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The approach of remote care enhanced therapy adherence and engagement among patients with type 2 diabetes

A recent study by researchers from Mass General Brigham has shown that a remote team dedicated to identifying, educating, and prescribing therapy can significantly enhance adherence to guideline-directed medical therapy (GDMT) in patients with type 2 diabetes who are also at high risk for cardiovascular and kidney complications. The study found that patients who received education concurrently with medication management had a higher uptake of medications and started treatment earlier than those who were educated about two months before beginning medication management. These findings were presented at the 2024 American College of Cardiology’s Annual Scientific Session and published in Circulation.

Dr. Alexander J. Blood, MD, MSc, the corresponding author who presented these findings, emphasized the effectiveness of simultaneous education and treatment. Dr Blood, who is an attending physician in the Division of Cardiovascular Medicine and the Heart and Vascular Center at Brigham and Women’s Hospital—part of the founding network of the Mass General Brigham healthcare system—advocated for initiating treatment promptly when a patient shows readiness to invest in their health, suggesting that providers should capitalize on the patient’s immediate interest.

Type 2 diabetes is a prevalent condition in the United States that heightens the risk of severe cardiovascular and kidney events. Despite the potential benefits of medications like SGLT2 inhibitors and GLP-1 receptor agonists in improving outcomes for these patients, widespread adoption remains limited. Clinical trials and societal recommendations have not sufficiently translated into broad clinical practice.

The study involved a parallel, randomized, open-label clinical trial funded by the Novo Nordisk Foundation. It enrolled 200 adult patients with type 2 diabetes at elevated risk for cardiac and kidney issues at Mass General Brigham. Participants were randomly assigned to either an “education-first” group, which received two months of dedicated educational content through patient-centric videos on disease management and medication before starting treatment, or a “simultaneous” group, which received the same academic resources concurrently with treatment initiation.

Both groups were managed using a research and clinical care management platform developed by the Accelerator for Clinical Transformation at Brigham and Women’s Hospital and Mass General Brigham. This platform supported coordinated care delivery involving patient navigators, pharmacists, nurse practitioners, and physicians, thus facilitating comprehensive patient engagement and streamlined communication. This system is integral to Mass General Brigham’s efforts to transform healthcare delivery. It allows patients to access services and monitor their health from home, which is particularly vital when hospitals are often over capacity.

Over a six-month follow-up period or one-month post-medication initiation, if longer, results showed notable benefits like weight loss and reduced blood glucose levels in both groups. However, the simultaneous education group demonstrated superior medication retention rates, with 60 per cent adherence compared to 44 per cent in the education-first group. Interestingly, the education-first group’s engagement with the educational platform was lower than initially expected.

The findings challenge the assumption that a pre-treatment education period alone can resolve medication adherence issues and highlight the potential of remote, team-based care delivery. This approach appears promising for facilitating the adoption of new therapies, reducing disparities in care quality, and improving health outcomes across diverse patient groups. The flexibility of remote treatment models can broaden access to care, particularly benefiting underserved communities and individuals with demanding schedules. Additionally, including a patient navigation team enhances ongoing communication between patients and providers, ensuring personalized support essential for sustained engagement in healthcare.

Dr. Benjamin M. Scirica, MD, MPH, the principal investigator of the DRIVE study and director of the Accelerator for Clinical Transformation, expressed strong belief in the impact of remote care programs that utilize non-licensed navigators, clinical pharmacists and team-based care in conjunction with a dedicated care delivery platform. He emphasized that such programs improve operational efficiencies and communication and significantly contribute to enhancing access, elevating patient outcomes, reducing physician burden, and promoting the appropriate use of guideline-recommended medications.

More information: Alexander J. Blood et al, Randomized Evaluation of a Remote Management Program to Improve Guideline-directed Medical Therapy: The Diabetes Remote Intervention to Improve Use of Evidence-based Medications (DRIVE) Trial, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.069494

Journal information: Circulation Provided by Brigham and Women’s Hospital

The Mediterranean Diet: Beneficial for Your Well-being and Wallet

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The Mediterranean diet, renowned for its health benefits, is a dietary approach that has piqued the interest of many. However, the misconception of it being expensive often discourages budget-conscious individuals from considering it.

