Daily Archives: 6 July 2024

Strategies to Tackle Homelessness Among Older Adults

Homelessness affects not only young people but also a growing number of older adults, as highlighted in an analysis in CMAJ (Canadian Medical Association Journal). Visible signs of ageing are often evident at younger ages among individuals experiencing homelessness compared to those with stable housing. This population frequently suffers from earlier onset of chronic medical conditions and age-related issues like cognitive impairment.

The risk of premature death among older homeless individuals is notably higher—3.5 times greater than their housed counterparts, particularly for those experiencing homelessness for the first time later in life. In 2021, 32% of individuals in Canadian shelters were aged 50 and older, with many others living outdoors or temporarily with friends or family.

Dr. Jillian Alston, a geriatrician at St. Michael’s Hospital, Unity Health Toronto, and her coauthors stress the need for shelter policies and government strategies tailored to the care needs of older adults experiencing homelessness. They advocate for age-friendly shelters with appropriate physical environments, adequate staffing, and access to essential medical services. These individuals often face substantial marginalization, dehumanization, and structural violence, necessitating care models focused on building trust, establishing rapport, and ensuring personal safety.

It is crucial to provide housing that meets individual needs to support older adults at risk or experiencing homelessness. Conditions like cognitive impairment and mobility issues, common with ageing, can challenge housing stability. Preventive measures include tenancy monitoring programs, personalized in-home supports, and community initiatives addressing social isolation. Health care programs within shelters, such as primary care and geriatric outreach services, play a vital role in supporting older adults.

Innovative housing solutions, such as The Oaks in Ottawa, demonstrate effective models for permanent supportive housing that accommodate ageing. Long-term care homes may provide the most suitable environment for some individuals to address their complex needs.

Addressing this pressing issue requires collaborative efforts across health care, long-term care, public health, housing sectors, and community support. Trauma-informed approaches are essential for individuals who have experienced adversity and trauma earlier in their lives.

Dr Andrew Boozary, Dr Catherine Varner, and Dr Andreas Laupacis emphasize the profound human toll of homelessness in their editorial. Chronically unhoused individuals have significantly shorter lifespans, experience accelerated ageing, and develop multiple health conditions at younger ages compared to their housed counterparts. Homelessness disproportionately affects Indigenous, Black, refugee, newcomer, and 2SLGBTQ+ communities.

To combat this crisis, some health networks are pioneering initiatives to build affordable housing for unhoused individuals, underscoring the urgency and scale of the homelessness problem. Hospitals redirect resources towards housing initiatives, highlighting the inadequacies and high costs associated with conventional approaches such as lengthy hospital admissions.

Urgent action is needed to address the marginalization and health disparities faced by older adults experiencing homelessness. Comprehensive strategies must encompass housing stability, tailored healthcare interventions, and community support systems to ensure dignified and sustainable solutions for this vulnerable population.

More information: Jillian Alston et al, Tackling late-life homelessness in Canada, Canadian Medical Association Journal. DOI: 10.1503/cmaj.231493

Journal information: Canadian Medical Association Journal

Enhancing Weight Loss Outcomes in Primary Care Clinics Through Obesity Specialist Integration

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In a recent University of Michigan study published in JAMA Network Open, researchers found that integrating obesity specialists into primary care clinics significantly enhanced weight loss outcomes for high-risk patients. The study focused on patients who had access to the collaborative Weight Navigation Program (WNP), designed to provide individualized obesity treatment plans through a team effort between patients, primary care providers, and board-certified obesity specialists.

Traditionally, primary care clinicians struggle to develop comprehensive weight-management plans during short clinic visits. Previous research highlighted that many patients with obesity fail to achieve the recommended 5% reduction in body weight, which can mitigate obesity-related health risks. Recognising this gap, Michigan Medicine launched the WNP in 2020, aiming to bridge this divide by integrating specialist expertise within routine primary care settings.

