1
|
Company-Morales M, Casadó-Marín L, Muñoz A, Fontalba-Navas A. Breaking the Silence on Food Risks for Elderly People Living Alone. Nutrients 2024; 16:2655. [PMID: 39203793 PMCID: PMC11357022 DOI: 10.3390/nu16162655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Currently, numerous qualitative research studies on food and its influence on health are being conducted. In qualitative research, data are obtained by analyzing participants' responses. However, silence during conversation has been little studied. The aim of this study was to interpret the silences in the narratives of elderly people living alone about the potential risks of not keeping a healthy diet. (2) Methods: This is a descriptive and interpretative observational study under the qualitative research paradigm following a phenomenological and ethnographic perspective. The study was developed in two phases with people over 65 years old. In the first phase, from June 2021 to January 2022, 90 interviews, 12 life history analyses, 58 food diaries and 51 free listings (cultural domain technique) were conducted. In the second phase, from March to June 2022, 3 participatory workshops and 24 pile sorts (cultural domain technique) were conducted, as well as 3 focus groups. Only data from participants over 65 years old living alone are analyzed in this paper. The ATLAS-ti (Version 22) qualitative analysis software was used for coding and data analysis. (3) Results: The results show that elderly people living alone would sometimes remain silent during the various conversations conducted within the research. This silence reflects their desire to downplay the risks to their health from not eating well due to their unwanted loneliness. The people participating in our research had chronic health problems, financial insecurity and emotional problems. (4) Conclusions: We concluded that elderly people living alone are unable to maintain a healthy diet because they downplay their risk of malnutrition. This mindset is caused by their loneliness and bolstered by a situation of learned helplessness and social injustice.
Collapse
Affiliation(s)
- Miguel Company-Morales
- Seron Primary Care Center, Northern Almería Integrated Healthcare Area, 04600 Almeria, Spain
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada, 04120 Almeria, Spain
- “Toxic Body” Interdisciplinary Network, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain; (L.C.-M.); (A.M.); (A.F.-N.)
| | - Lina Casadó-Marín
- “Toxic Body” Interdisciplinary Network, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain; (L.C.-M.); (A.M.); (A.F.-N.)
- Department of Nursing, Medical Anthropology Research Centre (MARC), University of Rovira i Virgili, 43003 Tarragona, Spain
- Medical Anthropology Research Center (MARC), University of Rovira i Virgili, 43005 Tarragona, Spain
| | - Araceli Muñoz
- “Toxic Body” Interdisciplinary Network, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain; (L.C.-M.); (A.M.); (A.F.-N.)
- Medical Anthropology Research Center (MARC), University of Rovira i Virgili, 43005 Tarragona, Spain
- Training and Research Unit, School of Social Work, University of Barcelona, 08035 Barcelona, Spain
- Research and Innovation Group in Social Work (GRITS), Training and Research Unit, School of Social Work, University of Barcelona, 08035 Barcelona, Spain
| | - Andrés Fontalba-Navas
- “Toxic Body” Interdisciplinary Network, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain; (L.C.-M.); (A.M.); (A.F.-N.)
- Antequera Hospital, Northern Málaga Integrated Healthcare Area, 29200 Malaga, Spain
- Department of Public Health and Psychiatry, University of Málaga, 29016 Malaga, Spain
| |
Collapse
|
2
|
Ashford JR. Impaired oral health: a required companion of bacterial aspiration pneumonia. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1337920. [PMID: 38894716 PMCID: PMC11183832 DOI: 10.3389/fresc.2024.1337920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.
Collapse
|
3
|
Ureta JU, Ureta JC, Bower LM, Peoples BK, Motallebi M. The value of improving freshwater ecosystem services: South Carolina residents' willingness to pay for improved water quality. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 353:120260. [PMID: 38325279 DOI: 10.1016/j.jenvman.2024.120260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Riverine ecosystems play a crucial role in providing essential services such as drinking water, food, recreation, and other aquatic resources. Yet, their capacity to deliver ecosystem services is threatened by rapid land use which modifies their ecological functions. While freshwater monitoring and restoration programs became more robust with technological advancement, the technical ecosystem indicators monitored by experts do not typically resonate with the public. Since public sentiments and preferences are crucial in conservation planning, we quantified households' mean willingness to pay (WTP) for riverine ecosystem services in South Carolina (SC) using a payment card approach. This technique in conducting a contingent valuation method allowed us to estimate mean WTP for five aquatic indicators. Findings revealed that households' monthly mean WTP is higher for indicators that can enhance recreational benefits, such as fish catch ($5.89- $6.58), species richness ($6.28- $6.72) and access ($6.75) compared to IBI ($5.74- $6.26) and instream flow quality ($5.34-6.06). When extrapolated to entire SC, the improvement of each indicator would translate to total benefits ranging between $131 to $165 million annually. The values computed from this study could serve as inputs for the computation of benefit-cost ratios of proposed freshwater programs. By incorporating households' WTP in the policy analysis, decision makers can prioritize programs that offer the greatest public benefit, while enhancing freshwater quality across the state.
Collapse
Affiliation(s)
- Joan U Ureta
- Department of Forestry and Environmental Conservation, Clemson University, Clemson, SC, USA.
