Medical marijuana could reduce opioid use in older adults

A questionnaire of older men and women suffering from chronic pain who were given medical marijuana found that the drug significantly reduced pain and their need for opioid painkillers, Northwell Health researchers report.

The results of the study, "Older Adults' Use of Medical Marijuana for Chronic Pain: A Multisite Community-Based Survey," are scheduled to be presented May 3, 2018 at the annual meeting of the American Geriatrics Society in Orlando, FL.

To gauge how effective medical marijuana was at managing chronic pain and reducing opioid use, researchers surveyed 138 medical marijuana users with an anonymous 20-question survey focusing on how often they used the marijuana, in what form they took it, how much it reduced pain and whether or not they were able to cut back their use of other painkillers.

When patients were asked if they were able to curb their use of other painkillers after starting medical marijuana, 18 percent reported decreasing their use "moderately," 20 percent "extremely" and 27 percent "completely." An overwhelming number of subjects (91 percent) would recommend medical marijuana to others.

Comments from patients tell the tale:

"My quality of life has increased considerably since starting medical marijuana," one patient said. "I was on opiates for 15 years, and 6 months on marijuana, and off both completely."

Another patient said: "It [medical marijuana] is extremely effective and has allowed me to function in my work and life again. It has not completely taken away the pain, but allows me to manage it."

"I was on Percocet and replaced it with medical marijuana. Thank you, thank you, thank you," said another.

These patients had been living with chronic pain from osteoarthritis, spinal stenosis, hips and knees that could not be replaced, and pain not relieved by steroid injections, said Diana Martins-Welch, MD, a co-author of the study and physician in the Division of Geriatric and Palliative Medicine, Department of Medicine at Northwell Health.

Based on these results, she believes that medical marijuana could be effective in curbing the opioid epidemic now ravaging the United States. "What I'm seeing in my practice, and what I'm hearing from other providers who are participating in medical marijuana programs, is that their patients are using less opioids," said Martins-Welch. "I've even gotten some patients completely off opioids."

As effective as medical marijuana can be, it's not widely available or prescribed, Martins-Welch said. Plus, people have to jump through many hoops just to get certified to receive it, she said.

Martins-Welch believes medical marijuana should be more widely available and easier to get.

Medical marijuana is legal in only 30 states, she said. In addition, because marijuana is federally illegal, it's expensive and not covered by insurance, putting it beyond the reach of many patients who could benefit from it, she said.

Medical marijuana can cost on average $300 for a one-month supply, Martins-Welch said. "And it's a cash-only business."

"Even the process you have to go through to get certified is expensive," she said.

Martins-Welch and colleagues surveyed men and women between the ages 61 to 70 about their use of medical marijuana. Patients responded to 20 questions about their marijuana use. The researchers found that most patients, 45 percent, used vaporized oil, while 28 percent used pills and 17 percent used marijuana-laced oil. Twenty-one percent used marijuana once a day, 23 percent used it twice daily, and 39 percent used marijuana more than twice a day.

Using marijuana in these forms dramatically reduces its mind-altering effect, Martins-Welch said.
In most cases, a doctor recommended medical marijuana (46 percent) followed by a family member or friend (24 percent) or another health care provider (6 percent), while others did not specify who recommended it (24 percent).

When asked how pain levels changed before and one month after starting marijuana, most patients reported that average pain scores dropped from 9.0 on a scale of 0-10 to a more moderate pain threshold of 5.6.

However, older patients reported a reduction in the use of other painkillers less often than younger patients (64 percent versus 93 percent), the researchers found. Older patients also recommended medical marijuana less often than younger ones (86 percent versus 100 percent respectively).
When patients were quizzed about whether side effects of medications impacted their daily activities, the average score went from 6.9 before starting medical marijuana to 3.5 a month after using the drug.

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To review the questions on the survey, see: https://redcap.northwell.edu/surveys/?s=PC9K3AEREP

Posting, commenting and customizing on Facebook help involve, empower older adults

Social networking sites, such as Facebook, offer tools and activities that may help older adults feel more empowered and less isolated, according to researchers.

