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Castaldo A, Bassola B, Zanetti ES, Nobili A, Zani M, Magri M, Verardi AA, Ianes A, Lusignani M, Bonetti L. Nursing Home Organization Mealtimes and Staff Attitude Toward Nutritional Care: A Multicenter Observational Study. J Am Med Dir Assoc 2024; 25:898-903. [PMID: 37989497 DOI: 10.1016/j.jamda.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the practices of registered nurses and nurse aides at mealtimes in nursing homes (NHs) and to evaluate the attitudes of health care staff toward the nutritional care of older people. DESIGN This is a multicenter cross-sectional study. SETTING AND PARTICIPANTS The study involved a convenience sample of NH health care staff: physicians, registered nurses, and nurse aides. METHODS Data were collected on characteristics of the dining environment, organizational and nutritional care practices, staff-resident ratio, and staff activities during meals, using 2 questionnaires and staff attitudes were assessed with Staff Attitudes to Nutritional Nursing Care Geriatric Scale (SANN-G). Total score ranges from 18 to 90 points, with the following cutoffs: ≥72, positive attitude; ≤54, negative; and 55-71 points, neutral attitude. RESULTS A total of 1267 workers from 29 NHs in northern Italy participated in the study. The most common nutritional assessment tool used by nurses was the Malnutrition Universal Screening Tool. A median of 4.0 and 4.2 people (family caregivers, volunteers and staff) were present for feeding support, respectively, at lunch and dinner. A median of 2.5 and 2.0 staff members at lunch and at dinner, respectively, fed residents. Overall, 1024 health care workers responded to SANN-G of which 21.9% showed a negative attitude, 57.2% neutral, and 20.9% a positive attitude. Nurse aides (190/714) showed worse attitudes compared with registered nurses (20/204) and physicians (2/36); differences were statistically significant. Overall, the best attitudes were toward "habits," "interventions," and "individualization" of nutritional care. Staff who had received nutritional training (29.2%) had best attitudes. CONCLUSIONS AND IMPLICATIONS The results suggest that NHs should ensure adequate staff-resident ratio during meals, involving trained volunteers and relatives. Moreover, health professionals' knowledge and attitude toward nutritional care should be improved through continuous training.
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Affiliation(s)
- Anna Castaldo
- IRCCS S. Maria Nascente Don Gnocchi Foundation, Milan, Italy; Bachelor in Nursing, University of Milan, Milan, Italy.
| | | | | | | | - Michele Zani
- Fondazione Le Rondini Città di Lumezzane Onlus, Lumezzane (BS), Italy
| | | | | | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Competence Center, Ente Ospedaliero Cantonale, Bellinzona, Canton Ticino, Switzerland; Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
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Trollebø MA, Tangvik RJ, Skeie E, Grønning MK, Nygård O, Eagan TML, Dierkes J. Malnutrition as a prognostic factor for 2-year mortality in hospitalized patients in Norway: A matched cohort study. JPEN J Parenter Enteral Nutr 2024; 48:308-317. [PMID: 38477359 DOI: 10.1002/jpen.2619] [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: 12/14/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Risk of malnutrition and malnutrition have been previously associated with increased risk of mortality. It remains unclear, however, whether the severity of malnutrition differentiates in association with all-cause mortality. The aim was to assess the association between being at risk of malnutrition or being diagnosed with malnutrition according to the diagnostic assessment of the Global Leadership Initiative on Malnutrition (GLIM) with all-cause mortality during a 2-year follow-up in hospitalized patients. METHODS A matched cohort study was conducted in hospitalized patients (excluding cancer, intensive care, and transmissible infections) at a university hospital in Bergen, Norway. All patients underwent nutrition screening with the Nutritional Risk Screening 2002 and a further nutrition assessment using the GLIM criteria. All-cause mortality was estimated from the Norwegian death registry after 2 years, and risk factors were calculated by Cox regression analysis. RESULTS Among 326 patients included, 55 patients died within 2 years (17% mortality rate). Risk of malnutrition was associated with increased all-cause mortality, which disappeared after adjustment for age and sex. Malnutrition was associated with an increased risk of all-cause mortality at 2 years also after adjustment for age and sex and, additionally, for further comorbidities (hazard ratio = 2.50; 95% CI, 1.41-4.42). When analyzed separately only severe malnutrition was associated with mortality (hazard ratio = 2.73; 95% CI, 1.44-5.15). CONCLUSION The findings highlight a strong association between inpatients with severe malnutrition, defined by the GLIM criteria, and an increased risk of all-cause mortality within a 2-year follow-up.
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Affiliation(s)
- Marte A Trollebø
- Centre for Nutrition and Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Randi J Tangvik
- Centre for Nutrition and Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eli Skeie
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Martin K Grønning
- Centre for Nutrition and Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ottar Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tomas M L Eagan
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jutta Dierkes
- Centre for Nutrition and Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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Ogawa M, Okamura M, Inoue T, Sato Y, Momosaki R, Maeda K. Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 59:365-377. [PMID: 38220398 DOI: 10.1016/j.clnesp.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services. METHODS We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected. RESULTS The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5 kg/m2) than in those with BMI ≥18.5 kg/m2 (risk ratio [RR] 1.49; 95 % confidence interval [CI] 1.31 to 1.73, 0.22; I2 93 %). Further, on categorising the participants based on a BMI cutoff of 25 kg/m2, those with a BMI of <25 kg/m2 had a significantly increased mortality rate (RR 1.21; 95 % CI 1.04-1.40; I2 = 98 %). BMI and weight loss did not affect ADL. CONCLUSIONS Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.
