Diabetes mellitus in older men

Most persons with diabetes mellitus are over the age of 60 years. Males develop diabetes more commonly than females. Older diabetics tend to have both impaired insulin release as well as insulin resistance. In older persons diabetes mellitus is associated with decreased functional status and cognitive dysfunction. In general, older persons with diabetes are inclined to be underdiagnosed and undertreated. Managing diabetes in older persons requires special considerations because of their differences in pathophysiology of diabetes and strong association with functional, cognitive impairments and comorbidities. The use of strict therapeutic diets is not recommended in older persons. Treatment of hypertension and hyperglycemia can improve outcomes in older persons. The interdisciplinary team approach is important for care of older diabetic persons.     

Age influences anthropometric and fitness-related predictors of bone mineral in men

Objective. This study assessed the influence of age on the predictors of bone mineral in men.

Methods. Middle-age (n = 41, 54 ± 4 yrs) and older (n = 40, 69 ± 5 yrs) men underwent grip and knee extensor strength tests, total body dual-energy X-ray absorptiometry with regional analyses and a graded exercise treadmill test.

Results. Bone-free lean mass (BFLM) and, to a lesser extent, fat mass (FM) were correlated with bone mineral variables in middle-age men. In older men, BFLM and, to a lesser extent, FM were related to bone mineral content (BMC) at most sites, but inconsistently to bone mineral density (BMD). Knee extensor strength related to bone mineral (BMC and BMD) at most sites in middle-age men, but none in older men. Grip strength inconsistently related to bone mineral in both groups. Aerobic capacity related to bone mineral in middle-age men, but none in older men. In multiple regression, body weight or BFLM predicted bone mineral in middle-age men (R² = 0.33–0.68) and BMC in older men (R² = 0.33–0.50). Predictors of BMD were inconsistent in older men.

Conclusions. Relationships of body composition, muscular strength and aerobic capacity to bone mineral are stronger in middle-age versus older men.     

Effects of long-term testosterone replacement therapy,with a temporary intermission,on glycemic control of nine hypogonadal men with type 1 diabetes mellitus – a series of case reports

Abstract

Type 2 diabetes mellitus (T2DM) is often associated with obesity and subnormal serum testosterone (T) levels. Until 5 years ago there was no indication that men with type 1 diabetes mellitus (T1DM) had subnormal serum T. But recent studies indicate that about 10% of men with T1DM suffer from hypogonadism, as a rule aged men and men with obesity. While hypogonadal men with T2DM benefit from normalization of their serum T, this has not been investigated in men with T1DM. Nine men with T1DM, erectile dysfunction and hypogonadism (total testosterone?≤?12?nmol/L) received testosterone replacement therapy (TRT). In seven men TRT was intermitted: one man with prostate malignancy and six men because of problems of reimbursement. Incidentally, this provided an opportunity to monitor the effects of withdrawal and of the reinstatement of TRT. In all men, glycemic control (serum glucose and HbA_1c), weight, waist circumference, lipid profiles and erectile function improved upon TRT. The seven men whose TRT was intermitted showed a deterioration which improved again upon reinstatement of TRT. The data suggest that aging and obese men with T1DM might have subnormal T levels and that their glycemic control, lipid profiles and erectile function might benefit from TRT.     

A comparison of HIV risk practices among unprotected sex-seeking older and younger men who have sex with other men

Purpose: In recent years, much attention has been devoted to understanding the HIV risk behaviors of younger men who have sex with men (MSM). Recent data suggest that HIV is becoming an increasing problem for older adults, but little attention has been devoted to understanding their HIV risk behaviors or the factors that underlie their risk taking. This study provides a comparison of these issues among younger and older MSM. Methods: The data come from a subset of younger (ages 18–39, n?=?113) and older (ages 50+, n?=?109) men participating in a national study of 332 men who use the Internet to find other men for unprotected sex. Men were sampled randomly from 16 websites. Data were collected via telephone interviews conducted in 2008 and 2009. Results: Younger and older men reported comparable involvement in HIV risk, including involvement in unprotected sex, proportion of sex acts involving internal ejaculation, number of times having anonymous sex, and number of times having multiple-partner sex. Generally speaking, the factors underlying the risk practices of younger and older men were quite different (e.g. self-esteem and condom use self-efficacy for younger men, versus HIV serostatus and depression for older men). Conclusions: Older MSM using the Internet to find partners for unprotected sex engage in high rates of behaviors that place them at risk for contracting or transmitting HIV. They were just as likely as their younger counterparts to practice these behaviors. The factors “fueling” involvement in risk generally differ for older and younger men, thereby warranting the development of age-specific HIV interventions that can take into account the unique life circumstances and needs of older MSM.     