Research from the University of South Australia has uncovered a fascinating aspect of the Mediterranean diet: it promotes health and offers significant economic benefits. Compared to a typical Western diet, adopting the Mediterranean diet could potentially save a family of four an average of $28 per week, translating to a substantial $1456 annually.

This research evaluated the nutritional content and cost of three dietary models: the conventional Australian Western diet, the Mediterranean diet, and the dietary approach recommended by the Australian Guide to Healthy Eating (AGHE). The Mediterranean and AGHE diets satisfied the criteria for recommended food groups, macronutrient ratios, and essential micronutrients for maintaining good health. In contrast, the typical Australian diet lacked several nutrients such as fibre, zinc, potassium, calcium, magnesium, vitamin E, and vitamin B6. It exceeded the advisable salt intake by twofold.

The cost analysis revealed that the Mediterranean diet required an expenditure of $78 weekly for an individual, $135 for two, $211 for three, and $285 for a family of four.

Ella Bracci, a researcher and PhD candidate at UniSA, has drawn attention to the implications of the study. She has underscored the Mediterranean diet as a viable and healthful choice for households on a budget, emphasizing the role of diet as a modifiable risk factor for chronic diseases. Bracci has also highlighted the alarming prevalence of unhealthy eating habits in Australia, contributing to the rising rates of type 2 diabetes, cardiovascular diseases, obesity, and osteoporosis.

The challenge in Australia has been the perceived expense associated with adopting diets like the Mediterranean, which emphasizes fruits, vegetables, whole grains, nuts, extra virgin olive oil, seeds, and seafood. Bracci’s research counters this perception, demonstrating the Mediterranean diet as an economically viable means to prioritize health and financial well-being.

The Australian Guide to Healthy Eating outlines a balanced diet encompassing five food groups. Despite these guidelines, only 8% of Australians meet the recommended vegetable intake, with many consuming a significant portion of their daily calories from high-salt, high-sugar, and high-fat foods.

Associate Professor Karen Murphy from UniSA remarked on the affordability of healthy eating, suggesting that maintaining a balanced diet could be more cost-effective than some might think, contrary to the financial toll unhealthy eating can have on the body. She advocated for the Australian Healthy Eating Guidelines and the Mediterranean diet, noting the latter’s lower cost.

Murphy provided practical advice on reducing grocery expenses, such as taking advantage of sales, buying seasonal produce, and opting for generic brands. She highlighted the significant cumulative savings – nearly $1500 annually – that can be achieved by choosing the Mediterranean diet, underscoring the potential impact on households’ budgets during challenging financial times.

More information: Ella L. Bracci et al, Developing a Mediterranean Healthy Food Basket and an Updated Australian Healthy Food Basket Modelled on the Australian Guide to Healthy Eating, Nutrients. DOI: 10.3390/nu15071692

Journal information: Nutrients Provided by University of South Australia

Global team investigates the potential of selenium in combating ovarian cancer

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Selenium, a critical micronutrient for human health, exhibits toxic properties at elevated concentrations. Nonetheless, recent advancements in biomedical research have highlighted its potential anti-cancer benefits when administered in high dosages.

Under the leadership of renowned experts, Professor Steve Conlan from Swansea University and Professor Laurent Charlet at Université Grenoble Alpes, a team embarked on exploring the feasibility of developing selenium nanoparticles as a viable cancer treatment option, addressing the challenge posed by selenium’s toxicity.

Their research, conducted in a unique 3D environment that closely mimics the natural tumour setting, showcased the efficacy of selenium nanoparticles in eradicating ovarian cancer cells.

A groundbreaking discovery emerged from their investigation, revealing a novel biological process through which selenium likely exerts its anti-cancer effects. The team identified that selenium alters the activity of histone methyltransferases, enzymes pivotal in regulating epigenetic modifications—changes influenced by environmental factors that affect gene expression without altering the DNA sequence. These reversible epigenetic modifications affect how DNA sequences are interpreted rather than their composition.

