FOR THE PRESS
Annals of Internal Medicine Tip Sheet
September 27, 2016
Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
1. Regular exercise helps seniors maintain mobility and independence
Elderly patients who participated in a structured exercise program reduced the amount of time spent suffering from major disability by 25 percent compared to their peers who did not. The findings suggest that adopting a regular routine of moderate physical activity, such as walking, helps seniors recover quicker after suffering a disability and maintain independence over time. Data from a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) study are published in Annals of Internal Medicine.
Research has shown that older adults often transition between states of independence and disability over time. Seniors who suffer a mobility disability are less likely to remain independent and have higher rates of morbidity, mortality, and diminished quality of life, among other negative effects. Therefore, it is an important goal of clinical medicine and public health to reduce the burden of major mobility disability on older adults.
The LIFE study compared the effects of a structured physical activity program to a health education program on more than 1,600 adults between the ages 70 and 89 who had been sedentary but were able to walk at least a quarter of a mile unassisted. Seniors in the exercise group mainly walked, and also performed some strength, flexibility, and balance training exercises. Over 3.5 years, participants in both groups were assessed for major mobility disability. Compared to the health education group, exercisers were less likely to experience disability in the first place, more likely to recover if they did suffer a disability, and were less likely to have a subsequent disability episode.
According to the authors of an accompanying editorial, these data add to the growing literature on the benefits of physical activity, especially for vulnerable populations. The authors suggest that prescribing exercise may be more important than prescribing medications, in some cases. Medical schools and health systems should give clinicians the training, tools, and support they need to address inactivity as they would any other health risk.
2. Cancer prevention benefits of colonoscopy may diminish after age 75
Colonoscopy screening is modestly effective for preventing colorectal cancer in patients aged 70 to 74, but the cancer prevention benefits may begin to diminish in older patients. The results of a prospective observational study are published in Annals of Internal Medicine.
Currently, no randomized, controlled trials of screening colonoscopy have been completed and ongoing trials exclude persons aged 75 or older. While screening guidelines from the U.S. Preventive Services Task Force recommend screening with any method, including colonoscopy, from age 50 to 75, Medicare reimburses colonoscopy with no upper age limit. Given that colonoscopy is invasive, expensive, and has potential for risks, it is important to understand the balance of benefits and harms in older patients.
Researchers reviewed a random sample of more than 1.3 million average-risk Medicare beneficiaries (2004 to 2012) aged 70 to 79 to evaluate the effectiveness and safety of colonoscopy to prevent colorectal cancer. Looking at data by age group (70 to 74 and 75 to 79), the researchers found that colonoscopy reduced the 8-year risk of colorectal cancer from approximately 2.6 percent to 2.2 percent in the younger group and from 3.0 percent to 2.8 percent in the older age group. The excess risk for serious adverse events after colonoscopy was small in both groups. Patients, physicians, and policymakers may want to consider these findings when making decisions about colorectal cancer screening, especially in upper age groups.
Also new in this issue:
A Call for a Patient-Centered Response to Legalized Assisted Dying
Stuart J. Youngner, MD, and John Frye, MA
Ideas and Opinions
The Annals of Medical Assistance in Dying
Catherine Frazee, DLitt, LLD, and Harvey Max Chochinov, MD, PhD
Ideas and Opinions