| | - J Carl Ureta
- Department of Forestry and Environmental Conservation, Clemson University, Clemson, SC, USA
| | - Luke M Bower
- U.S. Geological Survey, South Carolina Cooperative Fish and Wildlife Research Unit, Clemson University, Clemson, SC, USA
| | - Brandon K Peoples
- Department of Forestry and Environmental Conservation, Clemson University, Clemson, SC, USA
| | - Marzieh Motallebi
- Department of Forestry and Environmental Conservation, Clemson University, Clemson, SC, USA; Baruch Institute of Coastal Ecology and Forest Science, Clemson University, Georgetown, SC, USA
| |
Collapse
|
4
|
Hrabovsky V, Skrobankova M, Lys Z, Vrtkova A, Spacilova V, Vaclavik J. Point-of-care ultrasound (POCUS) in acute hospitalized older patients focused on hydration. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37799003 DOI: 10.5507/bp.2023.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Acutely ill older patients frequently suffer not only from their acute disease, but also polymorbidity and frailty. Dehydration is another typical symptom, usually occurring in its both forms: low-intake dehydration and volume depletion. POCUS is goal-directed bedside ultrasound examination and several studies refer to its positive impact on hydration assessment. The aim of our study was to determine whether POCUS might influence (de)hydration diagnostics and/or treatments in older patients with acute illness. METHODS We randomized 120 acutely ill patients, aged ≥65 years, into POCUS and non-POCUS groups. All participants underwent routine laboratory tests, including haematocrit, serum and urine osmolality, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, and C-reactive protein (CRP). POCUS was performed twice during the first two days to determine chest and abdominal status, with inferior vena cava (IVC) measurements. Length of hospital stay (HL) and consumption of infused fluids (CIF) was evaluated too. Data were analysed with exploratory methods and appropriate statistics. RESULTS Among all participants, the serum osmolality significantly correlated with age, BUN, creatinine and CIF. HL correlated with CRP and CIF. No significant correlations between IVC and other followed parameters were found. The POCUS group consumed significantly less infused fluids than the non-POCUS group, what could be influenced by POCUS examination of defined body compartments. CONCLUSION Dehydration is a common feature in older individuals and its diagnostics is rather complicated. The role of POCUS in assessing hydration status remains unclear. However, our study showed, that ultrasound assessment provides next important information for comprehensive understanding of clinical status in older patients and can be beneficial for optimizing the treatment strategy, including fluid management decisions.
Collapse
Affiliation(s)
- Vladimir Hrabovsky
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Martina Skrobankova
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Zdenek Lys
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Adela Vrtkova
- Department of Deputy Director of Science and Research, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Czech Republic
| | - Veronika Spacilova
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| |
Collapse
|
5
|
Parkinson E, Hooper L, Fynn J, Wilsher SH, Oladosu T, Poland F, Roberts S, Van Hout E, Bunn D. Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis. Clin Nutr 2023:S0261-5614(23)00185-1. [PMID: 37330324 DOI: 10.1016/j.clnu.2023.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND & AIMS Low-intake dehydration amongst older people, caused by insufficient fluid intake, is associated with mortality, multiple long-term health conditions and hospitalisation. The prevalence of low-intake dehydration in older adults, and which groups are most at-risk, is unclear. We conducted a high-quality systematic review and meta-analysis, implementing an innovative methodology, to establish the prevalence of low-intake dehydration in older people (PROSPERO registration: CRD42021241252). METHOD We systematically searched Medline (Ovid), Cochrane CENTRAL, Embase (Ovid), CINAHL and Proquest from inception until April 2023 and Nutrition and Food Sciences until March 2021. We included studies that assessed hydration status for non-hospitalised participants aged ≥65 years, by directly-measured serum/plasma osmolality, calculated serum/plasma osmolarity and/or 24-h oral fluid intake. Inclusion, data extraction and risk of bias assessment was carried out independently in duplicate. RESULTS From 11,077 titles and abstracts, we included 61 (22,398 participants), including 44 in quality-effects meta-analysis. Meta-analysis suggested that 24% (95% CI: 0.07, 0.46) of older people were dehydrated (assessed using directly-measured osmolality >300 mOsm/kg, the most reliable measure). Subgroup analyses indicated that both long-term care residents (34%, 95% CI: 0.09, 0.61) and community-dwelling older adults (19%, 95% CI: 0.00, 0.48) were highly likely to be dehydrated. Those with more pre-existing illnesses (37%, 95% CI: 0.14, 0.62) had higher low-intake dehydration prevalence than others (15%, 95% CI: 0.00, 0.43), and there was a non-significant suggestion that those with renal impairment (42%, 95% CI: 0.23, 0.61) were more likely to be dehydrated than others (23%, 95% CI: 0.03, 0.47), but there were no clear differences in prevalence by age, sex, functional, cognitive or diabetic status. GRADE quality of evidence was low as to the exact prevalence due to high levels of heterogeneity between studies. CONCLUSION Quality-effects meta-analysis estimated that a quarter of non-hospitalised older people were dehydrated. Widely varying prevalence rates in individual studies, from both long-term care and community groups, highlight that dehydration is preventable amongst older people. IMPLICATIONS One in every 4 older adults has low-intake dehydration. As dehydration is serious and prevalent, research is needed to better understand drinking behaviour and assess effectiveness of drinking interventions for older people.
Collapse
Affiliation(s)
- Ellice Parkinson
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Judith Fynn
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | | | - Titilopemi Oladosu
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Simone Roberts
- The Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom.
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| |
Collapse
|
6
|
Dehydration and hospital-associated disability in acute hospitalized older adults. Eur Geriatr Med 2023; 14:113-121. [PMID: 36445641 DOI: 10.1007/s41999-022-00722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Dehydration is highly prevalent in hospitalized older adults and has been linked to poor outcomes. It is considered a modifiable factor, so early identification and intervention may avoid adverse events and improve quality of life after discharge. Hospital-associated disability (HAD) is known to be a poor prognostic factor and can be categorized into mobility impairment and self-care impairment in setting goals for management. Few studies have directly examined the association between dehydration and HAD and therefore here we examined whether dehydration is a predictor of HAD categorized into mobility and self-care impairment among acute hospitalized older adults. METHODS Patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital were recruited for this prospective cohort study. Estimated serum osmolarity > 300 mOsm/kg was defined as current dehydration. HAD was assessed between baseline and discharge and at 3 months after discharge, and was evaluated separately for mobility and self-care impairments. RESULTS In total, 192 patients (mean age, 84.7 years; male, 41.1%; dehydration, 31.3%) were analyzed. The occurrence of HAD was significantly higher in the dehydrated group than in the non-dehydrated group (42.4% vs 26.5%) from baseline to 3 months after discharge. In multiple logistic regression analysis, dehydration was significantly associated with HAD in self-care from baseline to 3 months after discharge (odds ratio, 2.25; 95% confidence interval, 1.03-4.94). CONCLUSIONS Dehydration could predict the occurrence of HAD in acute hospitalized older adults. A multifaceted approach may be necessary to improve the management of dehydration in these patients.