Dr Benoit Toubans conducted this study as part of his joint PhD project under the auspices of the strategic partnership between Swansea and Grenoble and Dr Noor Al Kafri, a CARA fellow in Professor Conlan’s lab. They collaborated with specialists at the synchrotron facility in Grenoble and the University of Stuttgart.

The findings of their research were published in the esteemed journal Redox Biology.

Professor Conlan, who leads the Reproductive Biology and Gynaecological Oncology group at Swansea University Medical School, lauded the project as an exceptional scientific endeavour.

He remarked on the significance of the discovery and praised Noor and Benoit’s remarkable talent and commitment, which were instrumental in achieving this breakthrough. Professor Conlan also emphasized how the Swansea-Grenoble partnership exemplifies the impact of international and interdisciplinary collaborations in pioneering scientific discoveries.

The discovery of selenium nanoparticles’ mode of action opens new avenues in understanding their potential. It underscores the importance of considering both their antioxidant properties and novel impacts on histone methylation in the development of cancer therapies.

More information: Benoit Toubhans et al, Selenium nanoparticles modulate histone methylation via lysine methyltransferase activity and S-adenosylhomocysteine depletion, Redox Biology. DOI: 10.1016/j.redox.2023.102641

Journal information: Redox Biology Provided by Swansea University

How does climate change impact eczema?

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In a comprehensive analysis of all pertinent studies that examined the relationship between atopic dermatitis (also known as eczema) and climate-related hazards stemming from greenhouse gas emissions, researchers identified both direct and indirect impacts on the condition. Direct effects, such as inflammation triggered by particulate matter from wildfires, and indirect effects, including stress from drought-induced food shortages, were noted.

The findings, published in the journal Allergy, included maps crafted by the researchers depicting the historical, current, and predicted future burdens of eczema related to climate-related hazards. The study highlighted a significant shortage of data, particularly from areas expected to face increased frequency of these events due to climate change.

Katrina Abuabara, MD, MA, MSCE, from the University of California, San Francisco, the study’s corresponding author, commented on the sensitivity of atopic dermatitis to climatic factors such as air pollution. She noted that until now, the impacts of more frequent climate-related hazards such as warming, heatwaves, drought, wildfires, and floods were less understood. “Our findings suggest that most climatic hazards negatively affect atopic dermatitis,” Abuabara stated. “Future research needs to incorporate data on how various climate factors cumulatively affect the incidence, prevalence, and long-term activity of atopic dermatitis in a broader range of environments to fill these gaps in research.”

More information: Sheng-Pei Wang et al, Impact of climate change on atopic dermatitis: A review by the International Eczema Council, Allergy. DOI: 10.1111/all.16007

Journal information: Allergy Provided by Wiley

Experts develop a blueprint to assist elderly individuals at risk of storm floods

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Recent research findings suggest that emergency planners in Shanghai and New York City are under increasing scrutiny to safeguard elderly residents from the severe consequences of coastal flooding precipitated by storms and cyclones.

Both metropolises are acutely vulnerable to the ravages of storm-induced flooding, and a comparative analysis of their emergency management systems reveals marked disparities in their approaches to evacuating elderly individuals to safety.

Through an in-depth examination of emergency protocols within these cities, specialists have formulated a strategy for efficient evacuation that could potentially apply to other cities globally threatened by similar flood risks, including Mumbai, Bangkok, Jakarta, Ho Chi Minh City, Miami, and Tokyo.

This innovative research, featuring contributions from the University of Birmingham, was published in Nature Water. The authors urge emergency planning bodies to establish additional local shelters to expedite the safe evacuation of those in flood-prone areas.

The study points out the discrepancy in evacuation travel times, noting that trips to evacuation sites in New York City generally take less than 20 minutes. This starkly contrasts with Shanghai, where evacuating flood-threatened areas can extend up to 3 to 4 hours due to a scarcity of accessible shelters in vulnerable communities.

Professor Nigel Wright of the University of Birmingham remarked on the vulnerability of peripheral neighbourhoods in coastal cities to storm-induced flooding, highlighting that despite these areas’ lower population densities, they often house groups with special needs, including older adults.

