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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Chapman I, Oberoi A, Giezenaar C, Soenen S. Rational Use of Protein Supplements in the Elderly-Relevance of Gastrointestinal Mechanisms. Nutrients 2021; 13:nu13041227. [PMID: 33917734 PMCID: PMC8068133 DOI: 10.3390/nu13041227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Protein supplements are increasingly used by older people to maintain nutrition and prevent or treat loss of muscle function. Daily protein requirements in older people are in the range of 1.2 gm/kg/day or higher. Many older adults do not consume this much protein and are likely to benefit from higher consumption. Protein supplements are probably best taken twice daily, if possible soon after exercise, in doses that achieve protein intakes of 30 gm or more per episode. It is probably not important to give these supplements between meals, as we have shown no suppressive effects of 30 gm whey drinks, and little if any suppression of 70 gm given to older subjects at varying time intervals from meals. Many gastrointestinal mechanisms controlling food intake change with age, but their contributions to changes in responses to protein are not yet well understood. There may be benefits in giving the supplement with rather than between meals, to achieve protein intakes above the effective anabolic threshold with lower supplement doses, and have favourable effects on food-induced blood glucose increases in older people with, or at risk of developing, type 2 diabetes mellitus; combined protein and glucose drinks lower blood glucose compared with glucose alone in older people.
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Affiliation(s)
- Ian Chapman
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Avneet Oberoi
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Caroline Giezenaar
- Riddett Institute, Massey University, Palmerston North 9430, New Zealand;
| | - Stijn Soenen
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia
- Correspondence: ; Tel.: +61-07-55595-1390
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Aprahamian I, Romanini CV, Lima NA, An VN, Aguirre BN, Galdeano JR, da Costa DL, Petrella M, Ribeiro SML, Borges MK, Morley JE, Voshaar RCO. The concept of anorexia of aging in late life depression: A cross-sectional analysis of a cohort study. Arch Gerontol Geriatr 2021; 95:104410. [PMID: 33823473 DOI: 10.1016/j.archger.2021.104410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Carla Vasconcellos Romanini
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Natália Almeida Lima
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Vinicius Nakajima An
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Bianca Nobre Aguirre
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Júlia Riccetto Galdeano
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Daniela Lima da Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Marina Petrella
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Sandra Maria Lima Ribeiro
- Universidade de São Paulo, Faculdade de Saúde Pública, São Paulo, SP, Brasil; Universidade de São Paulo, Escola de Artes Ciências e Humanidades, São Paulo, SP, Brasil
| | - Marcus K Borges
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - John E Morley
- Geriatrics Division, Saint Louis University, Saint Louis, USA
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Söderström L, Rosenblad A, Bergkvist L, Frid H, Thors Adolfsson E. Dietary advice and oral nutritional supplements do not increase survival in older malnourished adults: a multicentre randomised controlled trial. Ups J Med Sci 2020; 125:240-249. [PMID: 32362168 PMCID: PMC7721033 DOI: 10.1080/03009734.2020.1751752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital.Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure.Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively).Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.Trial registration: ClinicalTrials.gov with ID: NCT01057914.
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Affiliation(s)
- Lisa Söderström
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Department of Statistics, Stockholm University, Stockholm, Sweden
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Leif Bergkvist
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
| | - Hanna Frid
- Department of Child and Adolescence Psychiatry, Västmanland Hospital, Västerås, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
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Wright J, Baldwin C. Oral nutritional support with or without exercise in the management of malnutrition in nutritionally vulnerable older people: A systematic review and meta-analysis. Clin Nutr 2018; 37:1879-1891. [DOI: 10.1016/j.clnu.2017.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/31/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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Dewansingh P, Melse-Boonstra A, Krijnen WP, van der Schans CP, Jager-Wittenaar H, van den Heuvel EG. Supplemental protein from dairy products increases body weight and vitamin D improves physical performance in older adults: a systematic review and meta-analysis. Nutr Res 2018; 49:1-22. [DOI: 10.1016/j.nutres.2017.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/24/2022]
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Ahmed N, Choe Y, Mustad VA, Chakraborty S, Goates S, Luo M, Mechanick JI. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care 2018; 6:e000471. [PMID: 29449950 PMCID: PMC5808633 DOI: 10.1136/bmjdrc-2017-000471] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the impact of pre-existing malnutrition on survival and economic implications in elderly patients with diabetes. RESEARCH DESIGN AND METHODS A retrospective observational study was conducted to examine the impact of malnutrition with or without other significant health conditions on survival time and healthcare costs using the Centers for Medicare and Medicaid Services (CMS) data from 1999 to 2014 for beneficiaries with a confirmed first date of initial diagnosis of diabetes (n=15 121 131). The primary outcome was survival time, which was analyzed using all available data and after propensity score matching. Healthcare utilization cost was a secondary outcome. RESULTS A total of 801 272 beneficiaries were diagnosed with malnutrition. The analysis on propensity score-matched data for the effect of common conditions on survival showed that the risk for death in beneficiaries with diabetes increased by 69% in malnourished versus normo-nourished (HR, 1.69; 99.9% CI 1.64 to 1.75; P<0.0001) beneficiaries. Malnutrition increased the risk for death within each of the common comorbid conditions including ischemic heart disease (1.63; 1.58 to 1.68), chronic obstructive pulmonary disorder (1.60; 1.55 to 1.65), stroke or transient ischemic attack (1.57; 1.53 to 1.62), heart failure (1.54; 1.50 to 1.59), chronic kidney disease (1.50; 1.46 to 1.55), and acute myocardial infarction (1.47; 1.43 to 1.52). In addition, the annual total spending for the malnourished beneficiaries was significantly greater than that for the normo-nourished beneficiaries ($36 079 vs 20 787; P<0.0001). CONCLUSIONS Malnutrition is a significant comorbidity affecting survival and healthcare costs in CMS beneficiaries with diabetes. Evidence-based clinical decision pathways need to be developed and implemented for appropriate screening, assessment, diagnosis and treatment of malnourished patients, and to prevent malnutrition in normo-nourished patients with diabetes.