Collapse
|
7
|
Carpenter L, Campain NJ. Overactive bladder: not just a normal part of getting older. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S16-S22. [PMID: 36227795 DOI: 10.12968/bjon.2022.31.18.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Overactive bladder (OAB) is a common yet under-reported condition affecting both men and women. Prevalence rises with age, but OAB can affect people of any age. It is associated with increased physical and mental health problems and may lead to social isolation and escalating care needs. It is a clinical diagnosis with symptoms of urgency, with or without urge incontinence and usually with urinary frequency and nocturia. Management includes conservative, medical and surgical treatments, which can significantly improve quality of life. This review aims to raise awareness of this under-reported condition and to empower health professionals to open discussions on bladder health with all those in their care.
Collapse
Affiliation(s)
- Lucy Carpenter
- Specialist Registrar, Department of Healthcare for Older People, Royal Devon University Healthcare NHS Foundation Trust
| | - Nicholas J Campain
- Consultant Urologist, Department of Urology, Royal Devon University Healthcare NHS Foundation Trust
| |
Collapse
|
8
|
Rosi IM, Milos R, Cortinovis I, Laquintana D, Bonetti L. Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: an observational diagnostic study. Nutrition 2022; 101:111695. [DOI: 10.1016/j.nut.2022.111695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
|
9
|
Danielsen MB, Worthington E, Karmisholt JS, Møller JM, Jørgensen MG, Andersen S. Adverse effects of subcutaneous vs intravenous hydration in older adults: An assessor-blinded randomised controlled trial (RCT). Age Ageing 2022; 51:6394989. [PMID: 34651171 DOI: 10.1093/ageing/afab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hydration therapy is essential in the care of the older patient. Subcutaneous (SC) hydration is a relevant method for parenteral hydration, but clinical trials on the subject have methodological shortcomings compared to updated standards. DESIGN Assessor-blinded, non-inferiority RCT to explore if SC is a safe alternative to intravenous (IV) hydration. PARTICIPANTS Eligible patients were: Admitted patients 65 years or older with a need for parenteral hydration. The targeted sample size was 67 patients in each group. INTERVENTION Patients were randomised to parenteral hydration via an IV or SC catheter during a 24 hours observation period. The non-randomised catheter (inactive) was placed as a sham on the patient, thereby blinding the caregivers and outcome assessors. MEASUREMENT Our primary outcome was the proportion of patients reporting at least one adverse effect with a non-inferiority calculation using a 20% margin. RESULTS We included 51 patients, with 24 randomised to SC and 27 to IV. We were unable to reach our target sample size due to challenges in recruitment, time limitation, and COVID-19. For the outcome of adverse effects, SC was non-inferior to IV (p = 0.012). Time spent on inserting the catheters was shorter with SC (p = 0.001). The groups did not differ by pain of insertion, discomfort during infusion, or the risk of developing delirium. CONCLUSION SC is a safe alternative to IV hydration, is faster to place and should be an available method for parenteral hydration wherever older adults are cared for. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03710408.
Collapse
Affiliation(s)
- Mathias Brix Danielsen
- Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Elisa Worthington
- Department of Emergency Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jesper Scott Karmisholt
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jørn Munkhof Møller
- Department of Emergency Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| |
Collapse
|
10
|
Shaban M, Mohammed H, Hassan S. Role of community health nurse in the prevention of elderly dehydration: A mini-review. JOURNAL OF INTEGRATIVE NURSING 2022. [DOI: 10.4103/jin.jin_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
11
|
Mukherjee U, Napier C, Oldewage-Theron W. ‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Upasana Mukherjee
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
12
|
Haemodynamic frailty - A risk factor for acute kidney injury in the elderly. Ageing Res Rev 2021; 70:101408. [PMID: 34271185 DOI: 10.1016/j.arr.2021.101408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
Clinical frailty in the elderly is defined by a composite measure of functional psychomotor decline. Herein, we develop the concept of haemodynamic frailty (HDF), a state of increased predisposition to disease prevalent in the elderly and characterised by impairment of the network of compensatory responses governing the defence of circulatory volume and adaptive haemodynamic function. We review the factors predisposing the elderly to HDF, with a focus on the impaired capacity to sustain total body water balance. As a component of HDF, dehydration generates vulnerability to diseases caused by tissue hypoperfusion, including acute kidney injury. We provide a detailed mechanistic explanation of how dehydration and depletion of the intravascular volume impacts on renal blood flow to become an important element of the heightened risk of acute kidney injury (AKI) in the elderly. We bring these mechanistic considerations into the clinical context with reference to examples of how pre-renal (haemodynamic) and intrinsic (involving renal parenchymal damage) AKI risk is elevated in the setting of dehydration. Finally, we present HDF as a state of opportunity to prevent disease, for which diagnostic and interventional standards need to be refined. Further prospective studies are warranted to help clarify the clinical utility of assessing and managing HDF with regard to the mitigation of AKI risk in the elderly.
Collapse
|
13
|
Sanson G, Marzinotto I, De Matteis D, Boscutti G, Barazzoni R, Zanetti M. Impaired hydration status in acutely admitted older patients: prevalence and impact on mortality. Age Ageing 2021; 50:1151-1158. [PMID: 33320928 DOI: 10.1093/ageing/afaa264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited. OBJECTIVES to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality. DESIGN retrospective cohort study. SETTING University Hospital-Internal Medicine Department. SUBJECTS a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016. METHODS according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (<275 mmol/L), euhydration (275-295 mmol/L), impending (296-300 mmol/L) and current dehydration (>300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated. RESULTS current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P < 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P < 0.001) with reduced short- and long-term survival. CONCLUSIONS impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.
