felt life was not worth living for compared to one in 20 non-carers. This increases the body of evidence that informal carers need support and service providers need to address this issue urgently.

Vitamin supplements are popular, however their use needs to be evidence-based. This minireview looks at the use of vitamin K. The authors conclude that there is not enough data to support a role for vitamin K supplementation in osteoporosis prevention among healthy, postmenopausal women taking calcium and vitamin D. There is inadequate data on the role of vitamin K on cardiovascular health and gynecological cancers and further research is required.

Depression is common in older adults, affecting up to 9.3% of those over 75 years. This review examines the efficacy and side effects of selective serotonin reuptake inhibitors (SSRIs) in older people. The authors conclude that there is not enough evidence to conclude that SSRIs can achieve remission of depression in elderly patients. However, a growing body of evidence supporting the notion that SSRIs are the treatment of choice in elderly depressed patients. But their use should be closely monitored in view of the side effects of SSRIs such as cardiotoxicity, electrolyte disturbances and predisposition to gastrointestinal bleeding and to falls and fractures.

The goal of regenerative medicine is to repair, replace, or regenerate diseased tissues/organs in order to restore normal function. The field of regenerative medicine encompasses various technologies that range from tissue engineering to cloning. This review explains the various technologies and their application totissues of the reproductive system including the vagina, the uterine cervix, the uterus, and the ovary.

The authors conclude that regenerative medicine holds immense promise for the treatment or cure of a variety of diseases of the reproductive system, and it is hoped that in no distant future the clinical translation of novel technologies in this emerging field of medicine will become a reality.

This is a 5-year interim analysis of a 10-year, prospective, observational study investigating the incidence of breast cancer in women presenting with symptoms of hormone deficiency treated with subcutaneous testosterone (T) implants or, T combined with the aromatase inhibitor anastrozole (A), i.e., T+A implants. Breast cancer incidence was compared with that of historical controls reported in the literature, age specific Surveillance Epidemiology and End Results (SEER) incidence rates, and a representative, similar age group of our patients used as a ‘control’ group. The authors found that T and/or T+A, delivered subcutaneously as a pellet implant, reduced the incidence of breast cancer in pre and postmenopausal women.

In this timely review, Sanaz Ghazal and Lubna Pal assess the way in which the WHI trials have impacted on the way menopause hormone therapy (MHT) is now approached. They detail who should be prescribed, when it should be given and what should be recommended. Thus the who are healthy and chronologically young perimenopausal and early menopausal women, the when is within 10 years of onset of menopause and the what are lower dose regimens preferentially utilizing a transdermal approach for estrogen delivery and cyclic progestin exposure, preferentially using natural progesterone for endometrial protection. Importantly they add that the choice of treatment modality for the management of menopausal symptoms should be guided by the severity of symptoms, the unique patient risk profile based on co-morbid conditions, her personal and family history, and by patient preference. For women deemed at risk for MHT related adverse effects or those reluctant to pursue a MHT regimen for symptom control other options can be pursued.

In order to make informed decisions, health care practitioners, public health professionals and policy makers rely on evidence from clinical research. It is therefore important that such evidence is made available in an easily accessible and unbiased way. OPEN, a European Union funded project, is a 24-month project, running from November 2011 to October 2013. It is an interdisciplinary initiative that brings together academics and key stakeholders from across Europe who aim to develop evidence-informed recommendations and strategies which focus on overcoming the failure to publish negative research findings. The editorial summarises the project's progress and directions.

Cancer incidence increases with advancing age. Over 60% of new cancers and 70% of cancer deaths occur in individuals aged 65 years or older. One factor that may contribute to this is immunosenescence – a term that is used to describe age-related declines in the normal functioning of the immune system. There is consensus that habitual physical exercise can offer protection against certain types of cancer; however the evidence linking immunological mechanisms, exercise, and reduced cancer risk remain tentative. The authors detail the pathways and propose a pathway by which exercise-induced alterations in immunosenescence may decrease the incidence of cancer and help improve prognosis in cancer patients.

  • Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013

    J. Compston, C. Bowring, A. Cooper, C. Cooper, C. Davies, R. Francis, J.A. Kanis, D. Marsh, E.V. McCloskey, D.M. Reid, P. Selby
    Maturitas, Vol. 75, Issue 4

Since the launch in 2008 by the National Osteoporosis Guideline Group (NOGG) of guidance for the diagnosis and management of osteoporosis in postmenopausal women and older men in the UK there have been significant advances in risk assessment and treatment. These have been incorporated into an updated version of the guideline, with an additional focus on the management of glucocorticoid-induced osteoporosis, the role of calcium and vitamin D therapy and the benefits and risks of long-term bisphosphonate therapy. This update, like its predecessor, will be of significaant use to all health professionals dealing with osteoporosis.

This study examined the relation between early age at natural menopause and mortality in African American women. Data were obtained from the Black Women's Health Study, a follow-up study of African-American women enrolled in 1995. Of 692 deaths identified during 91,829 person years of follow-up, 261 were due to cancer, 199 to cardiovascular diseases and 232 to other causes. The authors found that natural menopause before age 40 was associated with all-cause mortality and cause-specific mortality such as cancer and cardiovascular disease. The association was stronger among women who had never used postmenopausal female hormones. The associations were apparent among both smokers and nonsmokers but appeared stronger in smokers.

Worldwide 350 million men are aged over 60. This review explores lifestyle predictors of healthy ageing in men. It shows that not only do men with healthy lifestyles survive longer, but also with good health. Disability is postponed and compressed into fewer years at the end of life. Furthermore physical activity and smoking in midlife and late adulthood impact and predict healthy ageing in men. Thus adoption of healthier lifestyles could postpone age associated diseases and/or slow down the ageing process. Consequently, this allows men to live independently for a longer period of time reducing the burden on social and health care sectors.