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Affiliation(s)
- Naseer Ahmed
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | - Yong Choe
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | - Vikkie A Mustad
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | | | - Scott Goates
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | - Menghua Luo
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, USA
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Beelen J, Vasse E, Janssen N, Janse A, de Roos NM, de Groot LCPGM. Protein-enriched familiar foods and drinks improve protein intake of hospitalized older patients: A randomized controlled trial. Clin Nutr 2017; 37:1186-1192. [PMID: 28571713 DOI: 10.1016/j.clnu.2017.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/12/2016] [Accepted: 05/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Adequate protein intake is important in preventing and treating undernutrition. Hospitalized older patients are recommended to consume 1.2-1.5 g of protein per kg body weight per day (g/kg/d) but most of them fail to do so. Therefore, we investigated whether a range of newly developed protein-enriched familiar foods and drinks were effective in increasing protein intake of hospitalized older patients. METHODS This randomized controlled trial involved 147 patients of ≥65 years (mean age: 78.5 ± 7.4 years). The control group (n = 80) received the standard energy and protein rich hospital menu. The intervention group (n = 67) received the same menu with various protein-enriched intervention products replacing regular products or added to the menu. Macronutrient intake on the fourth day of hospitalization, based on food ordering data, was compared between the two groups by using Independent T-tests and Mann Whitney U-tests. RESULTS In the intervention group 30% of total protein was provided by the intervention products. The intervention group consumed 105.7 ± 34.2 g protein compared to 88.2 ± 24.4 g in the control group (p < 0.01); corresponding with 1.5 vs 1.2 g/kg/d (p < 0.01). More patients in the intervention group than in the control group reached a protein intake of 1.2 g/kg/d (79.1% vs 47.5%). Protein intake was significantly higher in the intervention group at breakfast, during the morning between breakfast and lunch, and at dinner. CONCLUSIONS This study shows that providing protein-enriched familiar foods and drinks, as replacement of regular products or as additions to the hospital menu, better enables hospitalized older patients to reach protein intake recommendations. This trial is registered on ClinicalTrials.gov, Identifier: NCT02213393.
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Affiliation(s)
- Janne Beelen
- Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands.
| | - Emmelyne Vasse
- Department of Dietetics, Hospital Gelderse Vallei, PO Box 9025, 6710HN Ede, The Netherlands.
| | - Nancy Janssen
- Department of Dietetics, Hospital Gelderse Vallei, PO Box 9025, 6710HN Ede, The Netherlands.
| | - André Janse
- Department of Geriatric Medicine, Hospital Gelderse Vallei, PO Box 9025, 6710HN Ede, The Netherlands.
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands.
| | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands.
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Abstract
Undernutrition is defined as a state induced by nutrient deficiency that may be improved solely by administration of nutrients. By this definition, provision of adequate protein and energy sources should reverse the clinical presentation and correct the problem. However, a large number of patients who seem to be undernourished fail to respond to refeeding. A developing understanding of the acute-phase inflammatory response to illness and the role of cytokines in the pathophysiology of chronic illness has challenged the current diagnostic paradigm of undernutrition. In the presence of adequate food, weight loss is most often due to cytokine-associated cachexia and anorexia. Failure of appetite, or anorexia, may play a role in involuntary weight loss. Intervention for involuntary weight loss should aim first at the provision of adequate calories and protein, often in the form of high-density nutrition supplements. However, cytokine-mediated cachexia is remarkably resistant to hypercaloric feeding. With continued weight loss, the use of an orexigenic drug should be considered. Orexigenic drugs have been demonstrated to improve appetite and produce weight gain. The mechanism is unknown but may relate to suppression of proinflammatory cytokines. General guidelines for the use of orexigenic agents are presented. Although much work remains to be done, anticytokine drugs seem to be a promising avenue for the treatment of involuntary weight loss.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis Universit Health Sciences Center, St Louis, MO, USA.
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Dionyssiotis Y, Papachristos A, Petropoulou K, Papathanasiou J, Papagelopoulos P. Nutritional Alterations Associated with Neurological and Neurosurgical Diseases. Open Neurol J 2016; 10:32-41. [PMID: 27563361 PMCID: PMC4962432 DOI: 10.2174/1874205x01610010032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 05/15/2016] [Accepted: 05/25/2016] [Indexed: 02/08/2023] Open
Abstract
Neurological and neurosurgical diseases lead to complications producing malnutrition increasing pathology and mortality. In order to avoid complications because of malnutrition or overcome deficiencies in nutrients supplements are often used for these subjects. The physiopathological mechanisms of malnutrition, methods of nutritional assessment and the supplemental support are reviewed in this paper based on the assumption that patients need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation.
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Affiliation(s)
- Yannis Dionyssiotis
- Physical Medicine & Rehabilitation Department, European Interbalkan Medical Center "DIABALKANIKO", Thessaloniki, Greece
| | | | - Konstantina Petropoulou
- 2 Physical Medicine & Rehabilitation Department, National Rehabilitation Center "EKA-KAT", Ilion, Athens, Greece
| | - Jannis Papathanasiou
- Section of Kinesiotherapy & Physiotherapy Department of Preventive Medicine, Medical University of Sofia, Sofia, Bulgaria
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Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility. Open Access Maced J Med Sci 2016; 4:423-427. [PMID: 27703567 PMCID: PMC5042627 DOI: 10.3889/oamjms.2016.094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.
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Affiliation(s)
- Lenche Neloska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Katerina Damevska
- University Clinic of Dermatology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Andjelka Nikolchev
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Lidija Pavleska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | | | - Milenko Kostov
- University Clinic of Neurosurgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Visvanathan R, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Chapman I. The Randomized Control Trial of the Effects of Testosterone and a Nutritional Supplement On Hospital Admissions in Undernourished, Community Dwelling, Older People. J Nutr Health Aging 2016; 20:769-79. [PMID: 27499311 DOI: 10.1007/s12603-016-0689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In a pilot single centre study we found that treatment of undernourished older, community dwelling people for one year with oral testosterone (placebo-controlled) and a nutritional supplement (no control) was associated with a significant reduction in hospitalizations. A larger, multicentre study was conducted to investigate further this potentially important finding. DESIGN One year, randomized, placebo-controlled, multi-centre, double-blind, trial. SETTING Community. PARTICIPANTS 53 undernourished men and women aged 65 years and older. INTERVENTION Oral testosterone undecanoate (40 mg/day women, 160 mg/day men) and high energy oral nutritional supplement (2108-2416 kJ/day) or placebo medication and low energy (142-191 kJ/day) "placebo" oral nutritional supplementation. MEASUREMENTS Hospital admissions, falls and other variables were assessed. RESULTS 53 subjects were recruited (64% male and mean age 77 years), which was substantially less than planned. Sixteen subjects (30%) were admitted to hospital at least once, with a total of 29 admissions. Eight subjects (32%) in the placebo arm were admitted to hospital, whilst in the intervention group also there were eight (29%) subjects admitted to hospital during the study period. There was no difference in the number of hospitalisations (P = 0.842), length of hospitalization (P=0.645) or quality of life [mental health P=0.195 and physical health P=0.451) between the treatment arms. CONCLUSIONS In undernourished older people, treatment with testosterone and a nutritional supplementation did not reduce the number and length of hospitalisations or improve quality of life.