Collapse
Affiliation(s)
- Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | - Ilaria Marzinotto
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | | | - Giuliano Boscutti
- Nephrology and Dialysis Department, University Hospital, Udine, 33100 Italy
| | - Rocco Barazzoni
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | - Michela Zanetti
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| |
Collapse
|
14
|
Dehydration in older people: A systematic review of the effects of dehydration on health outcomes, healthcare costs and cognitive performance. Arch Gerontol Geriatr 2021; 95:104380. [PMID: 33636649 DOI: 10.1016/j.archger.2021.104380] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/27/2021] [Accepted: 02/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To systematically examine the effect of dehydration on health outcomes, identify associated financial costs and consider impacts on cognitive performance in older adults. DESIGN A systematic review of English-language articles via OVID using MEDLINE, PsychINFO, EMBASE, and others, to March 2018. Included studies examined the relationship between hydration status and health, care costs or cognitive outcome. SETTING Cross sectional and cohort data from studies reporting on dehydration in older adults. PARTICIPANTS Adults aged 60 years and older. MEASUREMENTS Independent quality ratings were assessed for all extracted articles. RESULTS Of 1684 articles screened, 18 papers (N = 33,707) met inclusion criteria. Participants were recruited from hospital settings, medical long-term care centres and the community dwelling population. Data were synthesised using a narrative summary. Mortality rates were higher in dehydrated patients. Furthermore, health outcomes, including frailty, bradyarrhythmia, transient ischemic attacks, oral health and surgery recovery are linked to and worsened by dehydration. Length of hospital stay, either as a principal or secondary diagnosis, is greater in those with dehydration, compared to those who are euhydrated. Finally, neurocognitive functioning may be impacted by dehydration. There are issues with study design, inconsistency in hydration status measurement and different measures used for outcome assessment. CONCLUSION Dehydration in older people is associated with increased mortality, poorer course of illness and increased costs for health services. In addition, there is some, but sparse evidence that dehydration in older people is linked to poorer cognitive performance. Intervention studies should test strategies for reducing dehydration in older adults.
Collapse
|
15
|
Joseph NK, Barinsky GL, Kim DC, Din-Lovinescu C, Grube JG, Fang CH, Hsueh WD, Baredes S, Eloy JA. Impact of preoperative dehydration on endoscopic transsphenoidal pituitary surgery. Int Forum Allergy Rhinol 2021; 11:1124-1127. [PMID: 33539643 DOI: 10.1002/alr.22767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Nia K Joseph
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Dongmin C Kim
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJ Barnabas Health, Livingston, NJ
| |
Collapse
|
16
|
[Analysis of dehydration in older people in a nursing home in Spain: prevalence and associated factors]. NUTR HOSP 2021; 38:252-259. [PMID: 33593070 DOI: 10.20960/nh.03260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: dehydration in institutionalized elderly people has not been extensively studied. There are not clear data on the Spanish context. Aim: to estimate the prevalence of dehydration and to identify the associated factors in institutionalized older people in a nursing home. Methods: a cross-sectional study was carried out. Dehydration was measured through the colour of urine. For the identification of the associated factors, sociodemographic, clinical, functional, and mental variables were selected. Results: the total sample studied was comprised of 96 individuals with a mean age of 86.6 years (± 7.1), of whom 80.2 % were women. The prevalence of dehydration was 31.3% (95 % CI, 22.0 to 40.6). The factors that were independently associated with dehydration were the presence of sunken eyes (OR = 8.67; p = 0.004), low fluid intake (OR = 3.96; p = 0.041), and both functional (OR = 0.97; p = 0.012) and cognitive (OR = 1.10; p = 0.009) impairment. Conclusions: this study highlights the problem of dehydration in institutionalized older people in Spain. An urine colour table may be used routinely, non-invasively, and cheaply. So, it may well be the best simple method for detecting dehydration in this population. Taking into account that chronic dehydration is most prevalent in elderly people, the identification of associated factors is a key factor for a successful approach.
Collapse
|
17
|
Bracale R, Vaccaro CM, Coletta V, Cricelli C, Gamaleri FC, Parazzini F, Carruba M. Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study. Eat Weight Disord 2020; 25:1789-1798. [PMID: 31705447 PMCID: PMC7581569 DOI: 10.1007/s40519-019-00807-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Adopting a Mediterranean-like dietary pattern may help in preventing several chronic diseases. We assessed the eating behaviour and compliance with the Mediterranean diet pyramid recommendations in Italy. METHODS This is a cross-sectional study conducted in subjects aged ≥ 20 years. A 14-question survey based on the updated Mediterranean diet pyramid was launched online from April 2015 to November 2016. At test completion, a personalized pyramid displaying the possible deficiencies and/or excesses was generated, that could be the basis to plan diet and lifestyle modifications. RESULTS Overall, 27,540 subjects completed the survey: the proportion of females (75.6%), younger subjects (20.7%) and people with a University degree (33.1%) resembled those of the Italian population of Internet users rather than of the general population. 37.8% of participants declared a sedentary lifestyle, including 29.6% of those aged 20-29 years. A lower-than-recommended intake of all food categories included in the Mediterranean diet pyramid, along with excess of sweets, red and processed meats, emerged, that may affect health in the long term. Low adherence to recommendations was observed especially among females and older people. Notably, a discrepancy surfaced between the responders' perceived and actual behaviour toward the regular consumption of fruits and vegetables (81.8% vs 22.7-32.8%, respectively). CONCLUSIONS The nutritional habits and lifestyle of Italian participants are poorly adherent to the Mediterranean diet recommendations. The personalized pyramid tool may help in raising the awareness of individuals and their families on where to intervene, possibly with the support of healthcare professionals, to improve their behaviour. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
Collapse
Affiliation(s)
- Renata Bracale
- Department of Medicine and Sciences for Health, Molise University, Campobasso, Italy
| | | | | | - Claudio Cricelli
- Società Italiana di Medicina Generale e delle Cure Primarie Firenze, Florence, Italy
| | | | - Fabio Parazzini
- Dipartimento di scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| | - Michele Carruba
- Department of Medical Biotechnology and Translational Medicine, Center for the Study and Research on Obesity, University of Milan, Milan, Italy.
| |
Collapse
|
18
|
Chronic Dehydration in Nursing Home Residents. Nutrients 2020; 12:nu12113562. [PMID: 33233662 PMCID: PMC7709028 DOI: 10.3390/nu12113562] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/12/2023] Open
Abstract
Chronic dehydration mainly occurs due to insufficient fluid intake over a lengthy period of time, and nursing home residents are thought to be at high risk for chronic dehydration. However, few studies have investigated chronic dehydration, and new diagnostic methods are needed. Therefore, in this study, we aimed to identify risk factors for chronic dehydration by measuring serum osmolality in nursing home residents and also to evaluate whether examining the inferior vena cava (IVC) and determining the IVC collapsibility index (IVC-CI) by ultrasound can be helpful in the diagnosis of chronic dehydration. A total of 108 Japanese nursing home residents aged ≥65 years were recruited. IVC measurement was performed using a portable handheld ultrasound device. Fifteen residents (16.9%) were classified as having chronic dehydration (serum osmolality ≥295 mOsm/kg). Multivariate logistic regression analysis showed that chronic dehydration was associated with dementia (odds ratio (OR), 6.290; 95% confidential interval (CI), 1.270–31.154) and higher BMI (OR, 1.471; 95% CI, 1.105–1.958) but not with IVC or IVC-CI. Cognitive function and body weight of residents should be considered when establishing a strategy for preventing chronic dehydration in nursing homes.
