Have you ever noticed that people have thinner arms and legs as they get older? As we age it becomes harder to keep our muscles healthy. They get smaller, which decreases strength and increases the likelihood of falls and fractures. New research is showing how this happens — and what to do about it.
A team of Nottingham researchers has already shown that when older people eat, they cannot make muscle as fast as the young. Now they've found that the suppression of muscle breakdown, which also happens during feeding, is blunted with age.
The scientists and doctors at The University of Nottingham Schools of Graduate Entry Medicine and Biomedical Sciences believe that a 'double whammy' affects people aged over 65. However the team think that weight training may "rejuvenate" muscle blood flow and help retain muscle for older people.
These results may explain the ongoing loss of muscle in older people: when they eat they don't build enough muscle with the protein in food; also, the insulin (a hormone released during a meal) fails to shut down the muscle breakdown that rises between meals and overnight. Normally, in young people, insulin acts to slow muscle breakdown. Common to these problems may be a failure to deliver nutrients and hormones to muscle because of a poorer blood supply.
Research just published in the American Journal of Clinical Nutrition compared one group of people in their late 60s to a group of 25-year-olds, with equal numbers of men and women. Professor Rennie said "We studied our subjects first — before breakfast — and then after giving them a small amount of insulin to raise the hormone to what they would be if they had eaten breakfast, of a bowl of cornflakes or a croissant."
"We tagged one of the amino acids (from which proteins are made) so that we could discover how much protein in leg muscle was being broken down. We then compared how much amino acid was delivered to the leg and how much was leaving it, by analysing blood in the two situations.
"The results were clear. The younger people's muscles were able to use insulin we gave to stop the muscle breakdown, which had increased during the night. The muscles in the older people could not."
"In the course of our tests, we also noticed that the blood flow in the leg was greater in the younger people than the older ones," added Professor Rennie. "This set us thinking: maybe the rate of supply of nutrients and hormones is lower in the older people? This could explain the wasting we see."
Following this up Beth Phillips, a PhD student working with Professor Rennie, confirmed the blunting effect of age on leg blood flow after feeding, with and without exercise. The team predicted that weight training would reduce this blunting. "Indeed, she found that three sessions a week over 20 weeks 'rejuvenated' the leg blood flow responses of the older people. They became identical to those in the young," said Professor Rennie.
"I am extremely pleased with progress," he said. "Our team is making good headway in finding more and more out about what causes the loss of muscle with age. It looks like we have good clues about how to lessen it with weight training and possibly other ways to increase blood flow."
Health staff and relatives underestimate chronic pain experienced by nursing home residents
Researchers call for more education and greater awareness of strategies that don't involve drugs
Relatives and healthcare staff find it hard to diagnose pain levels in nursing home residents accurately, especially if they are cognitively impaired with illnesses such as dementia or unable to speak, according to a study in September issue of the Journal of Clinical Nursing.
The findings have led experts from The Netherlands to call for nurses to be given more education about how to assess and treat chronic pain. They would also like to see relatives being given more information about pain and for both parties to use other methods, like encouraging greater mobility and providing soothing massages, to alleviate pain.
"When the team interviewed the residents without cognitive impairments they found that all of them reported pain in the last week, but that only 89 per cent of the caregivers and 67 per cent of the relatives were aware of that pain" says Dr Rhodee van Herk. "However, if they were aware that the patient had experienced pain, the nurses and relatives gave it a median score of six out of ten, with the same score reported by the patients."
In general, there was more agreement between residents and relatives on pain levels than between relatives and nurses. The only exception was pain at rest in the impaired group, when relatives and nurses were in greater agreement.
"Our study shows that nurses and relatives find it hard to accurately assess pain in nursing home residents, especially if the resident has a cognitive impairment, such as dementia, or is unable to speak" concludes Dr van Herk.
"Pain seemed to differ, not only on an individual basis but also in different daily situations. It is clear that pain at rest is a particular issue that needs addressing as residents rated this much higher than caregivers and relatives.
""We are also keen to ensure that relatives receive more information on chronic pain and that both relatives and nurses explore pain relief methods that don't always rely on drugs.
"These can include massage, applying warmth, encouraging residents to be more mobile and distractions such as music and storytelling."