The study’s findings were compelling: over a year, participants in the WNP experienced an average weight loss of approximately 12 pounds, equivalent to about 4.4% of their initial body weight. In contrast, patients receiving standard care at similar clinics without the WNP showed minimal weight loss. More than 40% of WNP participants achieved the 5% weight loss goal, compared to less than 20% of their counterparts in standard care. Additionally, 22% of WNP patients achieved at least a 10% reduction in body weight, significantly higher than the less than 4% in the comparison group.

The success of the WNP underscores its potential as a scalable model for improving obesity care in primary care settings, offering a beacon of hope for the future. The programme is now accessible to eligible adult patients across U-M Health clinics, offering a gateway to various specialised weight management interventions. Dr. Dina Hafez Griauzde, the study’s lead author, emphasised the WNP’s collaborative approach, where obesity specialists work alongside primary care providers to tailor treatment plans that consider medical conditions, financial constraints, and patient preferences.

Moreover, the study highlighted disparities in referral rates for advanced obesity treatments between WNP participants and those in standard care. WNP patients were twice as likely to be referred for evaluations for bariatric surgery, reflecting a proactive approach to comprehensive obesity management within primary care. They were more frequently directed to specialised weight loss programmes, such as those focusing on low-calorie meal replacements or Mediterranean-style diets. Additionally, a notable proportion of WNP patients received prescriptions for obesity medications, further reinforcing the effectiveness of the program.

However, the study’s scope predates recent advancements in obesity pharmacotherapy, such as semaglutide and tirzepatide, approved by the FDA for weight management. Future research must evaluate how these newer treatments influence weight loss outcomes within integrated care models like the WNP. The findings underscore the potential of collaborative obesity care models to address the growing obesity epidemic by leveraging existing primary care infrastructure and specialist expertise effectively.

The University of Michigan’s Weight Navigation Program represents a promising paradigm for enhancing obesity management in primary care. By integrating obesity specialists into routine clinical practice, the programme facilitated weight loss and improved access to specialised treatments. Expanding such integrated care models could play a crucial role in improving health outcomes for individuals struggling with obesity-related conditions.

More information: Dina H. Griauzde et al, A Primary Care–Based Weight Navigation Program, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.12192

Journal information: JAMA Network Open Provided by Michigan Medicine – University of Michigan

Vitamin B12’s role in cellular reprogramming and tissue regeneration

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Vitamin B12 is a well-known micronutrient vital for nerve function, red blood cell production, and DNA synthesis. Recently, Dr. Manuel Serrano and his team at IRB Barcelona have highlighted its additional role in cellular reprogramming and tissue regeneration, as reported in Nature Metabolism.

Their research focused on cellular reprogramming, mimicking early tissue repair stages. They discovered that this process in mice requires substantial amounts of vitamin B12. Surprisingly, even with B12 naturally abundant in mouse diets, its supplementation significantly boosted reprogramming efficiency, indicating its critical role.

The study also explored ulcerative colitis, finding similarities between repair-initiating intestinal cells and reprogramming processes, benefiting from vitamin B12 supplementation. This suggests potential therapeutic benefits for patients with intestinal bowel diseases through improved nutrition.

Dr. Manuel Serrano underscores the findings’ significance for regenerative medicine, emphasizing vitamin B12’s role in enhancing cellular reprogramming and tissue repair.

The researchers delved into cellular reprogramming’s metabolic demands, identifying vitamin B12 as crucial for methylation reactions vital in DNA function during reprogramming and repair. Insufficient B12 led to significant epigenetic changes, impacting gene function. Supplementation corrected this, enhancing gene fidelity and reprogramming efficiency.

Dr Marta Kovatcheva, the study’s lead author and future head of a Milan-based laboratory at IFOM, highlights vitamin B12’s corrective role in maintaining gene function fidelity during reprogramming.

In collaboration with Dr Rosa Lamuela-Raventós and Dr Ramon Estruch, a separate study by Dr Serrano’s team explored vitamin B12’s anti-inflammatory potential. Higher blood B12 levels correlated with lower inflammatory markers in humans and aged mice, suggesting B12’s role in reducing inflammation and its potential health benefits.