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Affiliation(s)
- R Visvanathan
- Professor Renuka Visvanathan, University of Adelaide and The Queen Elizabeth Hospital, Department of Medicine and The Aged and Extended Care Services, Address: Level 8B, The Queen Elizabeth Hospital, Woodville South, SA 5011, Telephone No: 08-82226887, Fax No: 08-82228593, e-mail:
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14
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Xu ZR, Tan ZJ, Zhang Q, Gui QF, Yang YM. Clinical effectiveness of protein and amino acid supplementation on building muscle mass in elderly people: a meta-analysis. PLoS One 2014; 9:e109141. [PMID: 25268791 PMCID: PMC4182521 DOI: 10.1371/journal.pone.0109141] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/23/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE A major reason for the loss of mobility in elderly people is the gradual loss of lean body mass known as sarcopenia. Sarcopenia is associated with a lower quality of life and higher healthcare costs. The benefit of strategies that include nutritional intervention, timing of intervention, and physical exercise to improve muscle loss unclear as finding from studies investigating this issue have been inconsistent. We have performed a systematic review and meta-analysis to assess the ability of protein or amino acid supplementation to augment lean body mass or strength of leg muscles in elderly patients. METHODS Nine studies met the inclusion criteria of being a prospective comparative study or randomized controlled trial (RCT) that compared the efficacy of an amino acid or protein supplement intervention with that of a placebo in elderly people (≥ 65 years) for the improvement of lean body mass (LBM), leg muscle strength or reduction associated with sarcopenia. RESULTS The overall difference in mean change from baseline to the end of study in LBM between the treatment and placebo groups was 0.34 kg which was not significant (P = 0.386). The overall differences in mean change from baseline in double leg press and leg extension were 2.14 kg (P = 0.748) and 2.28 kg (P = 0.265), respectively, between the treatment group and the placebo group. CONCLUSIONS These results indicate that amino acid/protein supplements did not increase lean body mass gain and muscle strength significantly more than placebo in a diverse elderly population.
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Affiliation(s)
- Zhe-rong Xu
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhong-ju Tan
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qin Zhang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi-feng Gui
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yun-mei Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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15
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Sayer AA, Robinson SM, Patel HP, Shavlakadze T, Cooper C, Grounds MD. New horizons in the pathogenesis, diagnosis and management of sarcopenia. Age Ageing 2013; 42:145-50. [PMID: 23315797 PMCID: PMC3575121 DOI: 10.1093/ageing/afs191] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia is the age-related loss of skeletal muscle mass and function. It is now recognised as a major clinical problem for older people and research in the area is expanding exponentially. One of the most important recent developments has been convergence in the operational definition of sarcopenia combining measures of muscle mass and strength or physical performance. This has been accompanied by considerable progress in understanding of pathogenesis from animal models of sarcopenia. Well-described risk factors include age, gender and levels of physical activity and this knowledge is now being translated into effective management strategies including resistance exercise with recent interest in the additional role of nutritional intervention. Sarcopenia is currently a major focus for drug discovery and development although there remains debate about the best primary outcome measure for trials, and various promising avenues to date have proved unsatisfactory. The concept of 'new tricks for old drugs' is, however, promising, for example, there is some evidence that the angiotensin-converting enzyme inhibitors may improve physical performance. Future directions will include a deeper understanding of the molecular and cellular mechanisms of sarcopenia and the application of a lifecourse approach to understanding aetiology as well as to informing the optimal timing of interventions.
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Affiliation(s)
- Avan Aihie Sayer
- Academic Geriatric Medicine, University of Southampton, Southampton, UK.
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Frost H, Haw S, Frank J. Interventions in community settings that prevent or delay disablement in later life: an overview of the evidence. QUALITY IN AGEING AND OLDER ADULTS 2012. [DOI: 10.1108/14717791211264241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Gielen E, Verschueren S, O'Neill TW, Pye SR, O'Connell MDL, Lee DM, Ravindrarajah R, Claessens F, Laurent M, Milisen K, Tournoy J, Dejaeger M, Wu FC, Vanderschueren D, Boonen S. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int 2012; 91:161-77. [PMID: 22797855 DOI: 10.1007/s00223-012-9622-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/27/2012] [Indexed: 12/19/2022]
Abstract
A progressive decline in physiologic reserves inevitably occurs with ageing. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, frail elderly experience an excess vulnerability to stressors and are at high risk for functional deficits and comorbid disorders, possibly leading to institutionalization, hospitalization and death. The phenotype of frailty is referred to as the frailty syndrome and is widely recognized in geriatric medical practice. Although frailty affects both musculoskeletal and nonmusculoskeletal systems, sarcopenia, which is defined as age-related loss of muscle mass and strength, constitutes one of the main determinants of fracture risk in older age and one of the main components of the clinical frailty syndrome. As a result, operational definitions of frailty and therapeutic strategies in older patients tend to focus on the consequences of sarcopenia.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, KU Leuven, Leuven, Belgium
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18
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Freijer K, Nuijten MJC, Schols JMGA. The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting. Front Pharmacol 2012; 3:78. [PMID: 22629244 PMCID: PMC3355295 DOI: 10.3389/fphar.2012.00078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/11/2012] [Indexed: 12/14/2022] Open
Abstract
A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands.
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Affiliation(s)
- Karen Freijer
- CAPHRI – School for Public Health and Primary Care, Maastricht UniversityMaastricht, Netherlands
| | | | - Jos M. G. A. Schols
- CAPHRI – School for Public Health and Primary Care, Department of General Practice and Department of Health Services Research, Maastricht UniversityMaastricht, Netherlands
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Piantadosi C, Visvanathan R, Naganathan V, Hunter P, Cameron ID, Lange K, Karnon J, Chapman IM. The effect of testosterone and a nutritional supplement on hospital admissions in under-nourished, older people. BMC Geriatr 2011; 11:66. [PMID: 22023735 PMCID: PMC3213029 DOI: 10.1186/1471-2318-11-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/24/2011] [Indexed: 11/27/2022] Open
Abstract
Background Weight loss and under-nutrition are relatively common in older people, and are associated with poor outcomes including increased rates of hospital admissions and death. In a pilot study of 49 undernourished older, community dwelling people we found that daily treatment for one year with a combination of testosterone tablets and a nutritional supplement produced a significant reduction in hospitalizations. We propose a larger, multicentre study to explore and hopefully confirm this exciting, potentially important finding (NHMRC project grant number 627178). Methods/Design One year randomized control trial where subjects are allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. 200 older community-dwelling, undernourished people [Mini Nutritional Assessment score <24 and either: a) low body weight (body mass index, in kg/m2: <22) or b) recent weight loss (>7.5% over 3 months)]. Hospital admissions, quality-adjusted life years, functional status, nutritional health, muscle strength, body composition and other variables will be assessed. Discussion The pilot study showed that combined treatment with an oral testosterone and a supplement drink was well tolerated and safe, and reduced the number of people hospitalised and duration of hospital admissions in undernourished, community dwelling older people. This is an exciting finding, as it identifies a treatment which may be of substantial benefit to many older people in our community. We now propose to conduct a multi-centre study to test these findings in a substantially larger subject group, and to determine the cost effectiveness of this treatment. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066
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Affiliation(s)
- Cynthia Piantadosi
- The Health Observatory, University of Adelaide, Department of Medicine, Adelaide SA 5005, Australia
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Mehta KM, Pierluissi E, Boscardin WJ, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS. A clinical index to stratify hospitalized older adults according to risk for new-onset disability. J Am Geriatr Soc 2011; 59:1206-16. [PMID: 21649616 PMCID: PMC3839864 DOI: 10.1111/j.1532-5415.2011.03409.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge. DESIGN Data analyses derived from two prospective studies. SETTING Two teaching hospitals in Ohio. PARTICIPANTS Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission. MEASUREMENTS New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission. RESULTS Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80-89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2-3 ADLs, 1 point; 4-5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC)=0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC=0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival. CONCLUSION This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.