Collapse
|
19
|
Masot O, Miranda J, Santamaría AL, Paraiso Pueyo E, Pascual A, Botigué T. Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review. Nutrients 2020; 12:E3383. [PMID: 33158071 PMCID: PMC7694182 DOI: 10.3390/nu12113383] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 01/17/2023] Open
Abstract
The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.
Collapse
Affiliation(s)
- Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Jèssica Miranda
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
- Nursing Home and Day Center for the Elderly Balàfia II, Health services management (GSS), 25005 Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Elena Paraiso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Alexandra Pascual
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| |
Collapse
|
20
|
Prieto-García L, Vicente-Vicente L, Blanco-Gozalo V, Hidalgo-Thomas O, García-Macías MC, Kurtz A, Layton AT, Sanz AB, Morales AI, Martínez-Salgado C, Pericacho M, Sancho-Martínez SM, López-Hernández FJ. Pathophysiological mechanisms underlying a rat model of triple whammy acute kidney injury. J Transl Med 2020; 100:1455-1464. [PMID: 32719543 DOI: 10.1038/s41374-020-0473-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/09/2022] Open
Abstract
Simultaneous administration of certain antihypertensive (renin-angiotensin system inhibitors and diuretics) and nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a renal toxicity syndrome known as "triple whammy" acute kidney injury (TW-AKI), yet poorly characterized at the pathophysiological level, as no specific experimental model exists on which to conduct preclinical research. Herein, we generated and characterized a rat model of TW-AKI (0.7 mg/kg/day trandolapril +400 mg/kg/day ibuprofen +20 mg/kg/day furosemide). Double treatments involving the NSAID caused a subclinical acute kidney injury, as they reduced glomerular filtration rate to a significant but not sufficient extent to increase Crpl concentration. Only the triple treatment generated an overt AKI with increased Crpl provided that animals were under partial water ingestion restriction. Histological examination revealed no evidence of tissue renal injury, and no proteinuria or makers of renal damage were detected in the urine. These findings, along with a normal fractional excretion of sodium and glucose, indicated that these drug combinations produce a prerenal type of AKI. In fact, blood pressure and renal blood flow were also reduced (most markedly following the triple combination), although renal dysfunction was more pronounced than expected for the corresponding pressure drop, supporting a key pathological role of the interference with renal autoregulation mechanisms. In summary, prerenal TW-AKI only occurs when volemia is challenged (i.e., by furosemide in partially water-deprived animals) under the effects of renin-angiotensin system inhibitors and NSAIDs. This model will facilitate further pathophysiological knowledge for a better diagnosis and clinical handling of this syndrome.
Collapse
Affiliation(s)
- Laura Prieto-García
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Laura Vicente-Vicente
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Omar Hidalgo-Thomas
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | | | - Armin Kurtz
- Institute of Physiology, University of Regensburg, Regensburg, Germany.,Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain
| | - Anita T Layton
- Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain.,Departments of Applied Mathematics and Biology, and Schools of Computer Science and Pharmacology, University of Waterloo, Waterloo, N2L 3G1, Ontario, Canada
| | - Ana B Sanz
- National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.,Institute of Biomedical Research Fundación Jiménez Díaz, Madrid, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.,Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.,Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain.,Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Miguel Pericacho
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.,Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain
| | - Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,University of Salamanca (USAL), Department of Physiology and Pharmacology, Salamanca, Spain. .,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain. .,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain. .,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain. .,Disease and Theranostic Modeling (DisMOD) Consortium, Salamanca, Spain. .,Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain.
| |
Collapse
|
21
|
Munshi E, Bengtsson E, Blomberg K, Syk I, Buchwald P. Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer: a prospective cohort study. ANZ J Surg 2020; 90:1627-1631. [PMID: 32840053 DOI: 10.1111/ans.16258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Defunctioning loop ileostomy (DLI) in low anterior resection (LAR) in rectal cancer patients reduces the morbidity of anastomotic leakages. In our previous study, 30% of patients developed dehydration due to DLI, mostly during the first 6 weeks. This interventional study aimed to reduce these figures by establishing a surveillance programme. METHODS An interventional study of rectal cancer patients undergoing LAR and DLI between 2013 and 2015 was carried out. A historical study group was used as control. Stoma care nurses educated the intervention group about high-output stoma. Blood tests, including creatinine and electrolytes, were taken every second week until 8 weeks post-operatively and an additional control in case of subjective high-output stoma. RESULTS Eighty-seven patients underwent LAR and DLI during the study period. Twenty-one (24%) developed dehydration episodes, and nine (43%) of them required readmission. There was no difference compared to the control group, where 29% developed dehydration, and about half (52%) needed readmission (P = 0.62 and P = 0.57, respectively). However, when explicitly examining patients demonstrating symptomatic dehydration, there was a significant difference, that is 10 (11%) versus 27 (29%) (P < 0.005). Overall, the dehydrated group was older and more likely to take diuretics compared to the non-dehydrated group. CONCLUSION Our results indicate that reducing dehydration episodes and readmission after DLI is a challenging process. The proposed surveillance was only effective in preventing symptomatic dehydration. Subjects taking diuretics and the elderly are at risk of dehydration and should be followed cautiously.