In a study of Facebook use, older adults who posted a lot of personal stories on the social networking site felt a higher sense of community, and the more they customized their profiles, the more in control they felt, said S. Shyam Sundar, Penn State distinguished professor of communications and co-director of the Media Effects Research Laboratory. He added that the study suggests that using social media is not a uniform experience that is either all bad, or all good, but offers multiple functions for diverse users.

"People tend to think of Facebook as a black box that either has an overall positive effect or a negative effect, but what distinguishes this study is that it makes an effort to go in and see what people do in Facebook -- and that's what matters," said Sundar. "So, in other words, social media, by itself, is neither good, nor bad, but it's how you use it."

For older adults, who may be less mobile, Facebook and similar social networking sites could play a critical role in easing isolation and making them feel like they are part of a large community, according to the researchers, who report their findings in the journal New Media & Society.

"This is important, especially for older adults who might be aging in place, because they have mobility constraints that limit their ability to socialize," said Sundar. "And, for the last ten years or so, we've been looking into how social networking sites can enhance the social life of older adults and reduce the social isolation that they might feel. These are more fine-grained findings that say certain things you do on Facebook can give you gratifications, like fulfilling the needs for activity, having interactions with others, having a greater sense of agency, and building community."

The researchers also suggested that commenting on and responding to posts gave older users a feeling of social interaction.

Eun Hwa Jung, formerly a doctoral student at Penn State and currently assistant professor of communications and new media, National University of Singapore, who worked with Sundar, said older adults are increasingly adopting social media, in general, and are a growing number of Facebook's total membership. According to Pew research, 34 percent of Americans aged 65 years and older use social networks in 2017, an increase of 7 percent from 2016. Facebook is considered the most popular social network among older adults, the researchers add.

Given the widespread diffusion of Facebook in this group, understanding what gratifications older adults derive from particular technological features helps designers develop better user interfaces suited for them, Jung said.

"It can improve online interactions between individuals from different generations," she added.

According to Sundar, developers of social media networks should consider the needs of this growing group of users. For example, they should create features that enhance the identity of older adults while simultaneously protecting their privacy. More features that encourage older adults to exchange and visualize messages with others could also make sites more interactive for this group.

To collect the data, the researchers recruited 202 participants -- 79.7 percent female and 20.3 percent male -- who were 60 years and older and used Facebook for at least a year. The participants were recruited from 27 retirement centers throughout the United States.

The researchers "friended" the participants on Facebook so they could count the number of times they used the various tools in the site during the past year. The participants were also asked to respond to a questionnaire that captured the gratifications they obtained from Facebook.

Future research may look at whether these positive interactions on Facebook could lead to the enhancement of well-being for seniors, Sundar said. The researchers also suggested that the effects of other social media outlets, such as Twitter and Pinterest, as well as other mobile and wearable devices, on older adults should be investigated.

Ketogenic diets reduce athletes' anaerobic performance

Athletes who turn to ketogenic diets to help their performance in high-intensity, short duration sports may want to think again, according to new research from Saint Louis University.

In a small study, Edward Weiss, Ph.D., associate professor of nutrition and dietetics at Saint Louis University, together with SLU graduate students Kym Wroble, R.D. and Morgan Trott, R.D., examined the exercise performance of 16 men and women after following either a low-carbohydrate ketogenic diet or a high-carbohydrate diet for four days. His team then tested the anaerobic exercise performance of the participants.

The research team found that after following the ketogenic diet, the participants did not perform as well at the exercise tasks.

"In popular discussions, the term 'ketogenic diet' often is used as a broader term for low carb diets, including Atkins," Weiss said. "However, the language is often confused. People often think low carb and high protein. This is related, but different, as protein can only be at normal levels for a true ketogenic diet.

"The objective of a ketogenic diet is to starve the body of carbohydrate. If there is too much protein in the diet, the body will use the protein to make carbohydrates, which defeats the purpose. When the body is sufficiently deprived of carbohydrate, it manufactures ketone bodies as an alternate fuel. It's an emergency backup system that allows us to survive when we are at risk of starvation. But, it has side effects.