Metabolic Syndrome,Obesity, and Related Risk Factors Among College Men and Women

Abstract

Objectives: The primary objective of this study was to characterize the prevalence of overweight/obesity, metabolic syndrome (MbS) and its criteria, and nutrient intakes of college-age men and women via a large-scale screening. Participants and Methods: From August 2005 to July 2008, 2,722 subjects were recruited for the ongoing, cross-sectional Young Adult Health Risk Screening Initiative project. Anthropometric, biochemical, clinical, and dietary data were collected. Results: Approximately one-half of men and more than one-quarter of women were overweight or obese. MbS was identified in 9.9% of men and 3.0% of women; 77% of men and 54% of women had at least 1 MbS criterion. Intakes of saturated fat, magnesium, and fiber, as well as body mass index and reported physical activity levels were related to MbS. Conclusions: Because of high rates of overweight/obesity and MbS, college-age adults are at risk for developing chronic diseases including diabetes mellitus and cardiovascular disease     

Low total testosterone is associated with increased risk of incident type 2 diabetes mellitus in men: results from the Study of Health in Pomerania (SHIP)

Objective.?There is increasing evidence suggesting that low total testosterone concentration is associated with incident type 2 diabetes mellitus (T2DM) in men. The aim of this study was to evaluate the association between total testosterone and incident T2DM in a large population-based cohort.

Methods.?Of 2117 men at baseline, 1589 were followed up 5 years later. Low total testosterone concentration at baseline determined by <10th percentile (10-year age-strata) were used as a risk factor for incident T2DM at follow-up. To evaluate for potential non-response bias, drop out weights were used in sensitivity analysis.

Results.?From 1339 men eligible for analyses, 68 (5.1%) developed T2DM. Men with low total testosterone concentration had an increased risk of developing T2DM (odds ratio [OR] 3.4, 95% CI 1.9–6.1), even after adjustment for age, waist circumference and smoking, OR 3.0; (95% CI 1.6–5.7). Recalculated weighted models revealed almost identical estimates indicating no relevant non-response bias.

Discussion.?Our prospective findings suggest that low total testosterone concentration is associated with incident T2DM in men and might represent a biomarker that might causally be involved in the risk of T2DM. This underlines the importance of measuring total testosterone in men as the predominant male sex hormone.     

Emotional Well-Being Factors Associated with Sexual Dysfunction in Adults with Type 1 or Type 2 Diabetes: Results from Diabetes MILES—Australia

Abstract

Objective: Diabetes is a chronic health condition that requires daily self-management activities to prevent or delay the onset of serious long-term complications. The two main types of diabetes are Type 1 (T1D) and Type 2 diabetes (T2D). Although both differ in their etiology, they share similar challenges of self-management of blood glucose levels, which, if are persistently high over time can lead to serious long-term complications. Sexual dysfunction (SD) is a common complication of both types of diabetes and affects both men and women. Although the physical aspects of SD are established, less is known about the emotional factors that may also impact SD in adults with diabetes. This study explored the emotional well-being factors associated with SD among 3,338 men and women with T1D and T2D. Methods: The relationships between self-reported SD and depressive and anxiety symptoms, and diabetes-specific distress, were examined using logistic regression modelling. Results: SD was associated with depressive symptoms (all sub-groups), anxiety (men/T2D; women/T1D/T2D), and diabetes-specific distress (women/T1D/T2D). Diabetes-specific distress was significantly higher in those with T2D who believed their SD was caused by their diabetes. Conclusions: SD impacts both men and women with T1D/T2D and is associated with emotional distress. Evaluation of SD and emotional problems should form part of routine clinical assessment.     