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Affiliation(s)
- Masato Ogawa
- Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
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AlFehaidi AAAHZ, Khan SHU, Abdelrahman RA, Ahel NT, Shine P, De Ramos MD, Skairjeh NM, Khan SA, Al-Saadi RK. Predictors of malnutrition among older residents in Qatari long-term care facilities: a retrospective study. BMC Nutr 2024; 10:23. [PMID: 38303045 PMCID: PMC10835922 DOI: 10.1186/s40795-024-00827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent issue among older adults in long-term care facilities and is associated with adverse health outcomes and increased healthcare costs. Identifying the predictors of malnutrition in this population is crucial for developing effective intervention strategies. This study aimed to explore the factors contributing to malnourishment among older individuals living in long-term care facilities in Qatar. METHODS This cross-sectional study included 75 older adults from two long-term care facilities (Rumailah Hospital and Enaya Specialized Care Center) in Qatar. Baseline characteristics, including age, sex, length of stay, mortality, weight, body mass index, co-morbidities, and laboratory parameters, were assessed. Data were analyzed using the most recent version of the SPSS software, version 29. Predictors of malnutrition and mortality were identified using logistic regression analysis. RESULTS Of the 75 older individuals included in the study, 85% (64) were malnourished. The average age of the participants was 74.89 years, with a standard deviation of 10.21. Of all participants, approximately 61% (46) were males, and 39% (29) were females. Most malnourished older adults were classified as either at "moderate (29.69%)" or "severe risk (37.50%)," according to the Geriatric Nutritional Risk Index. Malnourished participants experienced a significant percentage of weight change within 3 months (14.01 ± 7.89); the only statistically significant predictor of malnutrition was the percentage of weight change within 3 months with an odds ratio (OR) of 4.8 (confidence interval [CI] 1.56-14.75) and p-value of 0.006. Statistically significant predictors of mortality were malnutrition (OR 24.84, CI 1.09-564) and age (OR 1.07, CI 1.00-1.14). CONCLUSIONS A significant predictor of malnutrition in older adults identified in this study was the sudden and recent change in weight, which can be employed to detect individuals at risk early and guide tailored interventions. Malnutrition is a significant predictor of mortality. Employing a multidimensional strategy to tackle malnutrition can improve outcomes for the older individuals.
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Affiliation(s)
- Al Anoud Ali H Z AlFehaidi
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar.
| | - Shafi Hashmath Ulla Khan
- Department of Geriatrics & Long-Term Care, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rana Albdeljubbar Abdelrahman
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nesreen Talal Ahel
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Pavithra Shine
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Monica Doroja De Ramos
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nisreen Mazin Skairjeh
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Shakeel Ahmad Khan
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
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Wang Y, Hua Y, Zhang H, Liang S, Cao Z, Chen L, Su Z, Zhang W. Ratio of waist circumference to body mass index: A novel predictor of clinical outcome in hypertension patients. J Clin Hypertens (Greenwich) 2024; 26:24-35. [PMID: 37864476 PMCID: PMC10795094 DOI: 10.1111/jch.14739] [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: 09/11/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
We aim to investigate the influence of waist circumference and body mass index (BMI) on all-cause death and cardiovascular-specific death in patients with hypertension. This prospective cohort study, based on waist circumference and body mass index measurements in patients with hypertension, provided risk estimates of all-cause mortality and cardiovascular events. The waist circumference-to-BMI ratio (WtBR) is an anthropometric measure integrating waist circumference and BMI. We utilized multivariable Cox regression analysis, restricted cubic spline model, Kaplan-Meier plot, random forest analysis, and sensitivity analysis to assess the relationship of WtBR with all-cause mortality. Subsequently, Fine-Gray competing risk regression models were applied to precisely evaluate the probability of cardiovascular-specific death attributed to high WtBR. The results indicate that thea deceased group showed significantly higher WtBR and lower BMI compared with the alive groups (P < .05), while no significant difference was observed in waist circumference (P = .373). When analyzed as continuous, the risk of all-cause death elevated with increasing WtBR in the adjusted model with an HR of 2.42 (95% CI, 2.06-2.85). The restricted cubic spline illustrated an elevated risk of all-cause mortality as WtBR increased (J-shaped curve). Nevertheless, WtBR showed no significant association with cardiovascular-specific death and the prediction model exhibited a reliable performance in the testing set. This study supported that WtBR, an anthropometric measure, is independently associated with all-cause death in hypertensive patients. It's advisable to routinely assess waist circumference in hypertensive patients regardless of BMI, in order to more effectively manage the risk of obesity-related health.
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Affiliation(s)
| | - Yang Hua
- Nanjing Medical UniversityNanjingChina
| | | | | | | | - Lu‐Lu Chen
- Department of Anatomy, Histology, and EmbryologyNanjing Medical UniversityNanjingChina
| | | | - Wei Zhang
- Department of Anatomy, Kangda CollegeNanjing Medical UniversityLianyungangJiangsuChina
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Feng L, Chen W, Yang T, Liu Q, Zhao Y, Song Q, Ping P, Fu S. Malnutrition significantly affected centenarian prognoses: A prospective study with 5-year follow-up. Clin Nutr ESPEN 2023; 58:117-121. [PMID: 38056994 DOI: 10.1016/j.clnesp.2023.09.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The world is currently facing a much-needed conundrum, and population aging has become an important worldwide problem. Appropriate nutritional intervention could prolong survival time and reduce mortality rate. However, scarce study has involved the effects of nutrition on survival time in centenarians and evaluated the malnutrition with prognostic nutritional index (PNI) in relation to healthy aging. This prospective study was designed to investigate the effects of malnutrition through PNI assessment on mortality rate and survival time with 5-year follow-up in Chinese centenarians. METHODS A household survey was conducted on the centenarians in 18 cities and counties of Hainan province, and malnutrition was evaluated by PNI as an effective tool in 423 centenarians followed up for 5-year. RESULTS Prevalence of malnutrition was 19.4%. Body mass index (BMI) was significantly lower and malnutrition was significantly more in the dead group than those in the survival group (all P < 0.05). Multivariate Cox regression analysis indicated that BMI [Hazard ratio (HR): 0.913; 95%CI: 0.854-0.977] negatively affected mortality rate, whereas malnutrition (HR: 2.630; 95%CI:1.474-4.695) positively affected mortality rate in centenarians (all P < 0.05). When BMI was <18.5 kg/m2, malnutrition (HR: 4.401; 95%CI: 1.948-9.943) also positively affected mortality rate (P < 0.05). CONCLUSIONS This prospective study with 5-year follow-up demonstrated that malnutrition had positive effect on mortality rate, especially when BMI was lower than 18.5 kg/m2, in Chinese centenarians. In order to reduce mortality rate and prolong survival time, it is essential to pay attention to malnutrition in elderly population.