The contrast in evacuation strategies for older adults in Shanghai and New York City underscores the importance of strategic, risk-informed evacuation planning against storm flooding. The study offers valuable insights into making operational emergency evacuation decisions and suggests a template for crafting flood management policies for major coastal cities worldwide.

The researchers also identified potential challenges in evacuating people from offshore islands, such as Shanghai’s Chongming Island, where emergency responders face difficulties promptly reaching evacuees. The centralisation of shelters and uneven distribution of vulnerable populations leave such high-risk neighbourhoods inadequately served during extreme flood events.

Amid the backdrop of increasing coastal population sensitivity to flood disasters, China and the United States are enhancing their emergency management strategies through better organisation and evacuation planning. The evolving nature of coastal flood risk necessitates further research into evacuation strategies, factoring in climate change, coastal urbanisation, and adaptation strategies.

The phenomenon of coastal flooding, exacerbated by storm surges, is a global issue. Incidents are becoming more frequent and severe due to factors such as climate-induced sea-level rise, changes in storm patterns, and human activities. Notable flood disasters in cities like Shanghai, New Orleans, New York City, and Macau highlight the acute vulnerability of coastal cities to such events.

Projections for the 136 largest coastal cities indicate a more than threefold increase in the population exposed to centennial coastal floods from 38.5 million in 2005 to 150 million by the 2070s, with potential economic damages escalating to more than ten times the current figures by 2050.

In Europe, without mitigative action, the expected annual exposure of individuals to coastal flooding could surge from 10,200 to 3.65 million by 2100, primarily affecting major urban areas due to rising sea levels and ongoing socioeconomic development.

More information: Jie Yin et al, Strategic storm flood evacuation planning for large coastal cities enables more effective transfer of elderly populations, Nature Water. DOI: 10.1038/s44221-024-00210-z

Journal information: Nature Water Provided by University of Birmingham

Patient-centered cardiovascular care is crucial for enhancing equity and outcomes

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According to a new American Heart Association Scientific Statement published today in Circulation, adult cardiovascular care focusing on the patient can enhance individual experiences and medical outcomes.

Patient-centred care revolves around recognizing the patient as an individual and respecting their beliefs, preferences, and values. It merges the healthcare professional’s expertise with the patient’s health priorities, empowering patients through informed decision-making by providing clear information and fostering an active partnership among the patient, their family, and the healthcare team. Michael J. Goldfarb, M.D., M.Sc., chair of the scientific statement writing committee and associate professor of cardiology at the Jewish General Hospital and McGill University in Montreal, Quebec, emphasized that patient-centred care involves informed choices rather than allowing patients unrestricted freedom in their healthcare decisions.

Dr Goldfarb also highlighted the necessity for healthcare professionals managing adults with heart disease to acquire guidance and practical tools for integrating a person-centred approach into regular clinical practice. The statement outlines several critical components of patient-centred care, including shared decision-making, medication management, and focusing on patient-oriented outcomes.

Shared decision-making is characterized by a collaborative relationship based on trust, mutual respect, and open communication between patients, families, and healthcare professionals. Health professionals must accommodate their patients’ health literacy levels and provide transparent, straightforward information about risks, current health conditions, and the potential outcomes of different screening and treatment options, encouraging patients to engage in discussions about their health.

Although the effectiveness of medications in preventing and treating heart disease is well-documented, adherence issues are significant, with many patients not consistently taking their medications as prescribed. This can be due to various factors, including the complexity of medication regimes and the cost of drugs. Engaging patients in discussions about their medication can help improve adherence, reduce costs, and minimize side effects, possibly through the use of combination pills or substituting expensive medications with cheaper but equally effective alternatives.

The statement further stresses the importance of incorporating the patient’s physical, emotional, and social well-being assessments into managing their heart disease. This holistic view allows healthcare professionals to understand better the patient’s condition and the effects of treatments, recognizing changes that might not be apparent through standard medical examinations alone.

Dr. Goldfarb also pointed out that care outcomes significant to health professionals and health systems might only sometimes align with what is important to patients. For instance, while the length of hospital stay is a standard metric for care quality, patients might prioritize their overall quality of life and functional ability post-treatment more highly.