Collapse
Affiliation(s)
- Eihab Munshi
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Eva Bengtsson
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Karin Blomberg
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Ingvar Syk
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Pamela Buchwald
- Colorectal Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
22
|
Impending Low Intake Dehydration at Admission to A Geriatric Ward- Prevalence and Correlates in a Cross-Sectional Study. Nutrients 2020; 12:nu12020398. [PMID: 32024303 PMCID: PMC7071250 DOI: 10.3390/nu12020398] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Dehydration risk increases with frailty and functional dependency, but a limited number of studies have evaluated this association in hospitalized geriatric patients. This cross-sectional study aimed to assess the prevalence and determinants of dehydration in patients admitted to the geriatric ward. Dehydration was diagnosed when calculated osmolarity was above 295 mMol/L. Logistic regression analyses (direct and stepwise backward) were used to assess determinants of impending dehydration. 358 of 416 hospitalized patients (86.1%) were included: 274 (76.5%) women, and 309 (86.4%) 75+ year-old. Dehydration was diagnosed in 209 (58.4%) cases. Significantly higher odds for impending dehydration were observed only for chronic kidney disease with trends for diabetes and procognitive medication when controlling for several health, biochemical, and nutritional parameters and medications. After adjusting for “dementia” the negative effect of “taking procognitive medications” became a significant one. Chronic kidney disease, diabetes, taking procognitive medications and hypertension were the main variables for the outcome prediction according to the stepwise backward regression analysis. This may indicate an additional benefit of reducing the risk of dehydration when using procognitive drugs in older patients with dementia.
Collapse
|
23
|
|
24
|
Adherence to the healthy eating guide issued by the Sociedad Española de Nutrición Comunitaria (SENC) (2018) among non-institutionalized elderly in Santander, Spain. NUTR HOSP 2020; 37:933-943. [DOI: 10.20960/nh.03093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
25
|
Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
Collapse
Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
| |
Collapse
|
26
|
O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167. [PMID: 30029632 PMCID: PMC6053717 DOI: 10.1186/s12877-018-0839-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. DISCUSSION There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners. CONCLUSION The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
Collapse
Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Unit 4, Merlin Park University Hospital, Galway, Ireland.
| |
Collapse
|
27
|
Inadequate fluid intake in long term care residents: prevalence and determinants. Geriatr Nurs 2018; 39:330-335. [DOI: 10.1016/j.gerinurse.2017.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/05/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
|
28
|
Hughes F, Mythen M, Montgomery H. The sensitivity of the human thirst response to changes in plasma osmolality: a systematic review. Perioper Med (Lond) 2018; 7:1. [PMID: 29344350 PMCID: PMC5763530 DOI: 10.1186/s13741-017-0081-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/21/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's thirst can provide an accurate guide to fluid therapy. This systematic review examines the sensitivity of thirst in responding to changes in plasma osmolality in participants of any age with no condition directly effecting their sense of thirst. METHODS Medline and EMBASE were searched up to June 2017. Inclusion criteria were all studies reporting the plasma osmolality threshold for the sensation of thirst. RESULTS A total of 12 trials were included that assessed thirst intensity on a visual analogue scale, as a function of plasma osmolality (pOsm), and employed linear regression to define the thirst threshold. This included 167 participants, both healthy controls and those with a range of pathologies, with a mean age of 41 (20-78) years.The value ±95% CI for the pOsm threshold for thirst sensation was found to be 285.23 ± 1.29 mOsm/kg. Above this threshold, thirst intensity as a function of pOsm had a mean ± SEM slope of 0.54 ± 0.07 cm/mOsm/kg. The mean ± 95% CI vasopressin release threshold was very similar to that of thirst, being 284.3 ± 0.71 mOsm/kg.Heterogeneity across studies can be accounted for by subtle variation in experimental protocol and data handling. CONCLUSION The thresholds for thirst activation and vasopressin release lie in the middle of the normal range of plasma osmolality. Thirst increases linearly as pOsm rises. Thus, osmotically balanced fluid administered as per a patient's sensation of thirst should result in a plasma osmolality within the normal range. This work received no funding.
Collapse
Affiliation(s)
- Fintan Hughes
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
| | - Monty Mythen
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
| | - Hugh Montgomery
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
| |
Collapse
|
29
|
Picetti D, Foster S, Pangle AK, Schrader A, George M, Wei JY, Azhar G. Hydration health literacy in the elderly. NUTRITION AND HEALTHY AGING 2017; 4:227-237. [PMID: 29276792 PMCID: PMC5734130 DOI: 10.3233/nha-170026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly. METHODS We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge. RESULTS About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death. CONCLUSIONS Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.
Collapse
Affiliation(s)
- Dominic Picetti
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephen Foster
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amanda K. Pangle
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amy Schrader
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Masil George
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanne Y. Wei
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gohar Azhar
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
30
|
Freitas HR, Ferreira GDC, Trevenzoli IH, Oliveira KDJ, de Melo Reis RA. Fatty Acids, Antioxidants and Physical Activity in Brain Aging. Nutrients 2017; 9:nu9111263. [PMID: 29156608 PMCID: PMC5707735 DOI: 10.3390/nu9111263] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022] Open
Abstract
Polyunsaturated fatty acids and antioxidants are important mediators in the central nervous system. Lipid derivatives may control the production of proinflammatory agents and regulate NF-κB activity, microglial activation, and fatty acid oxidation; on the other hand, antioxidants, such as glutathione and ascorbate, have been shown to signal through transmitter receptors and protect against acute and chronic oxidative stress, modulating the activity of different signaling pathways. Several authors have investigated the role of these nutrients in the brains of the young and the aged in degenerative diseases such as Alzheimer’s and Parkinson’s, and during brain aging due to adiposity- and physical inactivity-mediated metabolic disturbances, chronic inflammation, and oxidative stress. Through a literature review, we aimed to highlight recent data on the role of adiposity, fatty acids, antioxidants, and physical inactivity in the pathophysiology of the brain and in the molecular mechanisms of senescence. Data indicate the complexity and necessity of endogenous/dietary antioxidants for the maintenance of redox status and the control of neuroglial signaling under stress. Recent studies also indicate that omega-3 and -6 fatty acids act in a competitive manner to generate mediators for energy metabolism, influencing feeding behavior, neural plasticity, and memory during aging. Finding pharmacological or dietary resources that mitigate or prevent neurodegenerative affections continues to be a great challenge and requires additional effort from researchers, clinicians, and nutritionists in the field.