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Wenji Chen
- Department of Rheumatology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Ting Yang
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Qiong Liu
- Medical Care Center, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Qing Song
- Heatstroke Treatment and Research Center of Chinese People's Liberation Army, Sanya, China.
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Inspection, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China.
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China; Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
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Bahat G, Ilhan B, Catikkas NM, Tufan A, Ozturk S, Dogan H, Karan MA. Associations between obesity, self-reported weakness and their combinations with mortality in nursing home residents. Acta Clin Belg 2023; 78:112-121. [PMID: 35575752 DOI: 10.1080/17843286.2022.2075180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents. METHODS This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses. RESULTS We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; 'non-weak non-obese' participants or 'weak alone' participants or 'weak+obese' participants had higher mortality risk when compared with the 'obesity alone' participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02]. CONCLUSION This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.
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Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Asli Tufan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Savaş Ozturk
- Department of Internal Medicine, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Hafize Dogan
- Department of General Practitioner, Istanbul Kayisdagi Nursing Home, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
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Billeret A, Rousseau C, Thirion R, Baillard-Cosme B, Charras K, Somme D, Thibault R. Assessment of Food Intake Assisted by Photography in Older People Living in a Nursing Home: Maintenance over Time and Performance for Diagnosis of Malnutrition. Nutrients 2023; 15:nu15030646. [PMID: 36771353 PMCID: PMC9920108 DOI: 10.3390/nu15030646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
Malnutrition is related to poor outcomes. Food intake semi-quantitative assessment is helpful for malnutrition screening. Aims: to assess maintenance over one month of one-day semi-quantitative assessment of food intake (primary aim) and its performance in diagnosing malnutrition (secondary aim) in older people living in a nursing home. Food portions consumed at lunch and dinner were measured during 20 days by the Simple Evaluation of Food Intake (SEFI)® assisted by photography (SEFI®-AP) in 70 residents. Nutritional status was assessed in each patient during the first week of food intake monitoring according to Global Leadership Initiative on Malnutrition criteria. Food intake was decreased, i.e., SEFI®-AP < 7, in 39% (n = 27/73) of patients. According to the methods, 36 to 48% (n = 25 to 33/73) of patients had malnutrition, and 6 to 37% (n = 4 to 25/73) sarcopenia. According to a generalized linear model on ranks with repeated measures, the SEFI®-AP medians of lunch (p = 0.11) and means of lunch and dinner (p = 0.15) did not vary over time. Day 3 SEFI®-AP anticipated decreased food intake from days 4 to 20, with a sensitivity of 78% (95% confidence interval (CI), 62-94), a specificity of 30% [95%CI, 17-44] and positive and negative predictive values of 41% [95%CI, 28-55] and 68% [95%CI, 48-89]. The performance of SEFI®-AP for diagnosis of malnutrition using calf circumference <31 cm as a phenotypic criterion was correct: area under the curve = 0.71 [95%CI, 0.59-0.83]. SEFI®-AP sensitivity was better if ≤9.5 than <7, and inversely for specificity. The food intake of older people living in nursing homes is stable over one month. One-day SEFI®-AP correctly anticipates food intake during the following month and predicts diagnosis of malnutrition. Any decrease in food intake should lead to suspect malnutrition.
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Affiliation(s)
- Anne Billeret
- CHU Rennes, Service d’Endocrinologie-Diabétologie-Nutrition, Centre labellisé de Nutrition Parentérale au Domicile, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, F-35000 Rennes, France
| | | | - Rémy Thirion
- CHU Rennes, Service de Gériatrie, F-35000 Rennes, France
| | | | - Kevin Charras
- CHU Rennes, Living Lab Vieillissement et Vulnérabilités, F-35000 Rennes, France
| | - Dominique Somme
- CHU Rennes, Living Lab Vieillissement et Vulnérabilités, F-35000 Rennes, France
- CHU Rennes, Service de Gériatrie, CNRS, Arènes—UMR 6051, Inserm, RSMS—U 1309, Living Lab Vieillissement et Vulnérabilités, Univ Rennes, F-35000 Rennes, France
| | - Ronan Thibault
- CHU Rennes, Service d’Endocrinologie-Diabétologie-Nutrition, Centre labellisé de Nutrition Parentérale au Domicile, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, F-35000 Rennes, France
- Correspondence:
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Mesbah S, Mesbah H, Haumont LA, Thibault R. The evaluation of consumed food portions as a screening test for malnutrition in the older people living in a nursing home: A cross-sectional pilot study. NUTR CLIN METAB 2023. [DOI: 10.1016/j.nupar.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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10
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Keller H, Iraniparast M, Morrison-Koechl J, Lengyel C, Carrier N, Slaughter SE. Weight Loss and Weight Gain: Multi-Level Determinants Associated with Resident 3-Month Weight Change in Long-Term Care. J Nutr Gerontol Geriatr 2023; 42:15-29. [PMID: 36695567 DOI: 10.1080/21551197.2023.2169429] [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: 01/26/2023]
Abstract
This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment.
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Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute of Aging, Waterloo, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Maryam Iraniparast
- School of Public Health and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jill Morrison-Koechl
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Christina Lengyel
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Carrier
- School of Food, Nutrition and Family Studies, Université de Moncton, Moncton, Canada
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Campo-Rivera N, Ocampo-Chaparro JM, Carvajal-Ortiz R, Reyes-Ortiz CA. Sarcopenic Dysphagia Is Associated With Mortality in Institutionalized Older Adults. J Am Med Dir Assoc 2022; 23:1720.e11-1720.e17. [PMID: 35868351 DOI: 10.1016/j.jamda.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate mortality associated with sarcopenic dysphagia. DESIGN A 3-year follow-up cohort. SETTING AND PARTICIPANTS Ninety-five nursing home residents were evaluated to determine the baseline presence or absence of oropharyngeal dysphagia and followed up for 3 years. METHODS The primary outcome was the risk of death. Dysphagia was assessed using a volume-viscosity swallow test. We used an algorithm to determine sarcopenic dysphagia based on grip strength, walking speed, calf circumference, and exclusion of neurologic or structural causes of dysphagia. We constructed 3 subgroups: without dysphagia, nonsarcopenic dysphagia, and sarcopenic dysphagia. Cox proportional regression analyses were used to predict the risk of death. RESULTS Thirty-five percent of participants had no dysphagia, 20% nonsarcopenic dysphagia, and 45% sarcopenic dysphagia. Sarcopenic dysphagia was independently associated with a higher risk of death [hazard ratio (HR) 2.44, 95% CI 1.02-5.80, P = .043] than without dysphagia. In addition, a higher Charlson Comorbidity Index score was associated with a higher risk of death (HR 1.33, 95% CI 1.01-1.75, P = .040). CONCLUSIONS AND IMPLICATIONS This study shows that sarcopenic dysphagia was associated with increased mortality among institutionalized older adults. These deaths could be potentially preventable.