As coffee is enjoyed worldwide, with global consumption reaching 7 million tons per year, this review looks at its impact on health. There is a significant impact of coffee on the cardiovascular system, and carbohydrate and lipid metabolism. Contrary to previous beliefs, arrhythmias or heart failure seem unaffected by coffee intake. Coffee is associated with a reduction in the incidence of diabetes and liver disease. Protection seems to exist also for Parkinson's disease, while its potential as an osteoporosis risk factor is under debate. Its effect on cancer risk depends on the tissue concerned, although it appears to favor risk reduction. Finally coffee consumption seems to reduce mortality. So overall this is good news for a beverage that has been consumed for many centuries.

The anorexia of ageing or loss of appetite in the elderly is associated with comorbidity and represents a predictive factor for mortality. Anorexia is very prevalent among hospitalized and institutionalized elderly people, affecting about a third. No treatment for it has been proved to be effective. The authors of this review conclude that environmental factors (such as isolation), sensory alterations, poor oral hygiene and polypharmacy are potential targets for interventions aimed at improving ingestion and reducing the risk of malnutrition in elderly people. Research into the treatment of the anorexia of ageing should not focus exclusively on the search for yet another drug to stimulate appetite, in order to add it to the existing long list of treatments of elderly patients. Rather, it should focus on an integrated geriatric assessment, including a nutritional evaluation.

  • InterLACE: A new International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events

    Gita D. Mishra, Debra Anderson, Danielle A.J.M. Schoenaker, Hans-Olov Adami, Nancy E. Avis, Daniel Brown, Fiona Bruinsma, Eric Brunner, Janet E. Cade, Sybil L. Crawford, Annette J. Dobson, Jane Elliott, Graham G. Giles, Ellen B. Gold, Kunihiko Hayashi, Diana Kuh, Kathryn A. Lee, Jung Su Lee, Melissa K. Melby, Hideki Mizunuma, Lynette L. Sievert, Elisabete Weiderpass
    Maturitas, Vol. 74, Issue 3

Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. The recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease (InterLACE) aims to advance the evidence base for women's health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. It draws on individual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of women's health in seven countries. This research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk.

Age–related loss of muscle mass, or sarcopenia, and obesity have a growing impact on healthy life expectancy and health care costs in developed nations. Sarcopenia is commonly exacerbated in overweight and obese individuals. Progression towards obesity promotes an increase in fat mass and a concomitant decrease in muscle mass, producing an unfavourable ratio of fat to muscle. The coexistence of diminished muscle mass and increased fat mass (so-called ‘sarcobesity’) is ultimately manifested by impaired mobility and/or development of life-style-related diseases. Thus, the critical health issue for a large proportion of adults in developed nations is how to lose fat mass while preserving muscle mass. The authors conclude that current evidence strongly supports the inclusion of resistance and aerobic exercise to complement mild energy-restricted high-protein diets for healthy weight loss as a primary intervention for sarcobesity.

By 2050 the number of people with dementia will globally increase by three times affecting 115.4 million people. The anticipated prevalence and the economic impact of dementia care is significant, nevertheless, few countries have a national agenda for its treatment or management. There is a pressing need for innovative research that will enhance quality care for people with dementia, decrease caregiver burden and reduce care costs. Research in the area of social robots, such as robotic dogs, is in the initial stages of determining if their use can assist the elderly living with dementia. After review of the literature the authors concluded that social assistive robots may provide important and feasible alternatives to some of the care demands. However, these alternatives must be balanced with cautions to provide quality human contact in dementia care.

Tea leaves contain varying amounts of polyphenols of which the majority are catechins. There has been a sizable amount of research on the potential effect of green tea catechins for cancer risk, cardiovascular disease risk and weight loss; all conditions that are relevant to mid-life health. The authors reviewed the evidence for green tea for these three important health conditions. They conclude that the evidence for green tea and cancer risk is inadequate and inconclusive. However there is some positive evidence for risk reduction of breast, prostate, ovarian and endometrial cancers with green tea. Randomized controlled trials of green tea and cardiovascular risk factors suggest that green tea may reduce low-density lipoproteins and total cholesterol, although studies are of short duration. There is no robust evidence to support a reduction in coronary artery disease risk in green tea drinkers. There are a considerable number of randomised trials to suggest that green tea does reduce body weight in the short term, but this not likely to be of clinical relevance.

Breast cancer screening is a controversial issue as there are concerns about overdiagnosis. The authors put forward the case for individualized screening tailored to a woman's individual risk and involving women in shared decision making. The principles of individualized screening are (a) to start from the age at which the breast cancer risk is equal to that for an average woman aged 50 years, (b) to stop when the risk of co-mortality exceeds the risk of breast cancer mortality, (c) to adapt examination frequency and the imaging modalities to individual risk and breast density, (d) to reassess regularly and individually the screening strategy, and (e) to discuss honestly with each woman in order to help her to decide if she participates or not.

  • The quantification of vitamin D receptors in coronary arteries and their association with atherosclerosis

    Peter F. Schnatz, Matthew Nudy, David M. O'Sullivan, Xuezhi Jiang, J. Mark Cline, Jay R. Kaplan, Thomas B. Clarkson, Susan E. Appt
    Maturitas, Vol. 73, Issue 2

The activated vitamin D receptor (VDR) may have an important role in vascular health. The objective of this study was to determine whether there is an association between the expression of VDRs in coronary arteries and the extent of diet-induced atherosclerosis in female monkeys. The authors found that lower concentrations of VDRs in a main coronary artery were associated with greater atherosclerotic plaque size. Therefore studies to examine the role of vitamin D receptors in coronary artery health in women are warranted.