"Right now in the general public, it's touted for weight loss. Some studies have shown that it is effective for weight loss. I worry, though, that this may be a lot of smoke and mirrors. A typical diet is 60 percent carbohydrate. So, if you limit carbs, you might find yourself just not eating that much. If you eliminate most food options, you may just be losing weight because you are cutting calories."
The study has implications both for those who turn to ketogenic diets for weight loss and for athletes who aim to improve their performance.

"The energy metabolism system that's affected is anaerobic. Watching the summer Olympics, the 100 meter sprint and the triple jump depend on this system. You might say that this doesn't relate to me. But for someone with low fitness, they use this same metabolism to get up the stairs. Everyday people use this kind of metabolism without realizing it. This study shows that this energy system is compromised by this type of diet."

Weiss has one caveat.

"There are populations that a ketogenic diet may benefit," Weiss said. "For example, patients who have epilepsy benefit from this diet. For those with abnormal cell metabolism that causes seizures, causing cells to feed on ketones instead can be helpful."

The bottom line?

"Short-term low carbohydrate, ketogenic diets reduce exercise performance in activities that are heavily dependent on anaerobic energy systems," Weiss reports. "These findings have clear performance implications for athletes, especially for high-intensity, short duration activities and sports.

"This diet is especially hot among people who are trying to optimize their health. What this study tells me is that unless there are compelling reasons for following a low-carb diet, athletes should be advised to avoid these diets."

New research ranks the effectiveness of nonsurgical treatments for knee osteoarthritis

An estimated 45 percent of people are at risk of developing knee osteoarthritis (OA) in their lifetime. According to a network meta-analysis research article published in the May 1, 2018 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the nonsteroidal anti-inflammatory drug (NSAID) naproxen was ranked most effective in individual knee OA treatment for improving both pain and function, and is considered a relatively safe and low-cost treatment method.

Nonsurgical treatments for knee OA supported by previous research evidence include strength training, low-impact aerobic exercises, NSAIDs, and weight loss in individuals with a body mass index over 25. This new research analyzed data from multiple trials to determine the relative effectiveness of various nonsurgical treatments for knee OA. The treatments that were compared and ranked included acetaminophen; ibuprofen; intra-articular (IA) or joint injections of cortisone; platelet-rich plasma (PRP); hyaluronic acid (HA); several NSAIDs, such as naproxen, celecoxib, and diclofenac; and both oral and IA placebo.
"This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes," said lead author and orthopaedic surgeon David Jevsevar, MD, MBA. "Using a statistical ranking technique, we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function, and we attempted to fill in the gaps in evidence for more inconclusive treatments such as HA, PRP, and corticosteroids."
Authors analyzed 53 randomized controlled trials that examined knee OA treatments for at least 28 days and included a minimum of 30 participants per study group. Knee OA treatments were ranked on a scale of one to five, with one being the most effective. They found the following:

• For pain reduction, cortisone injections provided the greatest short-term (4 to 6 weeks) pain relief, followed by ibuprofen, PRP injections, naproxen, and celecoxib.
• Naproxen ranked the highest for probability for improving function, followed by diclofenac, celecoxib, ibuprofen, and PRP injections.
• Naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by cortisone injections, PRP injections, ibuprofen and celecoxib.
• HA injections did not achieve a rank in the top five treatments for pain, function, or combined pain and function. An analysis of 12 articles also found that results with HA are not significantly different from those with IA placebo for treatment of knee OA.

"Because knee OA has both a high disease burden and high treatment costs, additional prospective studies using similar outcomes, timelines, and measures of clinically important changes are needed," explained Dr. Jevsevar. "While the information in this analysis is helpful to physicians, patients also can benefit from these findings and use it with their doctors to weigh all possible treatment options."
Although the use of NSAIDs for arthritic conditions such as knee OA has potential risks, including heart attack and stroke, existing evidence indicates that naproxen has less potential for adverse cardiovascular events.