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Affiliation(s)
| | - Jose Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Programa de Geriatria, Universidad del Valle, Facultad de Salud, Cali, Colombia
| | | | - Carlos A Reyes-Ortiz
- Geriatrics, Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA.
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Ishikawa T, Sakai I, Amemiya A, Komatsu R, Sakuraba S, Isono S. Long-term body weight change assessed by non-contact load cells under the bed in older people with and without eating assistance: a preliminary study. Sci Rep 2022; 12:8107. [PMID: 35577928 PMCID: PMC9110330 DOI: 10.1038/s41598-022-12291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
Utilizing automatic daily body weight (BW) measurements may be helpful for assessing nutritional status and detecting underlying diseases particularly in older people who require nursing care. This preliminary study aimed to verify effectiveness of eating assistance for maintaining BW in older people using a contact-free load cells under the bed (Bed Sensor System: BSS). BW was measured every night for 3 months in eight nursing home older people with severe cognitive and physical dysfunctions. Body composition of the subject's trunk and each limb was measured using a segmented multi-frequency bioelectrical impedance analyzer (BIA). A monthly BW loss was estimated as a slope of linear regression of the daily BW plot. BSS successfully measured daily BW for the study period in all participants. The 4 residents with eating assistance gained slightly more weight, while the 4 residents without eating assistance lost weight. There was a significant difference between the two groups in the monthly BW change (- 0.79 ± 0.51 kg/month versus 0.20 ± 0.49 kg/month, P = 0.030). None of the BIA-derived parameters was associated with the monthly BW change. BSS revealed effectiveness of eating assistance to maintain BW in nursing home residents with severe cognitive and physical dysfunctions.
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Affiliation(s)
- Takahiro Ishikawa
- Department of General Medical Science, Chiba University Graduate School of Medicine, Chiba, Japan.
- Geriatric Medical Center, Chiba University Hospital, Chiba, Japan.
| | - Ikuko Sakai
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Ayumi Amemiya
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Ryou Komatsu
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Shoko Sakuraba
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Kawakami Y, Hamano J. Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study. BMC Geriatr 2022; 22:85. [PMID: 35100993 PMCID: PMC8805326 DOI: 10.1186/s12877-022-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Many factors can identify the mortality risks of institutionalized elderly people; among all such factors, body mass index (BMI) and energy intake (EI) can be employed as independent predictors. The objective of this study was to elucidate about the mortality risks and the trajectory of two parameters obtained from continuously monitored data. Methods This retrospective cohort study targeted 218 elderly people who were admitted to a nursing home for at least 6 months between 2007 and 2020 and passed away at the nursing home. BMI and EI (kcal) per body weight (BW) were continuously measured until death. Results BMI continued to decrease for 5 years until death. The rate of change of BMI significantly increased for 3 years before death (P = 0.004). In contrast, the rate of change of EI per BW significantly increased after 1 year before death (P < 0.001); in addition, 2 months before death, this rate of change significantly exceeded that of BMI (P = 0.007). In the four risk groups that were examined, a BMI of <18.0 + EI per BW of <29.2 and a BMI of <17.3 + EI per BW of <28.3 were significantly correlated with a high risk of death (log-rank test: P < 0.001, P = 0.002, respectively). There was no significant difference in the hazard ratio based on the age at the time of admission; however, when EI per BW was <23.8, the risk of death was significantly higher [hazard ratio = 4.36; 95% confidence interval: 2.31–8.24]. Conclusions Elderly people in the current study presented a tendency toward decreasing BMI starting 60 months prior to death even if EI per BW remained constant. In the 1 year before death, EI per BW rapidly decreased. When the rate of change of EI per BW exceeded the rate of decrease of BMI, it was considered to be the point of no return when death was imminent. Our study showed that identifying mortality risks from the relationship between the trajectories of the two parameters that were continuously measured for several months to years is possible.
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Affiliation(s)
- Yoshiaki Kawakami
- Department of Nursing, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Endo A, Watanabe Y, Matsushita T, Okada K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010776. [PMID: 34682525 PMCID: PMC8535238 DOI: 10.3390/ijerph182010776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.
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Affiliation(s)
- Akemi Endo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
- Correspondence: ; Tel./Fax: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan;
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba 272-8513, Japan;
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka 813-8588, Japan;
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka 573-1144, Japan;
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo 102-8158, Japan;
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan;
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Yoshihiko Watanabe
- Department of Healthcare Management, Tohoku Fukushi University, Miyagi 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Osaka 574-0012, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima 734-8553, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
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Uršulin-Trstenjak N, Dodlek Šarkanj I, Sajko M, Vitez D, Živoder I. Determination of the Personal Nutritional Status of Elderly Populations Based on Basic Foodomics Elements. Foods 2021; 10:2391. [PMID: 34681440 PMCID: PMC8535163 DOI: 10.3390/foods10102391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
Nutritional status is a series of related parameters collected using different available methods. In order to determine the nutritional status of elderly populations and ensure nutritional support based on an individual approach, the implementation of the increasingly used foodomics approach is available; this approach plays a key role in personalized diets and in the optimization of diets for a population group, such as an elderly population. The Mini Nutritional Assessment (MNA) method and the Nottingham Screening Tool (NST) form were used on 50 users in a home for the elderly in northwest Croatia. A loss of body mass (BM) was statistically significantly higher for those who had the following: decreased food intake in the last week and users who had complete and partial feeding autonomy. Additionally, the obtained data on drug intake, fluid, individual nutrients, and physical activity are based on an individual approach. The available documentation provides insight into nutritional values and food preparation in an attempt to satisfy a holistic approach in the evaluation of exposure while trying to achieve as many elements of foodomics as possible.