The statement also addresses the need to overcome barriers to implementing patient-centred care, particularly for populations burdened disproportionately by cardiovascular disease. This includes deploying culturally and linguistically appropriate services and considering social determinants of health such as economic stability and access to quality healthcare. Special attention is given to different demographics, such as older adults, women, individuals with behavioural and mental health issues, adults with congenital heart disease, and those with physical disabilities, emphasizing tailored approaches that consider their unique health needs and circumstances.

Moreover, the statement acknowledges the obstacles to patient-centred care stemming from patient, clinician, and health system-related factors. These include patients’ distrust or limited access to healthcare, clinicians’ time constraints and documentation demands, and health systems that may need more resources for team-based care.

In conclusion, while there are challenges to genuinely patient-centred care, the statement underscores that it is achievable and already practised to some extent. As highlighted by Dr Goldfarb, the ongoing development and incorporation of patient-centred outcome measures are vital for optimizing care for patients, their families, and caregivers.

More information: Michael J. Goldfarb et al, Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association, Circulation. DOI: 10.1161/CIR.0000000000001233

Journal information: Circulation Provided by American Heart Association

Can skin moisturisers aid in preventing eczema in infants?

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Atopic dermatitis (AD), alternatively known as atopic eczema, ranks as the most prevalent chronic, recurrent, inflammatory skin condition, impacting between 5% and 30% of children globally. An examination published in the Journal of the European Academy of Dermatology & Venereology, which reviewed relevant studies, concluded that early emollients, or moisturisers, represent a productive approach to preventing AD in high-risk infants.

This thorough examination delved into 11 randomised controlled trials involving a substantial number of infants. It found that three types of emollients—cream, emulsion (a mixture of two liquids that usually do not combine), and mixed types—were all effective in preventing AD. However, a closer look at the data suggests that the emollient emulsion might be the superior choice, instilling confidence in its effectiveness.

The systematic review and network meta-analysis authors noted, “The outcomes of this study indicate that the early application of skin emollients can successfully prevent the onset of AD in infants. Furthermore, among the three types of emollients available, the emollient emulsion is likely the best choice during infancy for more effectively preventing the development of AD.”

More information: Junqin Liang et al, Systematic review and network meta-analysis of different types of emollient for the prevention of atopic dermatitis in infants, Journal of the European Academy of Dermatology and Venereology. DOI: 10.1111/jdv.18688

Journal information: Journal of the European Academy of Dermatology and Venereology Provided by Wiley

Mental health inequalities increasing among transgender adults

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In the United States, transgender and gender non-conforming (TGNC) individuals form a historically marginalised group within society. They frequently encounter poorer outcomes in both physical and mental health realms when compared to their cisgender peers. Despite progress in enhancing both psychological and physical healthcare provisions for TGNC individuals over recent years, significant obstacles remain that impede access to essential services. These barriers include, but are not limited to, extended waiting periods, burdensome travel demands, and insufficient insurance coverage.

A recent study highlighted in the May 2024 edition of the American Journal of Public Health delves into shifts in self-reported mental health from 2014 to 2021 within a nationally representative sample of U.S. adults. Utilising data from the U.S. Behavioral Risk Factor Surveillance System Survey, researchers Donn Feir from the University of Victoria and Samuel Mann from the RAND Corporation observed that mental health distress has risen disproportionately among TGNC adults compared to cisgender individuals over this timeframe.

The frequency of self-reported “poor mental health days” per month is used as a critical gauge of mental health, and it aligns with other psychological and physical health markers. Although TGNC individuals recorded a higher number of poor mental health days in 2014, the disparity has notably widened over the subsequent seven years.

“In 2014, cisgender individuals reported an average of 3.68 poor mental health days, while transgender respondents reported an average of 5.42 poor mental health days. The size of this disparity, adjusted for differences in observable characteristics, expanded by 2.75 days throughout the sample period,” Mann clarified.

The researchers also revealed a disproportionate escalation in the frequency of mental health distress reported by TGNC individuals during the seven-year study span. “In 2014, 11.4% of cisgender adults reported frequent mental distress, in contrast to 18.9% of transgender adults. By 2021, these figures had risen to 14.6% of cisgender adults and 32.9% of transgender adults reporting frequent mental distress,” Feir noted.

