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Hypertension and Frailty Syndrome in Old Age

Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.

The hackable city

Sustained changes in body composition during 6 months follow-up after combined lifestyle intervention in older adults with obesity and type 2 diabetes

Just-in-Time prompts for running, walking, and performing strength exercises in the built environment: 4-Week randomized feasibility study

Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts.Objective: The main objective of this study was to examine user experience, app engagement, and users' perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants.Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth.Results: No differences in PA behavior were observed (Z=-1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=-3.342; P<.001 and Z=-1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=-1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience.Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable.

Building Biomimicry Bridges - a toolbox for biomimicry practitioners

Few people I know act likea magnet in the way Laura does. If you hear her speak, see her move, enjoy her smile - you can't help but want to be a part of what makes her heart beat faster. She radiates passion for her dream topic biomimicry and before you know it you're caught in that dream. From the day I met her, I was captivated by her enthusiasm and knowledge about this topic. In fact, meeting Laura made me decide to join the university as I thought: if people like Laura work at THUAS, I want to be a part of this organization'. Over the years I have seen her finish the Msc in biomimicry at Arizona State University followed by a PhD at TUDelft. And all that next to her full time job as a teacher. It's only a miracle that she still found the time to go outdoors and be in Nature. But luckily, she did as this is what nourishes her - and that nourishment is brought into the classroom affecting generations of students. I am very proud of how she builds her tribe just like Nature does; grassroots from the bottom up, not supported but also not inhibited by formal structures. In that way she truly acts as a bridge helping others to tap into Nature's wisdom. This morning I harvested the remaining vegetables from my garden and turned them into lunch. It's the second year I grow vegetables and it feels like I am only at the beginning of learning to collaborate with Nature. In Spring and Summer, Ihave witnessed in awe how seeds become seedlings which then grow into mature plants carrying fruit. The sheer wonder of Nature never ceases to amaze me, and my garden is only an attempt to be more aware of seasonal rhythms. It's Autumn right now, a time of year that invites us to go inside, reflect and let go of old baggage that no longer serves us. We'll be approaching the stage of wintering soon in which our inner journey will benefit from the darkness of wintertime introspection, along with the space to process the old, integrate learnings, and then germinate the new. Over the course of her career, Laura has gone through these seasonal cycles - reinventing herself in the past decade as a teacher, researcher and regenerative leader. One of Laura's many qualities is that she embodies three leadership characteristics derived from Nature. First, she acknowledges the importance of interconnection. Many times, we think of Nature as being separate from us, but in reality we humans are Nature. Connection with Nature enables us to think within systems and understand that we can't direct the system, but instead we're all part of multiple systems. Second, sensing the system and our part in it builds resilience. Even if things don't go as we expected or imagined, rather than reacting, we can step back and engage with more insight. Laura's adaptability to a system's needs while spotting opportunities to crack it open, is admirable. As the system is always in evolution, so is she - remarkably receptive to change even in the final stages of her career. Third, Laura creates space for people to develop and thrive, acting as multipliers of her vision and love for the natural world. In her leadership she embodies the ideal elder while being able to perceive the world through the eyes of a child - with continuous wonder for how life unfolds. This book is a bricolage of Laura's post-doc research conducted the past two years. In it you will find an array of fascinating reads and tools that help you deepen your practice as a biomimicry professional. The book is a community effort integrating tools Laura has co-created with her ecosystem as well as more in-depth readings written by some of the talents she has nourished over time. I wish for you to enjoy this careful curation of both practical as well as more conceptual contributions. May it inspire your own thriving in bringing Nature based wisdom to the core of our daily lives.

Brain dynamics in the comprehension of action-related language : a time frequency analysis of mu rhythms

EEG mu rhythms (8-13. Hz) recorded at fronto-central electrodes are generally considered as markers of motor cortical activity in humans, because they are modulated when participants perform an action, when they observe another's action or even when they imagine performing an action. In this study, we analyzed the time-frequency (TF) modulation of mu rhythms while participants read action language ("You will cut the strawberry cake"), abstract language ("You will doubt the patient's argument"), and perceptive language ("You will notice the bright day"). The results indicated that mu suppression at fronto-central sites is associated with action language rather than with abstract or perceptive language. Also, the largest difference between conditions occurred quite late in the sentence, while reading the first noun, (contrast Action vs. Abstract), or the second noun following the action verb (contrast Action vs. Perceptive). This suggests that motor activation is associated with the integration of words across the sentence beyond the lexical processing of the action verb. Source reconstruction localized mu suppression associated with action sentences in premotor cortex (BA 6). The present study suggests (1) that the understanding of action language activates motor networks in the human brain, and (2) that this activation occurs online based on semantic integration across multiple words in the sentence.