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Affiliation(s)
- Natalija Uršulin-Trstenjak
- Department of Food Technology, University Center Koprivnica, University North, Trg dr. Žarka Dolinara 1, 48000 Koprivnica, Croatia;
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
| | - Ivana Dodlek Šarkanj
- Department of Food Technology, University Center Koprivnica, University North, Trg dr. Žarka Dolinara 1, 48000 Koprivnica, Croatia;
| | - Melita Sajko
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
| | - David Vitez
- County Hospital Čakovec, I.G.Kovačića 1e, 40000 Čakovec, Croatia;
| | - Ivana Živoder
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
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Zanini M, Catania G, Ripamonti S, Watson R, Romano A, Aleo G, Timmins F, Sasso L, Bagnasco A. The WeanCare nutritional intervention in institutionalized dysphagic older people and its impact on nursing workload and costs: A quasi-experimental study. J Nurs Manag 2021; 29:2620-2629. [PMID: 34342076 PMCID: PMC9292428 DOI: 10.1111/jonm.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes. BACKGROUND Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes. METHOD This is an open pre-post longitudinal multicentre quasi-experimental study without a control group. RESULTS There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon-feeding. This resulted in nursing staff cost savings. CONCLUSIONS The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators. IMPLICATIONS FOR NURSING MANAGEMENT Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon-feeding, in addition to reduced malnutritional consequences.
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Affiliation(s)
- Milko Zanini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Gianluca Catania
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | | | - Roger Watson
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Antonio Romano
- Pharmaceutical and Technical Chemistry, Head R&D Healthy Ageing Research Group, Cremona, Italy
| | - Giuseppe Aleo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Fiona Timmins
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Loredana Sasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Annamaria Bagnasco
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents. Eur J Clin Nutr 2021; 76:382-388. [PMID: 34239065 PMCID: PMC8907076 DOI: 10.1038/s41430-021-00964-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/30/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022]
Abstract
Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals. Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
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18
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Liu XC, Huang Y, Lo K, Huang YQ, Chen JY, Feng YQ. Quotient of Waist Circumference and Body Mass Index: A Valuable Indicator for the High-Risk Phenotype of Obesity. Front Endocrinol (Lausanne) 2021; 12:697437. [PMID: 34135867 PMCID: PMC8202120 DOI: 10.3389/fendo.2021.697437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Measuring the body mass index (BMI) or waist circumference (WC) alone is insufficient for assessing possible health risks due to obesity. This study aimed to investigate whether the quotient of WC and BMI can be used as a proxy of the high-risk phenotype of obesity. METHODS Data for analysis were derived from the National Health and Nutrition Examination Survey (NHANES 1999-2014). The Waist-BMI Ratio was defined as WC divided by BMI. The associations between Waist-BMI Ratio and mortality were estimated using Cox regression models. Restricted cubic spline and two-piecewise linear regression models were used to identify non-linear relationships. The discriminative abilities of different anthropometric measures were compared using receiver operating characteristic curves (ROC). RESULTS This study is based on data from 35557 adults (51.1% female, mean age 44.9 years). During an average follow-up of 101.8 months, 3680 participants died, including 807 of cardiovascular causes. In fully adjusted models, Waist-BMI Ratio was independently associated with overall (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.48-2.13) and cardiovascular (HR, 1.77; 95% CI, 1.25-2.52) mortality. Spline analyses revealed that dose-response relationships existed between Waist-BMI Ratio and death. The mortality risk rises dramatically above the cut-off point of the Waist-BMI Ratio (HR, 3.22; 95% CI, 2.43-4.26 for overall mortality and HR, 3.07; 95% CI, 1.71-5.52 for cardiovascular mortality). ROC curve analysis suggested that Waist-BMI Ratio was a better discriminator of mortality (AUC 0.637 for overall and 0.639 for cardiovascular mortality) than BMI, WC, and waist-to-height ratio (Delong's test all P <0.001). CONCLUSIONS Waist-BMI Ratio was independently associated with overall and cardiovascular mortality in a J-shaped pattern, offering an immense potential risk marker for obesity in the clinical setting.
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Morrison-Koechl J, Wu SA, Slaughter SE, Lengyel CO, Carrier N, Keller HH. Hungry for more: Low resident social engagement is indirectly associated with poor energy intake and mealtime experience in long-term care homes. Appetite 2020; 159:105044. [PMID: 33227384 DOI: 10.1016/j.appet.2020.105044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 ± 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% CI = -111.2, -8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.
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Affiliation(s)
- Jill Morrison-Koechl
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Sarah A Wu
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Susan E Slaughter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Christina O Lengyel
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB, R3T 2N2, Canada.
| | - Natalie Carrier
- Département de Science Infirmière, Université de Moncton, Moncton, NB, Canada.
| | - Heather H Keller
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; Schlegel-UW Research Institute of Aging, 250 Laurelwood Drive, Waterloo, ON, N2J 0E2, Canada.