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Affiliation(s)
- Kala M Mehta
- Division of Geriatrics, University of California at San Francisco, San Francisco, CA 94121, USA.
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O'Leary F, Flood VM, Petocz P, Allman-Farinelli M, Samman S. B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients. J Nutr Health Aging 2011; 15:485-9. [PMID: 21623471 DOI: 10.1007/s12603-010-0330-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the relationships between previous diet, biomarkers of selected B vitamins, nutritional status and length of stay. DESIGN Cross sectional study. SETTING Geriatric rehabilitation patients, Sydney, Australia. PARTICIPANTS Fifty two consenting patients with normal serum creatinine levels and no dementia. MEASUREMENTS Serum vitamin B12, plasma vitamin B6, serum and erythrocyte folate, homocysteine and methylmalonic acid (MMA) concentrations; dietary intake using a validated semi-quantitative food frequency questionnaire and nutritional assessment using the Mini Nutritional Assessment (MNA). Length of stay data were collected from medical records after discharge. RESULTS The age was 80 ± 8 year (mean ± SD), BMI 26.4 ± 6.8 kg/m2 and MNA score 22 ± 3 indicating some risk of malnutrition. Deficiencies of vitamins B6, B12 and folate were found in 30, 22 and 5 subjects respectively. Length of stay was positively correlated with age and MMA (Spearman's correlation 0.4, p<0.01 and 0.28, p<0.05 respectively) and negatively correlated with albumin, vitamin B6 and MNA score (Spearman's correlation -0.35, -0.33 and -0.29, p<0.05). After adjustment for age and sex, ln vitamin B6 and ln MMA concentrations were significant in predicting ln LOS (p=0.006 and p=0.014 respectively). CONCLUSION The study indicates a high risk of vitamin B deficiencies in the elderly and suggests that deficiencies of vitamins B6 and B12 are associated with length of stay. This is concerning as B vitamin status is rarely fully assessed.
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Affiliation(s)
- F O'Leary
- Discipline of Nutrition and Metabolism, School of Molecular Bioscience, University of Sydney, NSW 2006, Australia
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22
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Abstract
Weight loss is common in older people. It is associated with increased morbidity and mortality, particularly when unintentional, excessive (>5% body weight), or associated with low body weight (body mass index <22 kg/m(2)). It is often unrecognized, the associated adverse effects not appreciated, and underlying causes not addressed. Intentional weight loss by overweight older people is probably appropriate only when functional problems have resulted from the excess weight. It is important to include, wherever possible, exercise in weight-loss measures to preserve skeletal muscle mass.
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Affiliation(s)
- Ian M Chapman
- Division of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, North Terrace, Adelaide 5000, Australia.
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23
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Westergren A, Hedin G. Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations? Food Nutr Res 2010; 54:5402. [PMID: 20877587 PMCID: PMC2946866 DOI: 10.3402/fnr.v54i0.5402] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/19/2010] [Accepted: 09/01/2010] [Indexed: 11/14/2022] Open
Abstract
Background Disease-related malnutrition is a major health problem in the elderly population and management issues are under-explored. Objectives What is the prevalence of undernutrition-risk (UN-risk), underweight, and overweight in special accommodations (SAs)? Do study circles and a nutritional care policy (NCP) improve the precision in nutritional care (NC) and decrease the prevalence of under- and overweight in a short- and/or long-term perspective? Design Quasi-experimental pre- and post-intervention design with three experimental groups and one control group (CG). Setting SAs. Participants In 2005 (Time 1 – T1), 1726 (90.4%) residents agreed to participate; in 2007 (Time 2 – T2), 1,526 (81.8%); and in 2009 (Time 3 – T3), 1,459 (81.3%) residents participated. Interventions Experimental groups: between T1 and T2 the first period of study circles was conducted in one municipality; between T2 and T3 a second period of study circles in another municipality was conducted; after T1 a NCP was implemented in one municipality. CG: residents in three municipalities. Measurements Under- and overweight were defined based on BMI. Risk of undernutrition was defined as involving any of: involuntary weight loss, low BMI, and/or eating difficulties. The ‘precision in NC’ describes the relationship between nutritional treatment (protein- and energy-enriched food (PE-food) and/or oral supplements) and UN-risk. Results The prevalence of UN-risk varied between 64 and 66%, underweight between 25 and 30%, and overweight between 30 and 33% in T1–T3. At T2 the prevalence of underweight was significantly lower in the first period study circle municipality, and at T3 in the second period study circle municipality compared to in the CG. The precision in NC was higher in a short-term perspective in the study circle municipalities and both in a short- and long-term perspective in the NCP municipality. At T3 between 54 and 70% of residents at UN-risk did not receive PE-food or oral supplements. Conclusions Study circles give positive short-term effects and a NCP gives positive short- and long-term effects on NC. Whether a combination of study circles and the implementation of a NCP can give even better results is an area for future studies.