Bone mineral density in men with and without the metabolic syndrome

The objective of this study was to measure bone mineral density (BMD) in middle-aged men with and without the metabolic syndrome according to the International diabetes federation (IDF) definition from 2005. We studied 80 men (mean age: 51.9 ± 9.0 y, mean body mass index (BMI): 32.0 ± 1.7 kg/m²) with and 92 men without the metabolic syndrome (mean age: 52.6 ± 15.1 y, mean BMI: 24.9 ± 2.8 kg/m²). Height (cm), weight (kg), waist circumference (cm) and blood pressure were measured. Fasting plasma glucose (FPG) and blood lipids were determined. BMD at the lumbar spine and total hip was measured by dual X-ray absorptiometry on a Hologic QDR 4500 bone densitometer. In men around 59.3% had a waist circumference > 94 cm (abdominal obesity). Among them 58.7% showed abnormal BP values. Around 30.7% had FPG ≥ 5.6 mmol/L and 22.7% had low high density lipoprotein (HDL)-cholesterol and 36.6% had hypertriglyceridemia. In men with the metabolic syndrome, mean lumbar spine BMD was 0.986 ± 0.210 g/cm² and total hip BMD – 1.012 ± 0.209 g/cm². The corresponding values in men without this syndrome were 0.934 ± 0.179 g/cm² and 0.894 ± 0.189 g/cm², respectively. The inter-group BMD difference reached statistical significance only at the hip (p = 0.039). Respectively, the prevalence of osteoporosis at the central sites was significantly higher in men without the metabolic syndrome (MS) (13.2 versus 20.8%, p = 0.03). Our data confirmed the trend for higher BMD in the studied men with the metabolic syndrome.     

Identifying and Working with Older Male Victims of Abuse in England

SUMMARY

The abuse of men is still very much a taboo subject, so identifying older men who have been abused in childhood or adulthood can be very difficult. This paper discusses the problems in identifying older male victims by drawing on the findings of two research projects. Statistical evidence is presented regarding the victims and the abuse they have experienced. It is argued that in general resources are not readily available to facilitate disclosure or to help men through the healing process. An example of good practice is presented by discussing the work undertaken with an older man through group work.     

Estrogen receptor alpha single nucleotide polymorphism as predictor of diabetes type 2 risk in hypogonadal men

Abstract

Estradiol (E2) is, apart from its role as a reproductive hormone, also important for cardiac function and bone maturation in both genders. It has also been shown to play a role in insulin production, energy expenditure and in inducing lipolysis. The aim of the study was to investigate if low circulating testosterone or E2 levels in combination with variants in the estrogen receptor alpha (ESR1) and estrogen receptor beta (ESR2) genes were of importance for the risk of type-2 diabetes. The single nucleotide polymorphisms rs2207396 and rs1256049, in ESR1 and ESR2, respectively, were analysed by allele specific PCR in 172 elderly men from the population-based Tromsø study. The results were adjusted for age. In individuals with low total (≤11?nmol/L) or free testosterone (≤0.18?nmol/L) being carriers of the variant A-allele in ESR1 was associated with 7.3 and 15.9 times, respectively, increased odds ratio of being diagnosed with diabetes mellitus type 2 (p?=?0.025 and p?=?0.018, respectively). Lower concentrations of E2 did not seem to increase the risk of being diagnosed with diabetes. In conclusion, in hypogonadal men, the rs2207396 variant in ESR1 predicts the risk of type 2 diabetes.     

