Gastric and colonic metastases of malignant melanoma diagnosed during endoscopic evaluation of symptomatic anemia presenting as angina: a case report.

A 72-year-old man visited cardiology for exertional chest pain, lightheadedness, and fatigue. Six years prior, he was surgically treated for cutaneous malignant melanoma of the lower back. After a negative cardiac work-up, primary care diagnosed severe iron deficiency anemia. Emergent upper and lower gastrointestinal (GI) endoscopy revealed simultaneous melanoma metastases to the stomach and colon with discrete macroscopic features. Metastatic disease, including brain, lung, and bone, was discovered on imaging. Treatment included immunotherapy with nivolumab and stereotactic radiosurgery of the brain metastases, and our patient has remained in continued remission even after 2 years. Melanoma with GI tract (GIT) metastasis has a poor prognosis and rarely presents symptomatically or with synchronous gastric and colonic lesions. This case illustrates the importance of early primary care involvement to expedite work-up for multifocal GI metastases in patients with a remote melanoma history presenting with symptoms related to iron deficiency anemia (IDA).

Innovations in Geroscience to enhance mobility in older adults.

Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.

Risk Factors for Pressure Ulcers in Hospitalized Elderly without Significant Cognitive Impairment.

PURPOSE: To evaluate risk factors for pressure ulcers (PU) in hospitalized elderly without significant cognitive impairment. METHODS: From July 2005 to February 2006, 40 hospitalized elderly patients without cognitive deficit were evaluated in a university hospital in Pouso Alegre, Brazil. Twenty patients with a PU formed the study group and 20 without a PU formed the control group. The Mini Mental State Examination (MMSE) was used to assess cognitive status. Pressure ulcers were classified using the National Pressure Ulcer Advisory Panel (NPUAP) guidelines, followed by evaluation of risk factors for PU using the Braden scale. The chi-squared test was applied and for the Braden scale the Mann-Whitney test was used. RESULTS: In the study group, 14 (70%) of the subjects were women and 6 (30%) were men. The average age was 71.5 years. The average score for the MMSE was 19.7. The average time of hospitalization was 23.1 days for the study group and 13 days for the control. In the Braden scale, the risk factors such as humidity, activity, mobility, friction, and shear force were significant (P < 0.05). CONCLUSION: The data from the present study demonstrate that hospitalized elderly patients have an increased risk for the development of PU. Humidity, activity, mobility, friction, and shear are important risk factors during the hospitalization period.

The influence of comorbid chronic medical conditions on the adequacy of depression care for older Americans.

OBJECTIVES: To assess the effect of the co-occurrence of four common chronic medical conditions (hypertension, diabetes mellitus, arthritis, heart disease) on the probability of receiving adequate depression treatment. DESIGN: Retrospective analysis of the 2000 and 2001 Medical Expenditure Panel Surveys (MEPS). SETTING: Households in the United States. PARTICIPANTS: MEPS respondents aged 65 and older with self-reported depression (N=498). MEASUREMENTS: Adequate depression treatment is defined as receiving eight psychotherapy sessions or filling at least four antidepressant prescriptions at a minimally adequate dosage. Comorbid diabetes mellitus, hypertension, heart disease, and arthritis in older persons with depression were identified from patient self-report. RESULTS: An estimated 34% (95% confidence interval=28-39%) of older persons with self-reported depression received an adequate course of depression treatment during a calendar year. Having hypertension or diabetes mellitus was associated with significantly greater odds of receiving adequate depression care (hypertension odds ratio (OR)=1.81, P=.02; diabetes mellitus OR=1.77, P=.03). Having heart disease or arthritis was not significantly associated with the odds of receiving adequate depression care. CONCLUSION: Some chronic medical conditions are associated with a greater likelihood of receiving adequate depression care; comorbid medical conditions do not result in lower quality of depression treatment in older persons. The high prevalence rates of comorbid depression and low rates of adequate depression care in elderly persons with chronic illnesses point to the importance of improving primary care depression treatment or enhancing specialty mental health referral.

Improved cardiorespiratory endurance following 6 months of resistance exercise in elderly men and women.

OBJECTIVE: To examine the effect of 6 months of high- or low-intensity resistance exercise on aerobic capacity and treadmill time to exhaustion in adults aged 60 to 83 years. METHODS: Sixty-two men and women completed the study protocol. Subjects were matched for strength and randomly assigned to a control (n = 16), low-intensity exercise (LEX, n = 24), or high-intensity exercise (HEX, n = 22) group. Subjects trained at either 50% of their one repetition maximum (1-RM) for 13 repetitions (LEX) or 80% of 1-RM for 8 repetitions (HEX) 3 times per week for 24 weeks. One set each of 12 exercises was performed. Strength was measured for the leg press, chest press, leg curl, leg extension, overhead press, biceps curl, seated row, and triceps dip. Muscular endurance was measured for the leg press and chest press. Aerobic capacity (peak oxygen consumption [VO(2)peak]) was measured during an incremental treadmill test (Naughton). Treadmill time to exhaustion was measured as the time to exhaustion during the incremental exercise test. RESULTS: The 1-RM significantly increased (P< or =.05) for all exercises tested for both the HEX and LEX groups. Aerobic capacity increased (P< or =.05) by 23.5% (20.2 to 24.7 mL x kg(-1) x min(-1)) and by 20.1% (20.9 to 24.4 mL x kg(-1) x min(-1)) for the LEX and HEX groups, respectively. Treadmill time increased (P< or =.05) by 26.4% and 23.3% for the LEX and HEX groups, respectively. CONCLUSIONS: Significant improvements in aerobic capacity and treadmill time to exhaustion can be obtained in older adults as a consequence of either high- or low-intensity resistance exercise. These findings suggest that increased strength, as a consequence of resistance exercise training, may allow older adults to reach and/or improve their aerobic capacity.