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Affiliation(s)
- Albert Westergren
- Department of Clinical Nursing Science, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Kennelly S, Kennedy NP, Rughoobur GF, Slattery CG, Sugrue S. An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals. J Hum Nutr Diet 2010; 23:567-74. [DOI: 10.1111/j.1365-277x.2010.01111.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Congedo M, Causarano RI, Alberti F, Bonito V, Borghi L, Colombi L, Defanti CA, Marcello N, Porteri C, Pucci E, Tarquini D, Tettamanti M, Tiezzi A, Tiraboschi P, Gasparini M. Ethical issues in end of life treatments for patients with dementia. Eur J Neurol 2010; 17:774-9. [DOI: 10.1111/j.1468-1331.2010.02991.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01383.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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Chen CCH, Tang ST, Wang C, Huang GH. Trajectory and determinants of nutritional health in older patients during and six-month post-hospitalisation. J Clin Nurs 2009; 18:3299-307. [DOI: 10.1111/j.1365-2702.2009.02932.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Clinical Update on Nursing Home Medicine: 2009. J Am Med Dir Assoc 2009; 10:530-53. [DOI: 10.1016/j.jamda.2009.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 12/25/2022]
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Westergren A, Axelsson C, Lilja-Andersson P, Lindholm C, Petersson K, Ulander K. Study circles improve the precision in nutritional care in special accommodations. Food Nutr Res 2009; 53:1950. [PMID: 19798421 PMCID: PMC2754113 DOI: 10.3402/fnr.v53i0.1950] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/07/2009] [Accepted: 08/31/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: Disease-related malnutrition is a major health problem in the elderly population, but it has until recently received very little attention, especially are management issues under-explored. By identifying residents at the risk of undernutrition (UN), appropriate nutritional care can be provided. OBJECTIVE: To investigate if study circles and policy documents improve the precision in nutritional care and decrease the prevalence of low or high body mass index (BMI). DESIGN: Pre and post-intervention study. SETTING: Special accommodations (nursing homes) within six municipalities were involved. PARTICIPANTS: In 2005, 1,726 (90.4%) of 1,910 residents agreed to participate and in 2007, 1,526 (81.8%) of 1,866 residents participated. INTERVENTION: Study circles in one municipality, having a policy document in one municipality and no intervention in four municipalities. MEASUREMENTS: RISK OF UN WAS DEFINED AS INVOLVING ANY OF: involuntary weight loss; low BMI; and/or eating difficulties. Overweight was defined as high BMI. RESULTS: In 2005 and 2007, 64% and 66% of residents, respectively, were at the risk of UN. In 2007, significantly more patients in the study circle municipality were accurately provided protein and energy enriched food (PE-food) compared to the no intervention municipalities. There was a decrease between 2005 and 2007 in the prevalence of low BMI in the study circle municipality, but the prevalence of overweight increased in the policy document municipality. CONCLUSIONS: Study circles improve the provision of PE-food for residents at the risk of UN and can possibly decrease the prevalence of low BMI. It is likely that a combination of study circles and implementation of a policy document focusing on screening and on actions to take if the resident is at UN risk can give even better results.
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Affiliation(s)
- Albert Westergren
- Department of Clinical Nursing Science, School of Health and Society, Kristianstad University College, Kristianstad, Sweden
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30
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Visvanathan R, Chapman IM. Undernutrition and anorexia in the older person. Gastroenterol Clin North Am 2009; 38:393-409. [PMID: 19699404 DOI: 10.1016/j.gtc.2009.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Minimizing frailty in older age is important to individuals and society, as the increasing prevalence of chronic disease is leading to greater disability and health care costs. Nutritional frailty can be defined as the disability that occurs in old age due to rapid, unintentional loss of body weight and sarcopenia (lack of lean mass). This article provides a brief overview of the prevalence and consequences of undernutrition, age-related changes to appetite, food intake, and body composition, the factors contributing to the development of anorexia and undernutrition, and recommended management strategies.
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Affiliation(s)
- Renuka Visvanathan
- Department of Medicine, University of Adelaide, Level 6 Eleanor Harrold Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
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Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial. Support Care Cancer 2009; 17:1543-52. [PMID: 19629539 DOI: 10.1007/s00520-009-0698-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 07/07/2009] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this present study was to evaluate Self-care Improvement through Oncology Nursing (SCION) program to reduce distressing anorexia, nausea, and emesis (ANE) in cancer patients undergoing chemotherapy. METHODS Two hundred eight patients receiving chemotherapy with moderate to high emetogenic potential participated in a cluster randomized trial on 14 wards in two German university hospitals. Additionally to standard antiemetic treatment, patients from the intervention wards received the SCION program consisting of four modules: advisory consultation, optimizing emesis prophylaxis, nutrition counseling, and relaxation. Patients from the control group received standard antiemetic treatment and standard care. Primary outcome was the group difference in ANE intensity assessed by Common Terminology Criteria for adverse events (CTCAE). MAIN RESULTS The SCION program did not result in a significant difference in the incidence of ANE symptoms as compared to standard care: mean difference on CTCAE scale was 0.24 pts (95%CI, -1.17 to 1.66 pts; P = 0.733). No difference could be found regarding patients' knowledge of side effects, self-care interventions, and agency. Health-related quality of life was significantly better for patients in the control group (mean difference 10.2 pts; 95%CI, 1.9 to 18.5; P = 0.017). CONCLUSIONS Contrary to our expectations, the groups did not differ in ANE intensity caused by the overall low acute or delayed symptom intensity. Symptom hierarchy in cancer patients alters and challenges nursing interventions targeting the patients' self-care strategies.
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Salva A, Coll-Planas L, Bruce S, De Groot L, Andrieu S, Abellan G, Vellas B, Andrieu S, Bartorelli L, Berner YN, Bruce S, Corman B, Domingo A, Egger TP, de Groot L, Guigoz Y, Imedio A, Planas M, Porras C, Rovira JC, Salvà A, Serra JA, Vellas B. Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA. J Nutr Health Aging 2009; 13:475-83. [PMID: 19536415 DOI: 10.1007/s12603-009-0097-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Unintentional weight loss and Undernutrition are major problems among older people living in Long-Term Care Facilities (LTCF). Undernutrition manifests in LTCF particularly as weight loss and low Body Mass Index (BMI) and is associated with increased morbidity and mortality as well as with functional decline. There are many factors associated with poor nutritional status and affecting protein-energy intake and/or energy expenditure. These include age of 85 years or older, low nutrient intake, loss of ability to eat independently, swallowing and chewing difficulties, becoming bed-ridden, pressure ulcers, history of hip fracture, dementia, depressive symptoms and suffering from two or more chronic illnesses. Nutritional evaluation is an essential part of the Comprehensive Geriatric Assessment (CGA). This evaluation ranges from methods such as BMI to several validated tools such as Mini-Nutritional Assessment (MNA). After diagnosis, the management of undernutrition in LTCF requires a multidisciplinary approach which may involve dietary and environmental improvements and managing multiple co-morbidities, while avoiding polypharmacy as far as possible. Finally, the need for supplementation or artificial (tube) feeding may be considered taking into account the CGA and individual needs. This document presents a succinct review and recommendations of evaluation and treatment of undernutrition.
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Affiliation(s)
- A Salva
- Institut Catala de l'Envelliment. Universitat Autonoma de Barcelona. Spain
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Westergren A, Wann-Hansson C, Börgdal EB, Sjölander J, Strömblad R, Klevsgård R, Axelsson C, Lindholm C, Ulander K. Malnutrition prevalence and precision in nutritional care differed in relation to hospital volume--a cross-sectional survey. Nutr J 2009; 8:20. [PMID: 19422727 PMCID: PMC2687453 DOI: 10.1186/1475-2891-8-20] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 05/08/2009] [Indexed: 01/11/2023] Open
Abstract
Background To explore the point prevalence of the risk of malnutrition and the targeting of nutritional interventions in relation to undernutrition risk and hospital volume. Methods A cross-sectional survey performed in nine hospitals including 2 170 (82.8%) patients that agreed to participate. The hospitals were divided into large, middle, and small sized hospitals. Undernutrition risk and overweight (including obesity) were assessed. Results The point prevalence of moderate/high undernutrition risk was 34%, 26% and 22% in large, middle and small sized hospitals respectively. The corresponding figures for overweight were 38%, 43% and 42%. The targeting of nutritional interventions in relation to moderate/high undernutrition risk was, depending on hospital size, that 7–17% got Protein- and Energy Enriched food (PE-food), 43–54% got oral supplements, 8–22% got artificial nutrition, and 14–20% received eating assistance. Eating assistance was provided to a greater extent and artificial feeding to a lesser extent in small compared to in middle and large sized hospitals. Conclusion The prevalence of malnutrition risk and the precision in provision of nutritional care differed significantly depending on hospital volume, i.e. case mix. It can be recommended that greater efforts should be taken to increase the use of PE-food and oral supplements for patients with eating problems in order to prevent or treat undernutrition. A great effort needs to be taken in order to also decrease the occurrence of overweight.