The observed trend of rapidly increasing mental distress among TGNC adults suggests a potential exacerbation of socioeconomic and other disparities, as well as an augmentation in the barriers preventing access to necessary support services. This uptick in mental distress within the TGNC community might also be attributed to factors such as societal discrimination or restricted access to gender-affirming and mental health care resources.

The worrying increase in the frequency of self-reported mental distress among transgender individuals underscores an urgent need to re-evaluate nationwide initiatives that support TGNC individuals throughout the U.S. Allocating resources that improve access to gender-affirming and mental health services could play a vital role in reducing the mental health disparities existing between TGNC and cisgender individuals.

In conclusion, policy shifts that foster overall well-being and inclusivity for TGNC individuals could significantly enhance mental health outcomes for this underrepresented community in the long term. “Policies are needed to address the deteriorating mental health of transgender and gender-nonconforming people in the United States,” Mann emphasised.

More information: Donn Feir et al, Temporal Trends in Mental Health in the United States by Gender Identity, 2014–2021, American Journal of Public Health. DOI: 10.2105/AJPH.2024.307603

Journal information: American Journal of Public Health Provided by American Public Health Association

Biomarkers in the middle-aged brain can forecast cognitive health in later years

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Researchers have suggested that the brain in middle age could offer insights into one’s cognitive health in later life, according to a review published on March 19 in the journal Trends in Neurosciences. The study delves into both human and animal research to argue that the middle years—broadly defined as between 40 and 65 years of age—signify a pivotal stage in the brain’s ageing process. This stage is of utmost importance and deserves more attention in our research, highlighting the urgency and significance of the topic.

They highlight that middle age comes with certain risk factors that are both specific and modifiable, potentially influencing the risk of future dementia. This stage, they contend, deserves more attention than it has historically received. The rationale behind their argument is that most research traditionally zeroes in on the older population, so preventive or mitigating treatments might be less effective. However, by identifying risks of cognitive decline earlier, treatments could commence at a stage when they prove more beneficial, instilling a sense of hope and optimism in our research.

The authors note that the brain experiences considerable changes during middle age at the molecular, cellular, and structural levels, which have been associated with cognitive decline. This decline accelerates during these years. They point out that during middle age, the brain undergoes notable structural and functional changes that affect mental functioning. These variations could explain why cognitive ageing differs so widely among individuals.

Significant structural changes during middle age include alterations in the volume of various brain structures, a reduction in the size of the hippocampus (vital for memory and learning), and diminished connectivity among different brain regions. The researchers describe the fourth and fifth decades of life as crucial for reorganising brain networks, marked by peak efficiency and connectivity, followed by a swift deterioration.

Changes are not limited to the brain structure alone but include gene expression variations within the brain and other body parts. In particular, there’s an increase in the expression of genes related to the immune system and a decrease in those associated with synaptic function in the brain. The study also suggests systemic changes, evidenced by the secretion of proteins by various organs, could indicate brain health and function during middle age.

The potential role of exercise in promoting healthy cognitive ageing is mentioned, with the authors calling for further research to explore this avenue. Investigating how ageing and exercise influence molecular processes could uncover new therapeutic opportunities. The need for more research into the observed differences in brain ageing between sexes, particularly given the higher dementia rates among women, is also highlighted. Future studies should differentiate between processes contributing to declining brain health and those merely biomarkers of compensatory mechanisms.

In conclusion, the authors advocate for the application of recent advancements in ageing research to the middle-aged population. This approach could identify new biomarkers and interventions to address cognitive decline and significantly impact your work, helping to tackle the challenges posed by an ageing global population. This should make you feel more engaged and motivated in your research.

More information: Sebastian Dohm-Hansen et al, The ‘middle-aging’ brain, Trends in Neurosciences. DOI: 10.1016/j.tins.2024.02.001

Journal information: Trends in Neurosciences Provided by Cell Press

Grasping self-inflicted ageism

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“Older individuals often encounter ageism, which manifests as negative perceptions about their value, capabilities, or level of comprehension, alongside humour that targets their age,” Professor Henry explained.