Resource Accessibility and Walkability Among Older Adults in Extended-Stay Hotels

Older adults represent a large and growing population group in the United States. This population cohort is projected to grow to 72.1 million, or 19% of the total population, by 2030, up from 40 million in 2010 (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012). Despite reported decreases in the proportion of older adults living in poverty in recent years, inequities prevail. Approximately 40% of older American households reported housing cost burdens¹Cost burdens are expenditures on housing and utilities that exceed 30% of household income. (Federal Interagency Forum on Aging-Related Statistics, 2012). Many of these low-income older adults live in socially and economically marginalized positions, and housing them remains a major challenge complicated by (a) limited affordable housing options and (b) chronic health conditions that seriously undermine long-term health and mobility. In a study on the impacts of public housing transformation in Atlanta, Oakley, Reid, & Ruel (2011) reported that 26% of seniors entered public housing because of a health condition or disability. According to Smith (2006), seniors in public housing are in worse health than other older Americans, even other poor older Americans suffering from such chronic health conditions as hypertension, diabetes, arthritis, and asthma. Despite these realities, Ball (2012) has noted that older adults receive little attention in comprehensive development planning beyond specialized age-segregated retirement and care communities. Salkin (2009) echoes similar concerns about the tendency toward housing initiatives and designs for more affluent older adults. She commented that most states have focused attention on programs that are best suited for seniors who do not have the same income limitations as those who are truly on fixed incomes and living close to the poverty level (Salkin, 2009). While public housing remains the predominant affordable housing option for low-income older adults, such housing is out of reach for many low-income older adults who find themselves displaced and homeless. As a result, some of these adults move into extended-stay hotels to remain sheltered.     

Out of Harmony: Health Problems and Young Native American Men

Abstract

Studies of the current health status of healthy young Native American men (American Indians and Alaska Natives) are rare compared with the attention researchers have given the many problems that plague the lives of these young men. Native American men are frequently not included in other studies focusing on men, and information on college-aged, healthy young Native American men is generally not readily available. Despite those drawbacks, this article brings together what is written or known about the health status of young Native American men. The emphasis, based on available information, is placed on some of the major health problems confronting this population.     

Marital Status and Problem Gambling Among Australian Older Adults: The Mediating Role of Loneliness

Problem gambling rates in older adults have risen dramatically in recent years and require further investigation. Limited available research has suggested that social needs may motivate gambling and hence problem gambling in older adults. Un-partnered older adults may be at greater risk of problem gambling than those with a partner. The current study explored whether loneliness mediated the marital status–problem gambling relationship, and whether gender moderated the mediation model. It was hypothesised that the relationship between being un-partnered and higher levels of loneliness would be stronger for older men than older women. A community sample of Australian men (n = 92) and women (n = 91) gamblers aged from 60 to 90 years (M = 69.75, SD = 7.28) completed the UCLA Loneliness Scale and the Problem Gambling Severity Index. The results supported the moderated mediation model, with loneliness mediating the relationship between marital status and problem gambling for older men but not for older women. It appears that felt loneliness is an important predictor of problem gambling in older adults, and that meeting the social and emotional needs of un-partnered men is important.     

Fractured Relationships and the Potential for Abuse of Older Men

SUMMARY

Elderly men are an understudied population in the area of abuse and neglect. The typical elder abuse or neglect victim is described as a frail woman. The National Elder Abuse Incidence Study shows men to be victims as well and at higher risk than women for abandonment, the most extreme form of neglect. A qualitative study of older widowed men did not specifically explore issues of abuse and neglect, but found several of the men experiencing alienation from one or more of their adult children. This paper explores the dynamics of these “fractured relationships” and finds several patterns that may increase an older man's risk of being neglected when his needs for support increase. Many men are not functioning in a kinkeeper role and are not attempting to repair fractured relationships. Minimizing their own feelings may prevent men from understanding the extent of alienation felt by an adult child.     

“How Do I View My Sister?”

Abstract

Little research to date has focused on what factors interfere with the process of African American women and men developing and maintaining healthy relationships. A better understanding of these factors can help to improve relationships between these individuals and create stronger families within the African American community. Research has documented that prevailing stereotypes of African American women impact the lives of African American women and that stereotypes have the potential to impact interpersonal relationships. The purpose of the current study was to assess whether African American men endorsed stereotypic views of African American women, and to discuss the potential of these views to negatively impact the quality of relationships between African American women and men. Results indicate that 71% of men surveyed endorsed stereotypic views of African American women. Implications of these findings and future directions for research are presented.     