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Onu JU, Osuji PN. Double burden of malnutrition amongst patients with first-episode schizophrenia in a psychiatric hospital: A 1-year follow-up study. S Afr J Psychiatr 2020; 26:1564. [PMID: 33240554 PMCID: PMC7669964 DOI: 10.4102/sajpsychiatry.v26i0.1564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/14/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Despite the burgeoning data on the double burden of malnutrition (DBM) in sub-Saharan Africa, longitudinal studies to examine malnutrition amongst first-episode schizophrenia are uncommon in the modern literature. AIM To determine the extent of nutritional variations amongst persons with schizophrenia at intervals of 1-year treatment follow-up. SETTING This study was conducted at the Federal Neuropsychiatric Hospital, Enugu, Nigeria. METHODS Consecutive incident cases that fulfilled the criteria for schizophrenia were recruited into the study. After a baseline assessment, 206 incident cases of schizophrenia were followed up at 4th, 8th, 12th weeks, 6 months and 1 year for indicators of nutritional outcome. The body mass index (BMI) was used to measure the nutritional status amongst the study participants. Changes in the BMI across intervals of follow-up were examined using repeated measures analysis of variance, whereas the socio-demographic and clinical variables were evaluated as predictors of outcome using multiple regression analysis. RESULTS After 1 year of treatment with antipsychotics, the prevalence of underweight decreased from 19.9% (95% CI, 19.8% - 20.0%) at baseline to 16.0% (95% CI, 15.9% - 16.1%) at 1 year, but the prevalence of overweight/obesity increased from 29.1% (95% CI, 29.0% - 29.2%) at baseline to 43.2% (95% CI, 43.0% - 43.3%) at 1 year of follow-up. The predictors of BMI at 1 year were antipsychotic medication (32.7% variance), duration of vagrancy (24.0%) and age at onset (20.0%). CONCLUSION The finding of coexistence of undernutrition and overnutrition across the intervals of treatment follow-up underscores the need for comprehensive interventions to address both extremes of malnutrition amongst patients with schizophrenia.
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Affiliation(s)
- Justus U Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Portia N Osuji
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Afonso-Argilés FJ, Meyer G, Stephan A, Comas M, Wübker A, Leino-Kilpi H, Lethin C, Saks K, Soto-Martin M, Sutcliffe C, Verbeek H, Zabalegui A, Renom-Guiteras A. Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs. BMC Geriatr 2020; 20:453. [PMID: 33153444 PMCID: PMC7643440 DOI: 10.1186/s12877-020-01835-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. Results The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. Conclusion Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.
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Affiliation(s)
- F Javier Afonso-Argilés
- Department of Geriatric Medicine and Palliative Care. Badalona Serveis Assistencials, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriele Meyer
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Astrid Stephan
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mercè Comas
- Department of Epidemiology and Evaluation. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Ansgar Wübker
- RWI - Leibniz-Institute for Economic Research, Leibniz Science Campus Ruhr and RUB, Essen, Germany
| | - Helena Leino-Kilpi
- Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
| | - Connie Lethin
- Department of Health Sciences. Faculty of Medicine, Lund University, SE-221 00, Lund, Sweden.,Clinical Memory Research Unit. Department of Clinical Sciences, Lund University, SE-221 00, Lund, Sweden
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, Toulouse, France
| | | | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Adelaida Zabalegui
- Hospital Clinic de Barcelona, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Anna Renom-Guiteras
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain
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22
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Reber KC, Lindlbauer I, Schulz C, Rapp K, König HH. Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data. BMC Geriatr 2020; 20:439. [PMID: 33129263 PMCID: PMC7603768 DOI: 10.1186/s12877-020-01847-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).
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Affiliation(s)
- Katrin C Reber
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claudia Schulz
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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23
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Wu SA, Morrison‐Koechl J, Slaughter SE, Middleton LE, Carrier N, McAiney C, Lengyel C, Keller H. Family member eating assistance and food intake in long‐term care: A secondary data analysis of the M3 Study. J Adv Nurs 2020; 76:2933-2944. [DOI: 10.1111/jan.14480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | | | - Carrie McAiney
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
| | | | - Heather Keller
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
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24
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Nishida Y, Tanaka S, Nakae S, Yamada Y, Shirato H, Hirano H, Sasaki S, Katsukawa F. Energy Gap between Doubly Labeled Water-Based Energy Expenditure and Calculated Energy Intake from Recipes and Plate Waste, and Subsequent Weight Changes in Elderly Residents in Japanese Long-Term Care Facilities: CLEVER Study. Nutrients 2020; 12:nu12092677. [PMID: 32887378 PMCID: PMC7551170 DOI: 10.3390/nu12092677] [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] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
Unintentional weight loss is a major frailty component; thus, assessing energy imbalance is essential for institutionalized elderly residents. This study examined prediction errors of the observed energy intake (OEI) against the actual energy intake obtained from the doubly labeled water (DLW) method and clarified the relationship between the energy gap obtained by subtracting total energy expenditure (TEE) from OEI and subsequent weight changes in elderly residents in long-term care facilities. Overall, 46 participants were recruited in Japan. TEE was measured using the DLW method, and OEI was calculated from recipes and plate waste simultaneously over a 14–15-day period at baseline. The total energy intake (TEIDLW) was determined on the basis of DLW and weight changes during the DLW period. The weight was longitudinally tracked monthly for 12 months in the 28 residents who still lived at the facilities. OEI was higher than TEIDLW by a mean of 232 kcal/day (15.3%) among 46 residents at baseline. The longitudinal data of 28 residents showed that the energy gap tended to be correlated with the slope of weight change (ρ = 0.337, p = 0.080) and the median value was significantly lower in the weight loss group (152 kcal/day) than in the weight gain group (350 kcal/day) (p < 0.05). In conclusion, weight loss could occur at Japanese long-term care facilities even if the difference obtained by subtracting TEE from OEI was positive because OEI was overestimated by more than 200 kcal/day.