Get off the golf cart if you have knee osteoarthritis

From presidents to retirees, more than 17 million people over the age of 50 golf regularly. Knee osteoarthritis, which causes swelling, pain and difficulty moving the joint, is one of the leading causes of disability in this age group.
It may seem intuitive that golfers with knee osteoarthritis should stay off their feet and ride in a golf cart. But new research from the Shirley Ryan AbilityLab and Northwestern Medicine has found, for the first time, that walking the course provides significantly higher health benefits and is not associated with increased pain, cartilage breakdown or inflammation.
This study is the first comparing the health benefits of walking the golf course versus using a cart, as well as the first to use a blood-based biomarker analysis in knee osteoarthritis during a prolonged sporting event. The findings will be presented April 28 at the Osteoarthritis Research Society International Annual Meeting in Liverpool, England.
The health benefits of golf have decreased as the number of people who ride the course has increased over the past 20 years. In the late 1980s, 45 percent of all rounds of golf were played with a golf cart. By 2006, 69 percent of rounds were played with a cart. During this same time period, activity has decreased among Americans, while obesity has increased.
"Individuals with knee osteoarthritis are often concerned about pain and may be more likely to use a golf cart," said lead study author Dr. Prakash Jayabalan, a physician scientist at the Shirley Ryan AbilityLab and an assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine.
"However, through sophisticated blood-based biomarker analysis, this study has shown that golfers with knee osteoarthritis do not need to be concerned about worsening their disease through walking the course. In fact, walking provides the best health benefit," Jayabalan said.
The study, completed in partnership with the Glenview Park District Golf Course in Glenview, Illinois, involved 15 participants -- 10 who had knee osteoarthritis and five who were of similar age but did not have the disease. Participants played 18 holes (one round of golf) walking the course and, on a separate day, the same individuals played a round riding a golf cart. The research team compared their heart rates to determine the intensity of exercise performed and took blood samples during each round to measure markers of cartilage stress and inflammation.
The researchers found that, prior to starting either round, the golfers with knee osteoarthritis had an average pain score of 1.3 (on a scale of 0-10). When they played the round walking the course, they had an average 2.1-point increase in pain score. When they played the round using the golf cart, they experienced on average a 1.5-point increase, a difference that is not clinically significant.
The research team also measured blood-based biomarkers of cartilage stress and inflammation. Although both methods of transportation caused an increase in these markers (as would be expected with regular walking), there was no difference between the rounds.
When walking the course, golfers with knee osteoarthritis spent more than 60 percent of the round with heart rates in the moderate intensity heart rate zone. When driving on a cart, golfers spent 30 percent of the round in this range. While this figure is lower, it still fulfills daily exercise recommendations.
Although walking the course offers the most significant health benefits, the study found that riding the course with a golf cart during a round -- and the requisite moderate walking that comes with it -- still offers cardiovascular benefits and helps fulfill daily exercise guidelines.

"Bottom line: walking the course is significantly better than using a golf cart, but using a golf cart is still better than not exercising at all," said Jayabalan.

Higher aerobic fitness levels are associated with better word production skills in healthy older adults

Healthy older people who exercise regularly are less inclined to struggle to find words to express themselves, research led by the University of Birmingham has discovered.

Researchers found that older adults' aerobic fitness levels are directly related to the incidence of age-related language failures such as 'tip-of-the-tongue' states.

The research, published today in Scientific Reports, is the first of its kind to investigate the relationship between aerobic fitness levels and temporary cognitive lapses, such as not having a word come to mind when speaking - known as a 'tip-of-the-tongue' state.

People in a tip-of-the-tongue state have a strong conviction that they know a word, but are unable to produce it, and this phenomena occurs more frequently as we grow older.

The University of Birmingham study - carried out in collaboration with the University of Agder in Norway, the University of Leuven in Belgium and King's College London - measured the occurrence of tip-of-the-tongue states in a psycholinguistic experiment.

The study saw a group of 28 healthy adults (20 women with the average age of 70 and 8 men with the average age of 67), being compared in a 'tip-of-the-tongue' language test to 27 young people (19 women with the average age of 23 and 8 men with the average age of 22).

The test involved a 'definition filling task', done on a computer. They were asked to name famous people in the UK, such as authors, politicians and actors, based on 20 questions about them. They were also given the definitions of 20 'low frequency' and 20 'easy' words and asked whether they knew the word relating to the definition.

The participants' underwent a static bike cycling test - a gold standard test which quantified their ability to use oxygen during exercise and their resulting individual aerobic fitness levels.