Collapse
Affiliation(s)
- Hércules Rezende Freitas
- Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
| | - Gustavo da Costa Ferreira
- Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
- Laboratory of Neuroenergetics and Inborn Errors of Metabolism, Institute of Medical Biochemistry Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
| | - Isis Hara Trevenzoli
- Laboratory of Molecular Endocrinology, Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
| | - Karen de Jesus Oliveira
- Laboratory of Endocrine Physiology and Metabology, Biomedical Institute, Universidade Federal Fluminense, Niterói 24210-130, Brazil.
| | - Ricardo Augusto de Melo Reis
- Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil.
| |
Collapse
|
31
|
Miller AJ, Theou O, McMillan M, Howlett SE, Tennankore KK, Rockwood K. Dysnatremia in Relation to Frailty and Age in Community-dwelling Adults in the National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci 2017; 72:376-381. [PMID: 27356976 DOI: 10.1093/gerona/glw114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023] Open
Abstract
Background Frailty represents an age-related state of increased risk of adverse health outcomes, reflecting some combination of increased damage and compromised repair processes. Our objectives were to establish whether frailty is associated with dysnatremia (a deviation of serum sodium from normal values), to determine whether frailty explains the previously established association between age and dysnatremia and to assay the impact of each on mortality. Methods The relationship between age, frailty, and dysnatremia was investigated across the adult life course in 8,911 respondents from the 2003-2004 and 2005-2006 cross-sectional National Health and Nutrition Examination Survey, on whom both laboratory and mortality data were available. A frailty index (FI) was calculated for each respondent and related to dysnatremia (serum sodium values outside a 136-144 mmol/L reference range). Results Dysnatremia was significantly related to both age and frailty; as the degree of frailty increased, so did the proportion with dysnatremia, for example, from 4.1% in those with FI less than 0.10, to 12.4% in those with FI 0.40 or more; p less than .001. Adjusted for frailty, the relationship between age and dysnatremia was no longer significant. In the age- and sex-adjusted Cox models, both frailty (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1.04-1.05 for every 0.01 increase in FI) and dysnatremia (HR: 1.85; 95% CI: 1.51-2.26) were significant predictors of mortality; when hyponatremia was separated from hypernatremia in the Cox models, hypernatremia wasn't significant, but only 41 participants were identified as hypernatremic. Conclusion Increasing frailty is associated with dysnatremia and confounds the association between age and dysnatremia.
Collapse
Affiliation(s)
| | | | | | - Susan E Howlett
- Division of Geriatric Medicine, and.,Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | |
Collapse
|
32
|
Lu C, Yuan L, Lin W, Zhou Y, Pan S. Depression and resilience mediates the effect of family function on quality of life of the elderly. Arch Gerontol Geriatr 2017; 71:34-42. [DOI: 10.1016/j.archger.2017.02.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 01/09/2023]
|
33
|
JafariNasabian P, Inglis JE, Reilly W, Kelly OJ, Ilich JZ. Aging human body: changes in bone, muscle and body fat with consequent changes in nutrient intake. J Endocrinol 2017; 234:R37-R51. [PMID: 28442508 DOI: 10.1530/joe-16-0603] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/25/2017] [Indexed: 12/14/2022]
Abstract
Aging affects almost all physiological processes, but changes in body composition and body phenotype are most observable. In this review, we focus on these changes, including loss of bone and muscle and increase in body fat or redistribution of the latter, possibly leading to osteosarcopenic obesity syndrome. We also address low-grade chronic inflammation, prevalent in aging adults and a cause of many disorders including those associated with body composition. Changes in dietary intake and nutritional requirements of older individuals, that all may lead to some disturbances on tissue and organ levels, are discussed as well. Finally, we discuss the hormonal changes in the aging body, considering each of the tissues, bone, muscle and fat as separate endocrine organs, but yet in the continuous interface and communication with each other. Although there are still many unanswered questions in this field, this review will enable the readers to better understand the aging human body and measures needing to be implemented toward reducing impaired health and disability in older individuals.
Collapse
Affiliation(s)
- Pegah JafariNasabian
- Department of NutritionFood and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
| | - Julia E Inglis
- Department of NutritionFood and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
| | - Wendimere Reilly
- Department of NutritionFood and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
| | | | - Jasminka Z Ilich
- Department of NutritionFood and Exercise Sciences, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
34
|
Nissensohn M, Sánchez-Villegas A, Galan P, Turrini A, Arnault N, Mistura L, Ortiz-Andrellucchi A, Edelenyi FSD, D'Addezio L, Serra-Majem L. Beverage Consumption Habits among the European Population: Association with Total Water and Energy Intakes. Nutrients 2017; 9:E383. [PMID: 28406441 PMCID: PMC5409722 DOI: 10.3390/nu9040383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/23/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fluid and water intake have received limited attention in epidemiological studies. The aim of this study was to compare the average daily consumption of foods and beverages in adults of selective samples of the European Union (EU) population in order to understand the contribution of these to the total water intake (TWI), evaluate if the EU adult population consumes adequate amounts of total water (TW) according to the current guidelines, and to illustrate the real water intake in Europe. METHODS Three national European dietary surveys have been selected: Spain used the Anthropometry, Intake, and Energy Balance Study (ANIBES) population database, Italy analyzed data from the Italian National Food Consumption Survey (INRAN-SCAI 2005-06), and French data came from the NutriNet-Santé database. Mean daily consumption was used to compare between individuals. TWI was compared with European Food Safety Authority (EFSA) reference values for adult men and women. RESULTS On average, in Spain, TWI was 1.7 L (SE 22.9) for men and 1.6 L (SE 19.4) for women; Italy recorded 1.7 L (SE 16.9) for men and 1.7 L (SE 14.1) for women; and France recorded 2.3 L (SE 4.7) for men and 2.1 L (SE 2.4) for women. With the exception of women in France, neither men nor women consumed sufficient amounts of water according to EFSA reference values. CONCLUSIONS This study highlights the need to formulate appropriate health and nutrition policies to increase TWI in the EU population. The future of beverage intake assessment requires the use of new instruments, techniques, and the application of the new available technologies.