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Affiliation(s)
- Yuki Nishida
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Faculty of Nutrition, Kagawa Nutrition University, Saitama 350-0288, Japan
- Correspondence: ; Tel.: +81-49-282-3722
| | - Satoshi Nakae
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Yosuke Yamada
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 615-8577, Japan
| | - Hiroyuki Shirato
- Silverpia-Kaga Long-Term Care Health Facility, Tokyo 173-0003, Japan;
| | - Hirohiko Hirano
- Dentistry and Oral Surgery, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Fuminori Katsukawa
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
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25
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Thompson J, Parkinson M, Collery R. Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity. Int J Older People Nurs 2020; 15:e12343. [DOI: 10.1111/opn.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Juliana Thompson
- Department of Nursing, Midwifery and Health Faculty of Health and Life Sciences Northumbria University Newcastle upon Tyne UK
| | - Mark Parkinson
- Department of Social Work, Education and Community Wellbeing Northumbria University Newcastle upon Tyne UK
| | - Robyn Collery
- Nutrition and Dietetics Department: Clinical Support and Screening Services Gateshead Health NHS Foundation Trust Gateshead UK
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26
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Body mass index, waist circumference, and mortality risks over 27 years of follow-up in old age. Ann Epidemiol 2020; 46:20-23. [PMID: 32532369 DOI: 10.1016/j.annepidem.2020.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE This study investigates the predictive effects of body mass index (BMI) and waist circumference (WC) for all-cause mortality in old age over 27 years of follow-up. METHODS Participants were from the Berlin Aging Study (n = 444, M ± SD = 84.55 ± 8.38 years). Reported significance values for hazard ratios were adjusted for age, sex, socioeconomic status, smokers, depressive illness, functional status, cholesterol, and objectively assessed physical diseases. RESULTS BMI emerged as a significant predictor of all-cause mortality after adjustment. WC was not a significant predictor of mortality either within the unadjusted model or when fully adjusted, including BMI. After the introduction of WC alongside all covariates, the effect for BMI remained significant. A significant quadratic effect for BMI and mortality within the fully adjusted model also emerged. CONCLUSIONS Our results suggest that lower BMI in the oldest old is associated with increased mortality hazards, and risks were particularly elevated for people who are underweight. This study found no evidence that higher BMI in old age is associated with increased mortality hazards relative to normal weight ranges.
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27
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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28
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Kiesswetter E, Keijser BJF, Volkert D, Visser M. Association of oral health with body weight: a prospective study in community-dwelling older adults. Eur J Clin Nutr 2019; 74:961-969. [PMID: 31767989 DOI: 10.1038/s41430-019-0536-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To prevent involuntary weight loss in older people, the knowledge about factors affecting body weight (BW) is essential. Therefore, we aimed to investigate the longitudinal associations of multiple oral health aspects with BW in community-dwelling older adults. METHODS This analysis is based on prospective data with a 10-year follow-up of 657 Dutch community-dwelling older adults (age 66.4 ± 5.8 years, 54% female) from the Longitudinal Aging Study Amsterdam. Participants' characteristics, BW, and 12 oral health variables (teeth, dentures, nine oral problems, self-rated oral health) were assessed in 2005/07 and 2015/16. The association between oral health and BW was analyzed by mixed models and adjusted for demographic, socio-economic, smoking, health, and functional aspects considering data of both assessments. RESULTS Mean BW was 79.1 ± 13.3 kg at baseline (B) and 77.6 ± 13.8 kg at follow-up (FU). At baseline, 29.6% of the participants reported being edentulous (FU:34.4%) and 55.8% to wear dentures (FU:62.3%). Dental pain while chewing was the oral problem with the lowest (B:5.2%, FU:6.6%) and xerostomia with the highest prevalence at both examinations (B:24.3%, FU:30.0%). Most participants rated their oral status as healthy (B:65.2%, FU:66.9%). Neither edentulism and denture use nor oral problems showed a longitudinal association with BW. In contrast, self-rated oral health was associated with BW (b = 0.724, SE = 0.296, p = 0.015) after adjusting for multiple confounders. CONCLUSIONS In community-dwelling older adults self-rated oral health may indicate changes in body weight in the long term. Therefore, this simple measure could serve to identify a risk for weight loss and to initiate oral interventions in clinical practice.
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Affiliation(s)
- Eva Kiesswetter
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Bart J F Keijser
- Research Group Microbiology and Systems Biology, TNO, Utrechtseweg 48, 3704HE, Zeist, The Netherlands.,Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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29
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Home Enteral Nutrition in Singapore's Long-Term Care Homes-Incidence, Prevalence, Cost, and Staffing. Nutrients 2019; 11:nu11102492. [PMID: 31627289 PMCID: PMC6835490 DOI: 10.3390/nu11102492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Data on home enteral nutrition (HEN) in long-term care facilities (LTCF) in Singapore is scarce. This study aims to determine the prevalence and incidence of chewing/swallowing impairment and HEN, and the manpower and costs related. Methods: A validated cross-sectional survey was sent to all 69 LTCFs in Singapore in May 2019. Local costs (S$) for manpower and feeds were used to tabulate the cost of HEN. Results: Nine LTCFs (13.0%) responded, with a combined 1879 beds and 240 residents on HEN. An incidence rate (IR) of 15.7 per 1000 people-years (PY) and a point prevalence (PP) of 136.6 per 1000 residents were determined for HEN, and an IR of 433.0 per 1000 PY, with PP of 385.6 per 1000 residents for chewing/swallowing impairment. Only 2.5% of residents had a percutaneous endoscopic gastrostomy (PEG). The mean length of residence in LTCF was 45.9 ± 12.3 months. More than half of the residents received nasogastric tube feeding (NGT) for ≥36 months. Median monthly HEN cost per resident was S$799.47 (interquartile range (IQR): 692.11, 940.30). Nursing costs for feeding contributed to 63% of total HEN costs. Conclusions: The high usage and length of time on NGT feeding warrants exploration and education of PEG usage. A national HEN database may improve the care of LTCF residents.
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30
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Guo D, Xu M, Zhou Q, Wu C, Ju R, Dai J. Is low body mass index a risk factor for semen quality? A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e16677. [PMID: 31393367 PMCID: PMC6709190 DOI: 10.1097/md.0000000000016677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Male infertility has become a worldwide public health problem. However, the effect of low body mass index (BMI) is still controversial. METHODS Relevant articles in Pubmed, Embase, Web of science, and Wanfang database published until September 2017 were searched without language restriction. We performed a meta-analysis about low BMI and semen parameters containing total sperm count, concentration, semen volume, and sperm motility (overall and progressive), including 709 men with low BMI and 14,622 men with normal BMI. RESULTS Thirteen studies were included in this meta-analysis and a total of 15,331 individuals were accumulated. We pooled data from these articles and found standardized weighted mean differences in semen parameters (total sperm count and semen volume) showed significant difference between low BMI and normal BMI. CONCLUSIONS This systematic review with meta-analysis has confirmed that there was a relationship between low BMI and semen quality, which suggesting low BMI may be a harmful factor of male infertility. Yet lacking of the raw data may influence the accuracy of the results. Further researches are needed to identify the role of underweight in male sterility.