He continued, “As individuals age, they increasingly depend on previous knowledge and environmental signals to shape their emotions, thoughts, and actions.

“In a society that undervalues ageing, these cognitive shifts can complicate the ability of the elderly to contest ageist prejudices they’ve internalized, often referred to as self-directed ageism.”

Self-directed ageism might manifest as doubts about one’s abilities, such as thinking, ‘I’m too old to learn this new technology’ or ‘I’m too old to form new friendships.’ It also appears as negative self-perceptions related to ageing, like believing, ‘I’m not as good at this as I once was.’

Furthermore, it may surface as worries about being judged based on age-related stereotypes, for instance, ‘If I forget this, they will assume it’s because I’m old.’

Professor Henry noted that when ageism becomes a personal belief, it is associated with reduced life expectancy, deteriorating physical and mental health, slower recovery from illness, and cognitive decline.

“It’s also detrimental when older adults let their adverse views on ageing impede their confidence to embrace new or challenging experiences and opportunities,” he added.

Interventions like fostering more positive interactions between younger and older people are essential to counteract these negative attitudes towards ageing.

“Our studies suggest that older adults would significantly benefit from a decrease in ageism cues within our broader social environment,” he stated.

“Reducing the number of ageist cues that capture the attention of older individuals could lower the chances of self-directed ageism occurring.”

More information: Julie D. Henry et al, The cognitive tenacity of self-directed ageism, Trends in Cognitive Sciences. DOI: 10.1016/j.tics.2023.03.010

Journal information: Trends in Cognitive Sciences Provided by The University of Queensland

Short-term incentives for exercise may result in prolonged enhancements in physical activity levels

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Adults at risk of heart disease who received daily prompts or incentives to increase their activity levels managed to boost their daily step count by over 1,500 steps after a year. Even six months after the study concluded, many participants maintained their new, more active routines. This research, funded by the National Institutes of Health and published in Circulation, was a significant step forward in our understanding of cardiovascular health. It was highlighted as groundbreaking at the American College of Cardiology’s Annual Session, underscoring its importance.

The study reported a rise in physical activity, equating to an additional 40 minutes of moderate exercise per week, but also showed a 6% decrease in the risk of premature mortality and a 10% lower risk of dying from cardiovascular issues, benchmarks set against data from previous research. These findings support the U.S. Department of Health and Human Services recommendation for adults to engage in at least 150 minutes of moderate aerobic exercise weekly, such as brisk walking, 75 minutes of vigorous activities like fast cycling, and twice-weekly strength training sessions.

The research indicated that simple daily reminders were effective in promoting increased activity; however, the introduction of financial incentives or point-based rewards akin to those in a game proved significantly more motivating. The most substantial increases in activity levels were observed in participants who received a combination of these incentives. Importantly, these benefits didn’t stay strong once the incentives ceased. They persisted for six months, suggesting a potential for long-term behaviour change.

Alison Brown, Ph.D., R.D., a program officer at the National Heart, Lung, and Blood Institute (NHLBI) of the NIH, remarked on the significance of moderate exercise in dramatically lowering cardiovascular risk. She emphasized the value of affordable, accessible strategies to encourage physical activity, particularly those implemented at home, as a significant advantage for public health.

Conducted between 2019 and 2024, the study monitored over 1,000 adults at heightened risk for major cardiovascular events. Participants were equipped with wearable fitness trackers connected to an online health platform, allowing researchers to monitor their initial daily step counts. Participants then aimed to increase their daily steps by 33%, 40%, 50%, or any increment exceeding 1,500 steps from their baseline. Following this, they were randomly assigned to one of four groups, three of which included incentives.

The incentivized groups featured game-like rewards, financial incentives, or a combination. In the game-focused group, participants earned weekly points that they retained by meeting daily step targets, losing points on less active days—those accumulating enough points advanced levels, while those falling short dropped levels. Participants could also have a family member or friend as their “support crew,” receiving weekly progress updates. At the study’s conclusion, the highest achievers were awarded trophies. In the financial incentive group, participants received $14 weekly but lost $2 each day they failed to meet their step goals. The third group combined these game-like and financial incentives.