Collapse
Affiliation(s)
- Mariela Nissensohn
- International Chair for Advanced Studies on Hydration (ICASH), University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- CIBER OBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, 28029 Madrid, Spain.
| | - Almudena Sánchez-Villegas
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- CIBER OBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, 28029 Madrid, Spain.
| | - Pilar Galan
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Aida Turrini
- CREA-Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per gli alimenti e la nutrizione, Via Ardeatina 546, 00178 Rome, Italy.
| | - Nathalie Arnault
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Lorenza Mistura
- CREA-Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per gli alimenti e la nutrizione, Via Ardeatina 546, 00178 Rome, Italy.
| | - Adriana Ortiz-Andrellucchi
- International Chair for Advanced Studies on Hydration (ICASH), University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- CIBER OBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, 28029 Madrid, Spain.
| | - Fabien Szabo de Edelenyi
- Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Laura D'Addezio
- CREA-Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per gli alimenti e la nutrizione, Via Ardeatina 546, 00178 Rome, Italy.
| | - Lluis Serra-Majem
- International Chair for Advanced Studies on Hydration (ICASH), University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
- CIBER OBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, 28029 Madrid, Spain.
| |
Collapse
|
35
|
Beverage Consumption Habits around the World: The Burden of Disease Attributable to Hydration. Nutrients 2016; 8:nu8110738. [PMID: 27869714 PMCID: PMC5133121 DOI: 10.3390/nu8110738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 12/15/2022] Open
|
36
|
Sui Z, Zheng M, Zhang M, Rangan A. Water and Beverage Consumption: Analysis of the Australian 2011-2012 National Nutrition and Physical Activity Survey. Nutrients 2016; 8:nu8110678. [PMID: 27792184 PMCID: PMC5133066 DOI: 10.3390/nu8110678] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 12/16/2022] Open
Abstract
Background: Water consumption as a vital component of the human diet is under-researched in dietary surveys and nutrition studies. Aim: To assess total water and fluid intakes and examine demographic, anthropometric, and dietary factors associated with water consumption in the Australian population. Methods: Dietary intake data from the 2011 to 2012 National Nutrition and Physical Activity Survey were used. Usual water, fluid and food and nutrient intakes were estimated from two days of dietary recalls. Total water includes plain drinking water and moisture from all food and beverage sources; total fluids include plain drinking water and other beverages, but not food moisture. Results: The mean (SD) daily total water intakes for children and adolescents aged 2–18 years were 1.7 (0.6) L for males and 1.5 (0.4) L for females, and for adults aged 19 years and over were 2.6 (0.9) L for males and 2.3 (0.7) L for females. The majority of the population failed to meet the Adequate Intake (AI) values for total water intake (82%) and total fluids intake (78%) with the elderly at highest risk (90%–95%). The contributions of plain drinking water, other beverages and food moisture to total water intake were 44%, 27%, and 29%, respectively, among children and adolescents, and 37%, 37% and 25% among adults. The main sources of other beverages were full-fat plain milk and regular soft drinks for children and adolescents, and tea, coffee, and alcoholic drinks for adults. For adults, higher total water intake was associated with lower percent energy from fat, saturated fat, and free sugars, lower sodium and energy-dense nutrient poor food intakes but higher dietary fibre, fruit, vegetable, caffeine, and alcohol intakes. No associations were found between total water consumption and body mass index (BMI) for adults and BMI z-score for children and adolescents. Conclusion: Reported water consumption was below recommendations. Higher water intakes were suggestive of better diet quality.
Collapse
Affiliation(s)
- Zhixian Sui
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Miaobing Zheng
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Man Zhang
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Anna Rangan
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Camperdown 2006, NSW, Australia.
| |
Collapse
|
37
|
Sfera A, Cummings M, Osorio C. Dehydration and Cognition in Geriatrics: A Hydromolecular Hypothesis. Front Mol Biosci 2016; 3:18. [PMID: 27252943 PMCID: PMC4860410 DOI: 10.3389/fmolb.2016.00018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Dehydration is one of the ten most frequent diagnoses responsible for the hospital admission of elderly in the United States. It is associated with increased mortality, morbidity and an estimated cost of 1.14 billion per year (Xiao et al., 2004; Schlanger et al., 2010; Pretorius et al., 2013; Frangeskou et al., 2015). Older individuals are predisposed to dehydration encephalopathy as a result of decreased total body water (TBW) and diminished sensation of thirst. We hypothesize that thirst blunting in older individuals is the result of a defective microRNA-6842-3p failing to silence the expression of the vesicular GABA transporters (VGAT) and alpha 7 cholinergic nicotinic receptors in the subfornical organ (SFO) of the hypothalamus. We hypothesize further that resultant dehydration facilitates protein misfolding and aggregation, predisposing to neurocognitive disorders. We completed a search of predicted microRNA targets, utilizing the public domain tool miRDB and found that microRNA-6842-3p modulates the SLC6A1 and CHRNA7 genes both of which were previously hypothesized to inhibit the thirst sensation by their action on SFO. The primary aim of this article is to answer two questions: Can prevention and correction of dehydration in elderly lower age-related cognitive deterioration? Can exosomal miR-6842 in the peripheral blood predict dehydration encephalopathy in elderly?
Collapse
Affiliation(s)
- Adonis Sfera
- Department of Psychiatry, Loma Linda UniversityLoma Linda, USA; Patton State HospitalPatton, USA
| | | | - Carolina Osorio
- Department of Psychiatry, Loma Linda University Loma Linda, USA
| |
Collapse
|
38
|
Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study. Nutrients 2016; 8:232. [PMID: 27104564 PMCID: PMC4848700 DOI: 10.3390/nu8040232] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/29/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI) are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. Methods: The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9–75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. Results: On average, TWI was 1.7 L (SE 21.2) for men and 1.6 L (SE 18.9) for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA) recommendations. Mean total energy intake (EI) was 1810 kcal/day (SE 11.1), of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39) and EI (r = 0.23), suggesting that beverage variety is an indicator of higher consumption of food and drinks. Conclusions: The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern.
Collapse
|