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Affiliation(s)
- Albert Westergren
- Research and Development Unit, Central Hospital Kristianstad, Kristianstad, Sweden.
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34
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Christensson L, Bachrach-Lindström M. Adapting "the Staff Attitudes to Nutritional Nursing Care scale" to geriatric nursing care. J Nutr Health Aging 2009; 13:102-7. [PMID: 19214337 DOI: 10.1007/s12603-009-0015-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A positive attitude is assumed to be important in nursing staff's help and support of elderly people during meals. As there is no specific tool for measuring staff's attitudes regarding important issues within eating and nutrition, the SANN (Staff Attitudes to Nutritional Nursing Care) scale was developed. The scale was developed and tested in nursing staff working at resident homes, and the number of items was reduced from 63 to 19 with five underlying factors. The aim of this study was to describe how the SANN scale was adapted and tested in nursing staff working in different types of elderly care. DESIGN The raw 63-item version went through minor changes, and one unclear worded item was excluded. The changed raw 62-item version was answered by 188 nursing staff working at six hospital care clinics and 64 staff working at one resident home. RESULTS The analysis reduced the 62 items to 18, and the adapted scale was named the SANN-G scale, G standing for "geriatric care". A rotated factor analysis gave a five-factor solution, explaining 54% of the variance. The scale achieved good internal reliability, with a Cronbach's alpha of 0.83. Fourteen items fulfilled inclusion criteria in both the SANN and the SANN-G scales. CONCLUSION The SANN-G scale is practicable for use in staff working in different types of elderly care. It can be used to explore existing attitudes and identify areas with a low degree of prevailing positive attitudes as well as to evaluate whether and how attitudes change after nutritional education and intervention.
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Affiliation(s)
- L Christensson
- Department of Nursing Science, University College of Health Sciences, Jönköping, Sweden.
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Silver HJ. Oral strategies to supplement older adults’ dietary intakes: comparing the evidence. Nutr Rev 2009; 67:21-31. [DOI: 10.1111/j.1753-4887.2008.00131.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Daniels R, van Rossum E, de Witte L, Kempen GIJM, van den Heuvel W. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 2008; 8:278. [PMID: 19115992 PMCID: PMC2630317 DOI: 10.1186/1472-6963-8-278] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 12/30/2008] [Indexed: 11/14/2022] Open
Abstract
Background There is an interest for intervention studies aiming at the prevention of disability in community-dwelling physically frail older persons, though an overview on their content, methodological quality and effectiveness is lacking. Methods A search for clinical trials involved databases PubMed, CINAHL and Cochrane Central Register of Controlled Trials and manually hand searching. Trials that included community-dwelling frail older persons based on physical frailty indicators and used disability measures for outcome evaluation were included. The selection of papers and data-extraction was performed by two independent reviewers. Out of 4602 titles, 10 papers remained that met the inclusion criteria. Of these, 9 were of sufficient methodological quality and concerned 2 nutritional interventions and 8 physical exercise interventions. Results No evidence was found for the effect of nutritional interventions on disability measures. The physical exercise interventions involved 2 single-component programs focusing on lower extremity strength and 6 multi-component programs addressing a variety of physical parameters. Out of 8 physical exercise interventions, three reported positive outcomes for disability. There was no evidence for the effect of single lower extremity strength training on disability. Differences between the multi-component interventions in e.g. individualization, duration, intensity and setting hamper the interpretation of the elements that consistently produced successful outcomes. Conclusion There is an indication that relatively long-lasting and high-intensive multicomponent exercise programs have a positive effect on ADL and IADL disability for community-living moderate physically frail older persons. Future research into disability prevention in physical frail older persons could be directed to more individualized and comprehensive programs.
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Affiliation(s)
- Ramon Daniels
- Faculty of Health and Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands.
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Cruz-Jentoft AJ, Calvo JJ, Durán JC, Ordóñez J, De Castellar R. Compliance with an oral hyperproteic supplement with fibre in nursing home residents. J Nutr Health Aging 2008; 12:669-73. [PMID: 18953467 DOI: 10.1007/bf03008280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake. Oral supplements may improve the health status in this population, but their use may be limited by compliance and side effects. OBJECTIVES To evaluate effects of an oral supplement of protein and fibre on compliance, on nutritional status, and on intestinal habits in nursing home residents. METHOD A prospective observational study was carried out in 66 Spanish nursing homes. 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements. After informed consent was given, subjects received 2 daily cartons (400 ml) of a liquid oral supplement rich in protein and fibre along 3 months. Supplement intake compliance was measured at baseline and after 6 and 12 weeks. Nutritional status was assessed using the Mini- Nutritional Assessment (MNA), weight, and Body Mass Index (BMI). Changes in intestinal habits and digestive symptoms were also recorded, as well as subject's supplement acceptance. RESULTS Compliance with the supplement intake was 97.46% at 6 weeks and 96% at 12 weeks of follow-up. Significant changes (p<0.0001) were found in nutritional status: mean value of MNA improved from baseline (MNA=14.0+/-3.9) after 12 weeks (MNA=17.0+/-4.0), as well as weight (+2.1 kg, a 4.1% increase). The BMI did not change significantly (BMI=21.43 at baseline; BMI=21.78 at 12 weeks). Undernutrition prevalence (MNA<17) decreased from 76.4 to 46.6% (p<0.0001). Intestinal habits showed a significant improvement in defecation frequency (from 4.7 to 6.1 stools per week, p<0.0001) and faeces consistency (from 53.2% to 74.5% reporting formed soft stools, p<0.0001). 48.9% of the subjects considered to have better intestinal habits after 6 weeks and 50.5% after 3 months of supplementary food intake, the rest reporting no change. Vomits and flatulence were also significantly reduced (p<0.0001). CONCLUSION The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance. Supplements improve their nutritional status and their intestinal habits.