A control group received no incentives but was provided with the fitness tracker and daily updates on their step count. Each intervention lasted 12 months and was followed by a six-month period where all participants were treated as controls.

Initially, participants averaged about 5,000 steps daily (approximately 2.4 miles). By the end of the year, they had increased their step count by more than 1,500 steps. Compared to the control group, those in the game-incentive group added an average of 538 steps to their baseline, while the financially incentivized group added 492 steps. The group that received both incentives added an average of 868 extra steps and maintained an increase of 576 steps six months post-intervention. Those in the single incentive groups maintained their increased activity levels, but the improvements were not significantly different from the 1,200 additional steps observed in the control group 18 months post-study.

Alexander C. Fanaroff, M.D., a study author and expert in behaviour change, interventional cardiologist, and assistant professor of medicine at the University of Pennsylvania, emphasized the immediate benefits of the interventions. He noted that focusing on present-day actions, whether for enhancing long-term heart health or planning for future financial goals, can be more compelling than long-term planning.

The researchers suggested that similar principles could be applied by individuals seeking to improve their exercise habits, utilizing apps that offer reminders and rewards, or involving family and friends for support. They also suggested that health systems and organizations could employ these methods to help boost physical activity among patients. This practical application of the research not only underscores its relevance but also empowers individuals and health systems to take action for better cardiovascular health.

More information: Alexander C. Fanaroff et al, Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.069531

Journal information: Circulation Provided by NIH/National Heart, Lung, and Blood Institute

Walking and reminiscing aid in enhancing brain health among older Black adults

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A groundbreaking research initiative by Oregon Health & Science University, which actively involves older Black adults in walking and sharing memories within historically Black neighbourhoods of Portland – areas significantly altered by rapid gentrification – has shown promising results in enhancing cognitive function, per recent findings.

Since its inception in 2016, the OHSU programme has garnered significant attention, inspiring similar projects in Seattle and Oakland, California. Recent research, now published in The Gerontologist, suggests potential benefits for brain health in a demographic particularly vulnerable to Alzheimer’s disease. The study documented health and mood improvements among participants and noted cognitive enhancements in individuals exhibiting mild memory issues at the outset, instilling hope for a brighter future.

Raina Croff, Ph.D., an associate professor of neurology at the OHSU School of Medicine and a researcher at the OHSU Layton Aging and Alzheimer’s Disease Research Center, highlighted the significant cognitive improvements observed in participants with memory loss. The intervention, Sharing History through Active Reminiscence and Photo-Imagery (SHARP), leads groups on 72 unique mile-long walks three times weekly for six months, integrating exercise, social interaction, and active reminiscence. This unique combination, facilitated through memory markers displayed on intelligent tablets, encompasses news clips, photos, ads, and historical artefacts, enriching the walking experience.

According to Croff, the consistent practice of walking, reminiscing, and socialising has demonstrated a substantial positive impact on health. The programme’s effectiveness is deeply rooted in the communal aspect of the walks, which sets it apart from individual walking exercises. This aspect, often overlooked, is a critical factor in the program’s sustainability and success, highlighting the importance of human connection and community well-being.

Participants have recounted mixed emotions, mainly when traversing North and Northeast Portland neighbourhoods that have undergone drastic changes due to construction projects and gentrification, displacing long-established families. Despite the painful memories, the shared experience of walking through these changes has fostered communal healing.

The research underscores the mood-enhancing effects of the walks, with participants reporting improved well-being immediately after and at the end of the study. Engaging directly with the community and its rich historical backdrop, the participants connected in ways that counter the isolating trends of modern society, where remote work and digital interaction have diminished neighbourly conversations.

Croff believes the study affirms the importance of maintaining social and cultural connections for individual and community health. She emphasises the inherent human need for face-to-face interaction and a connection to our physical surroundings, suggesting that these elements foster community well-being in an increasingly digital age.

More information: Raina Croff et al, Walking and Social Reminiscence in Gentrifying Neighborhoods: Feasibility and Impact on Cognitive, Physical, and Mental Health Among Older Black Adults in the SHARP Study , The Gerontologist. DOI: 10.1093/geront/gnae019

Journal information: The Gerontologist Provided by Oregon Health & Science University