These findings underscore vitamin B12’s multifaceted role—from cellular reprogramming facilitation to anti-inflammatory action—promising advancements in regenerative medicine and potential therapeutic strategies for inflammatory conditions.

More information: Marta Kovatcheva et al, Vitamin B12 is a limiting factor for induced cellular plasticity and tissue repair, Nature Metabolism. DOI: 10.1038/s42255-023-00916-6

Journal information: Nature Metabolism Provided by IRB Barcelona – Institute for Research in Biomedicine

Rapid Impact on Immune System: Transitioning to Vegan or Ketogenic Diets

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Researchers at the National Institutes of Health have identified rapid and distinct changes in the immune systems of individuals who transitioned to either a vegan or ketogenic (keto) diet. Conducted at the NIH Clinical Center’s Metabolic Clinical Research Unit, the study closely monitored biological responses in participants as they sequentially adopted vegan and keto diets for two-week periods. The findings revealed that the vegan diet stimulated responses associated with innate immunity—our body’s initial non-specific defence against pathogens—while the keto diet triggered responses linked to adaptive immunity, which develops specificity through exposure and vaccination.

In addition to immune responses, the study observed significant metabolic changes and shifts in the participants’ gut microbiomes, the communities of bacteria residing in the digestive tract. These findings underscore the potential impacts of dietary choices on health outcomes, particularly in conditions such as cancer and inflammatory diseases. However, further research is essential to determine whether these observed changes are beneficial or detrimental in the context of nutritional interventions.

Scientific understanding of how diets influence the human immune system and microbiome remains limited, particularly regarding therapeutic nutritional interventions to improve health outcomes. Comparisons between diets are scarce, with the keto diet characterized by low carbohydrate intake and high fat content. In contrast, the vegan diet excludes animal products and is typically high in fibre and low in fat.

The study, conducted by researchers from the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), involved 20 diverse participants in terms of ethnicity, race, gender, body mass index (BMI), and age. Each participant consumed ad libitum quantities of one diet (vegan or keto) for two weeks, followed by another for two weeks in a random order. Throughout the study, comprehensive analyses of blood, urine, and stool samples were conducted to assess biochemical, cellular, metabolic, and immune responses and microbiome changes.

Both diets induced notable changes across all participants. The vegan diet prominently affected pathways associated with innate immunity, particularly antiviral responses. Conversely, the keto diet triggered significant increases in biochemical and cellular processes linked to adaptive immunity, including pathways involving T and B cells. Furthermore, the keto diet influenced a broader range of proteins in the blood plasma and tissues compared to the vegan diet. It also impacted amino acid metabolism differently, reflecting this dietary approach’s higher protein content characteristic.

Beyond immune responses, both diets caused shifts in the participants’ gut microbiomes, altering the abundance of bacterial species associated with each diet type. The vegan diet notably influenced pathways related to red blood cells and heme metabolism, possibly due to its higher iron content. These findings highlight the interconnectedness of diet with metabolic and immune pathways, illustrating how dietary changes can impact multiple physiological systems in a relatively short period.

The study’s findings emphasize the rapid and interconnected nature of the body’s response to dietary interventions. Despite the diversity among participants, consistent and significant changes were observed across various physiological pathways. This underscores the potential for tailored dietary interventions to empower individuals to influence disease prevention and complement existing treatments for conditions such as cancer and neurodegenerative disorders.

In conclusion, while the study provides valuable insights into how vegan and keto diets affect immune responses, metabolism, and microbiomes, it also highlights the ongoing need for further research. Understanding the precise mechanisms underlying dietary impacts on health is a collective endeavour that can pave the way for more targeted nutritional strategies to improve overall well-being and manage chronic diseases effectively.

More information: Verena M. Link et al, Differential peripheral immune signatures elicited by vegan versus ketogenic diets in humans, Nature Medicine. DOI: 10.1038/s41591-023-02761-2

Journal information: Nature Medicine Provided by National Institutes of Health / National Institute of Allergy and Infectious Diseases