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Affiliation(s)
- A J Cruz-Jentoft
- Servicio de Geriatria, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID. Frailty Intervention Trial (FIT). BMC Geriatr 2008; 8:27. [PMID: 18851754 PMCID: PMC2579913 DOI: 10.1186/1471-2318-8-27] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 10/13/2008] [Indexed: 11/25/2022] Open
Abstract
Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems, has lost functional abilities and is likely to deteriorate further. However, despite its common use, only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence. The criteria Fried and colleagues used to define the frailty syndrome will be used in this study (i.e. weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity). Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment, and single interventions such as exercise programs or nutritional supplementation, but no interventions have been developed to specifically reverse the syndrome of frailty. We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty, mobility, hospitalisation and institutionalisation in frail older people. Methods and Design A single centre randomised controlled trial comparing a multidisciplinary intervention with usual care. The intervention will target identified characteristics of frailty, functional limitations, nutritional status, falls risk, psychological issues and management of chronic health conditions. Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital. Participants will be followed for a 12-month period. Discussion This research is an important step in the examination of specifically targeted frailty interventions. This project will assess whether an intervention specifically targeting frailty can be implemented, and whether it is effective when compared to usual care. If successful, the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation. The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services. Trial Registration Australian New Zealand Clinical Trails Registry: ACTRN12608000250336.
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Affiliation(s)
- Nicola Fairhall
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney Australia.
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Atalay BG, Yaǧmur C, Nursal TZ, Atalay H, Noyan T. Use of Subjective Global Assessment and Clinical Outcomes in Critically Ill Geriatric Patients Receiving Nutrition Support. JPEN J Parenter Enteral Nutr 2008; 32:454-9. [DOI: 10.1177/0148607108314369] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Betül Gülşen Atalay
- From the Department of Nutrition, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (BGA); Department of Food Engineering, Çukurova University, Adana, Turkey (CY); Department of General Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (TZN, TN); and Department of Cardiovascular Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (HA)
| | - Cahide Yaǧmur
- From the Department of Nutrition, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (BGA); Department of Food Engineering, Çukurova University, Adana, Turkey (CY); Department of General Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (TZN, TN); and Department of Cardiovascular Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (HA)
| | - Tarik Zafer Nursal
- From the Department of Nutrition, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (BGA); Department of Food Engineering, Çukurova University, Adana, Turkey (CY); Department of General Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (TZN, TN); and Department of Cardiovascular Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (HA)
| | - Hakan Atalay
- From the Department of Nutrition, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (BGA); Department of Food Engineering, Çukurova University, Adana, Turkey (CY); Department of General Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (TZN, TN); and Department of Cardiovascular Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (HA)
| | - Turgut Noyan
- From the Department of Nutrition, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (BGA); Department of Food Engineering, Çukurova University, Adana, Turkey (CY); Department of General Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (TZN, TN); and Department of Cardiovascular Surgery, Başkent University, Adana Teaching and Medical Research Center, Adana, Turkey (HA)
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Beck AM, Damkjaer K, Beyer N. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Nutrition 2008; 24:1073-80. [PMID: 18586458 DOI: 10.1016/j.nut.2008.05.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/09/2008] [Accepted: 05/13/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We tested the hypothesis that a multifaceted 11-wk intervention comprising nutrition, group exercise, and oral care would have a significant influence on nutrition and function in elderly (>or=65 y) nursing-home residents. METHODS The study was an 11-wk randomized controlled intervention study with nutrition (chocolate and homemade oral supplements), group exercise twice a week (45-60 min, moderate intensity), and oral care intervention one to two times a week, with the aim of improving nutritional status and function in elderly nursing-home residents. A follow-up visit was made 4 mo after the end of the intervention. Assessments were weight, body mass index, dietary intake, handgrip strength, Senior Fitness Test, Berg's Balance Scale, and the prevalence of plaque. RESULTS A total of 121 subjects (61%) accepted the invitation and 62 were randomized to the intervention group. Six of these dropped out during the 11 wk. At the 4-mo follow-up there were 15 deaths in the intervention group and 8 in the control group. The nutrition and exercise were well tolerated. After 11 wk the change in percentage of weight (P = 0.005), percentage of body mass index (P = 0.003), energy intake (P = 0.084), protein intake (P = 0.012), and Berg's Balance Scale (P = 0.004) was higher in the intervention group than in the control group. In addition, the percentage of subjects whose functional tests improved was higher in the intervention group. Both groups lost the same percentage of weight after the intervention (P = 0.908). The total percentage of weight loss from baseline to follow-up was higher in the control group (P = 0.019). Oral care was not well accepted and the prevalence of plaque did not change. CONCLUSION It is possible to improve nutrition and function in elderly nursing-home residents by means of a multifaceted intervention consisting of chocolate, homemade supplements, group exercise, and oral care.
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Affiliation(s)
- Anne Marie Beck
- Department of Nutrition, National Food Institute, Technical University of Denmark, Soeborg, Denmark.
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Abellan van Kan G, Gambassi G, de Groot LCPGM, Andrieu S, Cederholm T, André E, Caubère JP, Bonjour JP, Ritz P, Salva A, Sinclair A, Vellas B, Daydé J, Deregnaucourt J, Latgé C. Nutrition and aging. The Carla Workshop. J Nutr Health Aging 2008; 12:355-64. [PMID: 18548172 DOI: 10.1007/bf02982667] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- G Abellan van Kan
- Gérontopôle, Department of Geriatric Medicine, CHU Toulouse, France.
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Abstract
BACKGROUND Malnutrition is common among older hospital patients and contributes to poor clinical outcomes. Poor intake among this group of patients could be due to a variety of factors. OBJECTIVE To better understand the causes and consequences of inadequate food intake among hospitalised elderly patients, specifically: to determine (i) the prevalence of factors contributory to inadequate food intake, (ii) the relationship of these factors to nutritional status and course of hospital stay. DESIGN A longitudinal observational study of a convenience sample. SETTING Inpatients of an inner city elderly care unit in the UK. METHODS One hundred patients (mean 81.7 years (sd 7.2);27 male,73 female) were observed twice weekly, from admission to discharge/maximum of 4 weeks. Anthropometric assessments of nutritional status were made on admission and discharge. At each visit, adequacy of intake in the preceding 24-hour period, and reasons for inadequate intake, were determined using nurse observations, food-charts, case-notes, and interviews of patients/carers. With all available information, adequacy was estimated whether the subject had consumed at least three-quarters of their standard diet along with any prescribed food supplements. Inadequate nutritional intake was defined as completing less than this amount. RESULTS On admission, 21 patients were malnourished [below the 10th percentile for demiquet (weight/demispan2) for males or mindex (weight/demispan) for females. Three patients became malnourished during their stay. At 285/425 assessments (67%), patients were judged to be eating inadequately. Acute illness, anorexia, catering limitations and oral problems were the most prevalent reasons for inadequate intake during the earlier part of patients' hospital stay. Confusion, low mood and dysphagia remained prevalent throughout. Compared to well-nourished patients (n=67), malnourished patients (n=24) had higher prevalence of oral problems (22%v6%;p<0.001), mood/anxiety disturbances (33% v 19%;p=0.02), anorexia (38% v 23%;p=0.02) and catering limitations (34% v 12%;p<0.001), but lower prevalence of dysphagia (4% v 13%,p=0.015). Of 51 patients in hospital for less than 10 days, 36 were eating inadequately. CONCLUSION Reasons for inadequate intake vary according to stage of hospital stay and nutritional status. Inadequate intake in the early stage after admission is mainly due to self-limiting temporary factors associated with acute illness.
