Promoting and maintaining daily mobility among the elderly is central to healthy aging. Assessing how the environment influences older adults’ health has moved from a residence-centred approach to the activity space concept, which acknowledges the importance of individuals’ daily mobility.
Little research has been undertaken on the environmental correlates of selective daily mobility, which means detours from the shortest path. Therefore, Klein et al (2022) evaluated the selective mobility of 470 older adults (aged 67 to 94 years) living in Luxembourg, by measuring detour percentage between their observed paths and their shortest routes, whether walking or driving. Participants carried an integrated Global Positioning System and accelerometer tracker for 7 days.
The authors found that walkers sought walking-friendly environments with more low-speed areas and better connectivity. On the other hand, car users sought car-friendly environments by favouring high-speed areas rather than taking shortest routes. Further, ‘low-speed areas seem to foster greater detours among walkers and reduced detours among drivers’ and the authors suggest that integrating the environmental correlates of walking detours into broader urban planning strategies to promote walking could promote walking among older adults and increase walking time by providing supportive environments for walking detours: ‘The increase in walking time through walking detours may also help people to spend more time in the corresponding neighbourhood environment…’
Pharmacological treatments may decrease disease severity and improve function in severe dementia
Dementia affects some 50 million people worldwide, and prevalence data show that an estimated 12.5% of people above the age of 60, and 17.3% of those aged over 85 years are affected by severe dementia. Yet despite this, those individuals living with a severe form of dementia remain under-treated and often excluded by research that evaluates treatments. This is cited by Profyri et al (2022), who systematically reviewed the effectiveness of pharmacological and non-pharmacological treatments for people living with severe dementia. In total, 30 trials met their inclusion criteria, of which 14 evaluated the effectiveness of pharmacological interventions and 16 evaluated a non-pharmacological intervention.
The authors found that moderate-certainty evidence showed that pharmacological treatment (donepezil, memantine and galantamine) benefitted those with severe dementia by improving severity of symptoms and activities of daily living. The authors suggest that results consistent with improved severity of symptoms and reduced functional decline in this group are important ‘as they may translate to reduced costs of care, delays in care home admission, and reductions in caregiver burden.’ And while non-pharmacological treatments are probably effective in reducing neuropsychiatric symptoms, the quality of evidence for this is low.
The authors conclude that there is ‘an urgent need for high-quality evidence for other outcomes and for developing serviceuser informed interventions for this under-served group.’
Saturated fat not significantly associated with CVD risk
Cardiovascular disease (CVD) is the world's leading cause of death, and Valk et al (2022) cite evidence that by 2030 nearly 23.6 million people will die from cardiovascular disorders. Many assume that consuming saturated fat (SFA) clogs the arteries and increases CVD risk. This misconception, explain Valk et al (2022), arose from the flawed Seven Country Study undertaken by physiologist Ancel Keys, leading in the 1950s to the diet-heart hypothesis prevalent today.
In this review, the authors considered the association between SFA consumption and CVD risk and outcomes by evaluating 33 articles published between 2010 and 2021, comprising observational studies, prospective epidemiological cohort studies, randomised controlled trials (RCTs), systematic reviews and meta-analyses, and long-term RCTs.
The evidence adduced demystifies common allegations and misconceptions about SFA and the diet-heart hypothesis and proposes an evidence-based recommendation for a healthy intake of different SFA food sources that help to promote cardiovascular health. The authors’ evaluation of the evidence indicates that the consumption of SFA is not significantly associated with CVD risk, cardiovascular events, or mortality: ‘Based on the scientific evidence, there is no scientific ground to demonize SFA as a cause of CVD. SFA naturally occurring in nutrient-dense foods can be safely included in the diet.’
Different approaches to improving HPV vaccine uptake for different populations
There are approximately 200 different types of human papillomavirus (HPV), which is implicated in almost all cases of cervical cancer, some 90% of anal cancers and a substantial proportion of oropharyngeal, penile, vaginal and vulval cancers. Further, types 16 and 18 are estimated to cause around 5% of all cancers worldwide.
Most HPV-associated cancers can be prevented by vaccination, ideally given in early adolescence. But there is wide variation across, and even within, countries as to how HPV vaccination is best offered and accepted. Bennett et al (2022) undertook an assessment of ten systematic reviews published between 2011 and 2021, aiming to identify what interventions exist to promote uptake and how effective they are.
Their assessment included 95 randomised controlled trials, 28 quasi-experimental studies, 14 cohort studies, 6 non-randomised pretest/post-test studies with control groups, 5 single group pretest/post-test studies, 1 single-group post-test study and 1 randomised longitudinal study. The authors found no single solution to increasing vaccination uptake but suggest that specific approaches may be more suited to some populations than others. For example, ‘face-to-face presentations, printed information and supplementing both strategies with additional components appear effective at increasing vaccination intention, and reminders and multicomponent strategies, especially ones that include some intervention aimed at provider level, appear effective at increasing vaccination uptake.’