In sickness and in health: A qualitative study of elderly men who care for wives with dementia

It is estimated that approximately 1,000,000 elderly men care for spouses with Alzheimer's disease or other forms of cognitive impairment, yet we have only a limited understanding of their work, and central questions arise. What do men caregivers do, and what meanings do they ascribe to their work? What are their distinctive strengths and vulnerabilities, and what can we learn about men and caregiving from their stories? This qualitative study was based on in-depth, open-ended interviews with 14 elderly men who are primary caregivers to wives with dementia. All interviews were taped, transcribed, and manually coded. The resulting information then underwent analysis from which three major themes emerged: feelings of isolation and invisibility of their care work, a style of caregiving that jointly utilizes management and nurturing, and feelings of commitment, responsibility, and devotion.     

Effect of testosterone therapy on lumbar spine and hip mineral density in elderly men

Objective.?The aim of the present study was to analyse the effect of testosterone therapy on bone mineral density in healthy elderly men who had low levels of total testosterone.

Design.?Randomized, double-blind, placebo-controlled study.

Participants.?Forty-eight men over 60 years old with decreased testosterone levels (≤320 ng/dL) comprised the study. Twenty-five out of 48 received intramuscular injections of testosterone enanthate every three weeks during 12 months; the remaining 23 participants formed the control group. All participants had measurements of bone mineral density (BMD) in both lumbar spine and hip before and at the end of the study as well as testosterone and 17-β estradiol levels.

Results:?Testosterone treated group exhibited a significant (p < 0.05) increment (from 1.198 ± 0.153 to 1.240 ± 0.141 g/cm²) in lumbar BMD in parallel with a significant (p < 0.001) increment (from 301 ± 32 to 471 ± 107 ng/dL) in testosterone concentrations, whereas no significant change occurred in femoral neck BMD.

Conclusions.?Testosterone therapy elicited a positive effect only in lumbar BMD in elderly men with diminished testosterone serum levels.     

The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men

Sexual activity in older people has become a topic of growing interest. The aim of this study is to investigate the effect of physical health and socioeconomic factors on the sexual activity of middle-aged and elderly Taiwanese men. From August 2007 to April 2008, 744 men older than 40 years were enrolled from a free health screening in Kaohsiung, Taiwan. All participants received detailed physical examination and answered questionnaires that collected demographic and lifestyle information, and medical history as well as answered items from the International Prostate Symptoms Score and five-item version of the International Index of Erectile Function (IIEF-5). Overall, 100 (13.4%) participants reported to be sexually inactive in previous 6 months. Older age, lower education levels, loss of a partner, erectile dysfunction, and increased number of comorbidities were found to be independent predictors for sexual inactivity. In conclusion, most middle-aged and elderly Taiwanese men remain sexually active. In addition to erectile dysfunction and loss of a partner, lower education levels and increased number of comorbidities were found to be predictors for sexual inactivity. Further research would need to elucidate whether improvement of those factors could help to preserve sexual activity.     

Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity,voiding function and prostate safety parameters

Whether testosterone replacement therapy (TRT) is a lifelong treatment for men with hypogonadism remains unknown. We investigated long-term TRT and TRT withdrawal on obesity and prostate-related parameters. Two hundred and sixty-two hypogonadal patients (mean age 59.5) received testosterone undecanoate in 12-week intervals for a maximum of 11 years. One hundred and forty-seven men had TRT interrupted for a mean of 16.9 months and resumed thereafter (Group A). The remaining 115 patients were treated continuously (Group B). Prostate volume, prostate-specific antigen (PSA), residual voiding volume, bladder wall thickness, C-reactive protein (CRP), aging male symptoms (AMS), International Index of erectile function – erectile function (IIEF-EF) and International Prostate Symptoms Scores (IPSS) were measured over the study period with anthropometric parameters of obesity, including weight, body mass index (BMI) and waist circumference. Prior to interruption, TRT resulted in improvements in residual voiding volume, bladder wall thickness, CRP, AMS, IIEF-EF, IPSS and obesity parameters while PSA and prostate volume increased. TRT interruption reduced total testosterone to hypogonadal levels in Group A and resulted in worsening of obesity parameters, AMS, IPSS, residual voiding volume and bladder wall thickness, IIEF-EF and PSA while CRP and prostate volume were unchanged until treatment resumed whereby these effects were reversed. TRT interruption results in worsening of symptoms. Hypogonadism may require lifelong TRT.     

A systematic review of the association between lower urinary tract symptoms and falls,injuries, and fractures in community-dwelling older men

Background: Lower urinary tract symptoms (LUTS) have been associated with falls in studies either exclusively or predominantly of women. It is, therefore, less clear if LUTS are risk factors for falls in men.

Methods: We conducted a systematic review of the literature on the association between LUTS and falls, injuries, and fractures in community-dwelling older men. Medline, Embase, and Cinahl were searched for any type of observational study that has been published in a peer-reviewed journal in English language. Studies were excluded if they did not report male-specific data or targeted specific patient populations. Results were summarized qualitatively.

Results: Three prospective cohort studies and six cross-sectional studies were identified. Incontinence, urgency, nocturia, and frequency were consistently shown to have weak to moderate association with falls (the point estimates of odds ratio and relative risk ranged from 1.31 to 1.67) in studies with low risk of bias for confounding. Only frequency was shown to be associated with fractures.

Conclusions: Urinary incontinence and lower urinary tract storage symptoms are associated with falls in community-dwelling older men. The circumstances of falls in men with LUTS need to be investigated to generate hypotheses about what types of interventions may be effective in reducing falls.     

Use of thermobalancing therapy in ageing male with benign prostatic hyperplasia with a focus on etiology and pathophysiology

Introduction: We investigated if “thermobalancing” therapy (TT), using Dr Allen’s therapeutic device (DATD) in men with benign prostatic hyperplasia (BPH), can aid in understanding the etiology and pathophysiology of BPH.

Methods: We compared urinary and other parameters of BPH patients who received TT over 6 months (treatment group) with those of healthy volunteers who had not received the treatment (control group). Dynamics of symptoms and indicators in each group were evaluated in comparison with their data at the beginning and end of the study. Parameters were the International Prostate Symptom Score (IPSS) for urinary symptoms and quality of life (QoL), ultrasound measurement of prostate volume (PV) and uroflowmetry (maximum flow rate, Q_max). TT effectiveness was examined in 124 men with BPH and PV?<60?mL. We also investigated the data of five patients with BPH and PV?>60?mL.

Results: TT decreased urinary symptoms and PV, increased Q_max and improved QoL in men with BPH, PV?<60?mL, and in men with BPH, PV?>60?mL.

Conclusions: The present study demonstrated that TT is effective for BPH, suggesting that blood circulation plays a crucial role in its cause. The continuous heat exposure that does not exceed the normal body temperature terminates the trigger of BPH development, “micro-focus” of hypothermia, and the following spontaneous expansion of capillaries. TT could be considered to be a useful tool in BPH treatment.     

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS)

The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (Q_MAX), while the second group of patients exhibited significant improvement in both PVR and Q_MAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.     

The impact of testosterone replacement therapy on glycemic control,vascular function,and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).

Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n?=?28) was treated with testosterone undecanoate (1000?mg i.m. every 10?weeks) while group P (n?=?27) received placebo.

Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.

Results: TRT resulted in reduction of HOMA-IR by 4.64?±?4.25 (p?p?p?=?.005).

Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.