Assessing the Psychosocial Well-Being of African American Gays:

This paper presents a model for assessing personal, cultural, and social factors influencing the psychosocial well-being of black gay men. Differences are discussed by focusing on three groups-adolescent, adult and older gay African American men. Each of these groups is considered in connection with the developmental tasks of play, work and love. These tasks are explored as a function of age cohort, gender appearances, socioeconomic status, church and religon, and area of residence as they are linked to an individual's participation in the black, gay, and black gay communities. These intersecting domains are addressed within the context of racism as they affect the psychosocial well-being of black gay men.     

Increased incidence of metabolic syndrome in older men with high normotension

Introduction: Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. Methods: In this cross-sectional study, totally 2388 normotensive older men aged 65–80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. Results: Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55–fold OR (p < 0.001) for having MetS than Group-1. Conclusions: In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.     

The influence of exercise on the functioning of the pituitary–gonadal axis in physically active older and younger men

Age is a meaningful factor modulating the functioning of the human endocrine system. In our research, the factor stimulating the pituitary–gonadal axis was a 400 m race. In this type of effort, glycolytic and lactic acid transformations are dominant and a fundamental increase in lactic acid concentration is noted. The aim of the research was to compare the response of the pituitary–gonadal axis in physically active men of various ages after a 400 m race. Nine men aged 21.7 ± 0.7 years and nine men aged 60.0 ± 3.4 years took part in the study. Blood samples were taken from the elbow vein before the race at 08.00 and immediately after the effort. The levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone and free testosterone were determined in blood sera. The concentration of lactic acid was measured in full blood at 5 min after the race. Before the effort, statistically significant differences in the concentration of FSH and free testosterone between the two age groups were observed (higher FSH in older men but lower free testosterone). No differences in the level of LH, total testosterone and lactic acid were observed. Immediately after the effort, no changes in the level of FSH were found in both groups; a statistically significant decrease in LH concentration was noted only in the group of younger men. In both groups, statistically significant increases in total testosterone, free testosterone and lactic acid concentrations were observed after the race. In the group of younger men, compared to the older, larger increases in free testosterone and lactic acid concentrations, as well as shorter race time, were revealed after the effort test. Analysis of the two groups after the race showed statistically significant differences in FSH, free testosterone and lactic acid concentrations. A positive correlation (r = 0.57) was demonstrated between the after-effort increase in the concentration of free testosterone and lactic acid, and negative correlation (r = –0.66) between the after-effort increase in the concentration of free testosterone and the time of the 400 m race. In older men, the concentration of free testosterone may play an important function in lowering strength capacities. It must be stressed that the 400 m race was a more significant stimulus for changes in hormone concentrations of the pituitary–gonadal axis in younger men (greater changes in the level of the investigated parameters) than in the older. The results obtained allow us to conclude that, in older men, as compared to the younger ones, the response of the pituitary–gonadal axis to an effort stimulus is to some extent different.     

Life Course Diversity Among Older Lesbians and Gay Men: A Study in Chicago

How much can we assume about the shared life experiences of older lesbians and gays? This article is broadly concerned with rethinking the significance of this question as it pertains to cultural images and stereotypes of “older gay and lesbian” identities in a large and diverse American city. In 1996, the authors completed a 10-month needs assessment study regarding the lives and needs (social and psychological), which must be addressed for older lesbians and gays in the city of Chicago. The authors take the approach that simply being of the same or similar age is insufficient to understand the meaning of people's sexual identities. They entered into this study aware of some stereotypes about older lesbians and gays, but like previous investigators, they were surprised at the range of diversity that they uncovered. They discovered not only the common denominators in their participants' experiences and their lives, but as some commentators have already suggested, they also discovered a great deal of variation. To address the issues, the authors describe conceptual problems that emerged in a recent needs assessment of older lesbians and gay men in Chicago.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.