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Affiliation(s)
- M D Patel
- Division of Medicine, University Hospital Lewisham, Lewisham, London SE13 6LH
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Botella-Carretero JI, Iglesias B, Balsa JA, Zamarrón I, Arrieta F, Vázquez C. Effects of Oral Nutritional Supplements in Normally Nourished or Mildly Undernourished Geriatric Patients After Surgery for Hip Fracture: A Randomized Clinical Trial. JPEN J Parenter Enteral Nutr 2008; 32:120-8. [DOI: 10.1177/0148607108314760] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- José I. Botella-Carretero
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
| | - Borja Iglesias
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
| | - José A. Balsa
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
| | - Isabel Zamarrón
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
| | - Francisco Arrieta
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
| | - Clotilde Vázquez
- From the Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
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Friedlander AH, Tajima T, Kawakami KT, Wang MB, Tomlinson J. The Relationship Between Measures of Nutritional Status and Masticatory Function in Untreated Patients With Head and Neck Cancer. J Oral Maxillofac Surg 2008; 66:85-92. [DOI: 10.1016/j.joms.2007.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 08/24/2007] [Indexed: 11/24/2022]
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Intensive Session: New Approaches to Medical Issues in Long-Term Care. J Am Med Dir Assoc 2007; 8:421-33. [PMID: 17845944 DOI: 10.1016/j.jamda.2007.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Indexed: 02/02/2023]
Abstract
This article, based on a series of presentations at the American Medical Directors Association, briefly highlights new advances in medical areas of interest to long-term care physicians. The areas discussed are heart failure, vitamin D, falls, new treatments for diabetes mellitus, blood pressure measurement, anemia, clinical nutrition, pressure ulcers, Clostridium difficile, insomnia, and antipsychotic therapy.
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Beavan JR, Conroy S, Leonardi-Bee J, Bowling T, Gaynor C, Gladman J, Good D, Gorman P, Harwood R, Riley J, Sach T, Sunman W. Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke? Trials 2007; 8:19. [PMID: 17683555 PMCID: PMC1976319 DOI: 10.1186/1745-6215-8-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 08/03/2007] [Indexed: 11/11/2022] Open
Abstract
Background Dysphagia occurs in up to 50% of patients admitted to hospital with acute strokes with up to 27% remaining by seven days. Up to 8% continue to have swallowing problems six months after their stroke with 1.7% still requiring enteral feeding. Nasogastric tubes (NGT) are the most commonly used method for providing enteral nutrition in early stroke, however they are easily and frequently removed leading to inadequate nutrition, early PEG (Percutaneous Endoscopic Gastrostomy) insertion or abandoning of feeding attempts. Looped nasogastric tube feeding may improve the delivery of nutrition to such patients. Methods Three centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability. Trial Registration ISRCTN Number: ISRCTN61174381
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Affiliation(s)
- Jessica R Beavan
- Nottingham University School of Community Health Sciences, B Floor, Medical School, Queen's Medical Centre, Nottingham, UK.
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Xia Z, Zhang Y, Dong BR. Amino acid, fat emulsion and energy supplementation for severe pneumonia in the elderly. Cochrane Database Syst Rev 2007. [DOI: 10.1002/14651858.cd006603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Nematy M, O'Flynn JE, Wandrag L, Brynes AE, Brett SJ, Patterson M, Ghatei MA, Bloom SR, Frost GS. Changes in appetite related gut hormones in intensive care unit patients: a pilot cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R10. [PMID: 16420657 PMCID: PMC1550795 DOI: 10.1186/cc3957] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 11/28/2005] [Indexed: 12/26/2022]
Abstract
Introduction The nutritional status of patients in the intensive care unit (ICU) appears to decline not only during their stay in the ICU but also after discharge from the ICU. Recent evidence suggests that gut released peptides, such as ghrelin and peptide YY (PYY) regulate the initiation and termination of meals and could play a role in the altered eating behaviour of sick patients. The aim of this study was to assess the patterns of ghrelin and PYY levels during the stay of ICU patients in hospital. Methods Sixteen ICU patients (60 ± 4.7 years, body mass index (BMI) 28.1 ± 1.7 kg/m2 (mean ± standard error of the mean)) underwent fasting blood sample collections on days 1, 3, 5, 14, 21 and 28 of their stay at Hammersmith and Charing Cross Hospitals. Changes in appetite and biochemical and anthropometric markers of nutritional status were recorded. A comparison was made to a group of 36 healthy volunteers matched for age and BMI (54.3 ± 2.9 years, p = 0.3; BMI 25.8 ± 0.8 kg/m2 p = 0.2). Results Compared to healthy subjects, ICU patients exhibited a significantly lower level of ghrelin (day one 297.8 ± 76.3 versus 827.2 ± 78.7 pmol/l, p < 0.001) during their stay in the ICU. This tended to rise to the normal level during the last three weeks of hospital stay. Conversely, ICU patients showed a significantly higher level of PYY (day one 31.5 ± 9.6 versus 11.3 ± 1.0 pmol/l, p < 0.05) throughout their stay in the ICU and on the ward, with a downward trend to the normal level during the last three weeks of stay. Conclusions Results from our study show high levels of PYY and low levels of ghrelin in ICU patients compared to healthy controls. There appears to be a relationship between the level of these gut hormones and nutritional intake.
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Affiliation(s)
- Mohsen Nematy
- Phd Student, Nutrition and Dietetic Research Group, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Jacqui E O'Flynn
- Senior Dietician, Nutrition and Dietetic Research Group, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Liesl Wandrag
- Senior Dietician, Nutrition and Dietetic Research Group, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Audrey E Brynes
- Chief Research Dietician, Honorary Lecturer Imperial College, Nutrition and Dietetic Research Group, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Stephen J Brett
- ICU Consultant, Division of Surgery, Anaesthetics and Intensive Care, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Michael Patterson
- Graduate student, Department of Metabolic Medicine, Imperial College, Hammersmith Hospitals NHS Trust, London W12 0NN, UK
| | - Mohammad A Ghatei
- Professor of Metabolic Medicine, Department of Metabolic Medicine, Imperial College, Hammersmith Hospitals NHS Trust, London W12 0NN, UK
| | - Stephen R Bloom
- Professor of Nutrition, Department of Metabolic Medicine, Imperial College, Hammersmith Hospitals NHS Trust, London W12 0NN, UK
| | - Gary S Frost
- Professor of Nutrition, Nutrition and Dietetic Research Group, Imperial College, Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 0HS, UK
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