Lead author Dr Katrien Segaert, of the University of Birmingham's School of Psychology, said:

"Older adults free from medical diseases still experience age-related cognitive decline.
"Significantly, what we found was that the degree of decline is related to one's aerobic fitness.
"In our study, the higher the older adults' aerobic fitness level, the lower the probability of experiencing a tip-of-the-tongue state. 

"Importantly, our results also showed that the relationship between the frequency of tip-of-the-tongue occurrences and aerobic fitness levels exists over and above the influence of a person's age and vocabulary size."

Dr Segaert said that tip-of-the-tongue states are uniquely a problem with language functioning.

"Older adults sometimes worry that tip-of-the-tongue states indicate serious memory problems but this is a misconception: tip-of-the-tongue states are not associated with memory loss," she added. "In fact, older adults usually have a much larger vocabulary than young adults. Instead, tip-of-the-tongue states occur when the meaning of a word is available in our memory, but the sound form of the word can temporarily not be accessed."

"Accessing the sound forms of words is essential for successful and fluent language production, and its disruption has very noticeable negative consequences for older adults."

She said she hoped the study would add gravitas to the public health message that regular exercise is important to ensure healthy ageing.

She added: "There are a lot of findings already on the benefits of aerobic fitness and regular exercise, and our research demonstrates another side of the benefits, namely a relationship between fitness and language skills. We were able to show, for the first time, that the benefits of aerobic fitness extend to the domain of language."

"Maintaining good language skills is extremely important for older adults. Older adults frequently have word finding difficulties and they experience these as particularly irritating and embarrassing."
"Speaking is a skill we all rely on every day. Communication with others helps us maintain social relationships and independence into old age."

In future research, the University of Birmingham plans to undertake exercise intervention studies to determine whether regular exercise can successfully increase language abilities.

Following five healthy lifestyle habits may increase life expectancy by decade or more

Maintaining five healthy habits--eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking--during adulthood may add more than a decade to life expectancy, according to a new study led by Harvard T.H. Chan School of Public Health.

Researchers also found that U.S. women and men who maintained the healthiest lifestyles were 82% less likely to die from cardiovascular disease and 65% less likely to die from cancer when compared with those with the least healthy lifestyles over the course of the roughly 30-year study period.
The study is the first comprehensive analysis of the impact of adopting low-risk lifestyle factors on life expectancy in the U.S. It will be published online April 30, 2018 in Circulation.

Americans have a shorter average life expectancy--79.3 years--than almost all other high-income countries. The U.S. ranked 31st in the world for life expectancy in 2015.

The new study aimed to quantify how much healthy lifestyle factors might be able to boost longevity in the U.S.

Harvard Chan researchers and colleagues looked at 34 years of data from 78,865 women and 27 years of data from 44,354 men participating in, respectively, the Nurses' Health Study and the Health Professionals Follow-up Study.

The researchers looked at how five low-risk lifestyle factors--not smoking, low body mass index (18.5-24.9 kg/m2), at least 30 minutes or more per day of moderate to vigorous physical activity, moderate alcohol intake (for example, up to about one 5-ounce glass of wine per day for women, or up to two glasses for men), and a healthy diet--might impact mortality.

For study participants who didn't adopt any of the low-risk lifestyle factors, the researchers estimated that life expectancy at age 50 was 29 years for women and 25.5 years for men. But for those who adopted all five low-risk factors, life expectancy at age 50 was projected to be 43.1 years for women and 37.6 years for men. In other words, women who maintained all five healthy habits gained, on average, 14 years of life, and men who did so gained 12 years, compared with those who didn't maintain healthy habits.

Compared with those who didn't follow any of the healthy lifestyle habits, those who followed all five were 74% less likely to die during the study period. The researchers also found that there was a dose-response relationship between each individual healthy lifestyle behavior and a reduced risk of early death, and that the combination of all five healthy behaviors was linked with the most additional years of life.

"This study underscores the importance of following healthy lifestyle habits for improving longevity in the U.S. population," said Frank Hu, chair of the Department of Nutrition at Harvard Chan School and senior author of the study. "However, adherence to healthy lifestyle habits is very low. Therefore, public policies should put more emphasis on creating healthy food, built, and social environments to support and promote healthy diet and lifestyles.