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Affiliation(s)
- Dan Guo
- Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing
| | - Min Xu
- Reproductive Health and Infertility Clinic, Huai’an First People's Hospital, Nanjing Medical University, Huai’an
| | - Qifan Zhou
- Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing
| | - Chunhua Wu
- Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing
| | - Rong Ju
- Department of Gynaecology and Obstetrics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Jiazhen Dai
- Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing
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31
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Shimizu A, Sonoda S, Muraoka Y, Setoyama K, Inoue K, Miura T, Anai R, Sanuki Y, Miyamoto T, Oginosawa Y, Tsuda Y, Araki M, Otsuji Y. Bleeding and ischemic events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients. J Cardiol 2019; 73:470-478. [DOI: 10.1016/j.jjcc.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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32
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Julio MPM, Clavero AE, Soler MLM. Nutritional status and factors associated with non-institutionalized people over 75 years of age. Rev Bras Enferm 2018; 71:1007-1012. [PMID: 29924162 DOI: 10.1590/0034-7167-2017-0207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/20/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE to determine the factors related to the risk of malnutrition in a non-institutionalized population over 75 years of age. METHOD a cross-sectional study was conducted using a questionnaire in a sample of 326 individuals over 75 years of age in Castellón (Spain), during 2015, and selected through intentional sampling. RESULTS Malnutrition prevalence was 2.8%. 26.9% of the individuals were at risk of malnutrition, whereas women presented a higher rate (31.5%). Women with a good overall health status showed a lower rate than men, 55% and 69%, respectively. Individuals that showed a lower risk of malnutrition are those with a positive perception than those who have a good overall health. Frail elderly people showed a higher risk of malnutrition (57.5%) compared to non-frail subjects (20.2%) p< 0.001. CONCLUSION Frail women, self-assessed health, overall health, and use of health care services (nursing consultation) were related to a higher risk of malnutrition.
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33
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Röhrig G. [Anemia in the aged]. Z Gerontol Geriatr 2018; 51:935-946. [PMID: 30498858 DOI: 10.1007/s00391-018-01479-y] [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: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
Anemia in the aged is still often an underestimated clinical problem; however, in recent years increasing research on this topic has permitted deeper insights, allowing a differentiated approach to anemia in the aged. Meanwhile, multicausality and a negative impact on functional outcome have become characteristics of anemia in older people. This has led to a scientific discussion on the question of accepting anemia as a geriatric syndrome. The present article gives a concise overview of the current state of research on this clinically relevant subject.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann-Classen-Str. 68, 51103, Köln, Deutschland.
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34
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Desbordes F, Jouveau S, Broussaudier A, Noailletas V, Fayemendy P, Morin B, Misset B, Rebière F, Desport JC, Jésus P. État nutritionnel des résidents d’un établissement d’hébergement pour personnes âgées dépendantes (EHPAD) et liens entre la dénutrition, la consommation de compléments nutritionnels oraux et le service à l’assiette. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Sánchez-Rodríguez D, Annweiler C, Ronquillo-Moreno N, Vázquez-Ibar O, Escalada F, Duran X, Muniesa JM, Marco E. Prognostic Value of the ESPEN Consensus and Guidelines for Malnutrition: Prediction of Post-Discharge Clinical Outcomes in Older Inpatients. Nutr Clin Pract 2018; 34:304-312. [DOI: 10.1002/ncp.10088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- School of Medicine; Pompeu Fabra University; Barcelona Spain
| | - Cédric Annweiler
- Department of Neurosciences and Aging; Division of Geriatric Medicine; Angers University Hospital; Angers University Memory Clinic; Research Center on Autonomy and Longevity; UPRES EA 4638; University of Angers; UNAM Angers France
- Robarts Research Institute; Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | | | - Olga Vázquez-Ibar
- Geriatrics Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Pompeu Fabra University; Barcelona Spain
| | - Ferran Escalada
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Xavier Duran
- Methodology and Biostatistics Support Unit; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Josep M. Muniesa
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
| | - Ester Marco
- Rehabilitation Research Group; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- School of Medicine; Autònoma University of Barcelona; Barcelona Spain
- Physical Medicine and Rehabilitation Department; Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- International University of Catalunya; Barcelona Spain
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Wirth R, Pourhassan M, Streicher M, Hiesmayr M, Schindler K, Sieber CC, Volkert D. The Impact of Dysphagia on Mortality of Nursing Home Residents: Results From the nutritionDay Project. J Am Med Dir Assoc 2018; 19:775-778. [PMID: 29778638 DOI: 10.1016/j.jamda.2018.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia. DESIGN One-day, annually repeated cross-sectional study, evaluating the nutritional situation of nursing home residents with 6-month mortality as outcome. SETTING 191 nursing homes from 14 countries in Europe and the United States participating in the nutritionDay study between 2007 and 2012. PARTICIPANTS Data of all nursing home residents in the nutritionDay study aged 65 years or older with available information about dysphagia and outcome were analyzed. MEASUREMENTS Residents' characteristics and mortality rate were calculated by group comparison, and mortality risk was calculated by multivariate regression analysis with adjustment for potential confounding factors. RESULTS 10,185 residents (78% female) with a mean age of 85 ± 8.1 years were included in the analysis. Dysphagia was reported in 15.4% of residents. The 6-month mortality of residents with dysphagia was significantly higher than of those without dysphagia (24.7% vs 11.9%; P < .001). The multivariate regression analysis revealed dysphagia [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.24-1.68, P < .001] along with body mass index <20 (OR 1.78, 95% CI 1.55-2.03, P < .001) and weight loss >5 kg (OR 1.61, 95% CI 1.37-1.88, P < .001) as independent and significant risk factors for mortality. Because of significant interaction, a disproportionately high mortality of 38.9% was found in residents with dysphagia accompanied by previous weight loss >5 kg (OR for interaction 1.44; 95% CI 1.03-2.01; P = .032). Tube feeding was reported in 14.6% of residents with dysphagia. The mortality rate of dysphagic residents receiving tube feeding vs those who were not was not significantly different (21.4% vs 25.3%; P = .244). CONCLUSION In this nutritionDay study, dysphagia was identified as an independent risk factor for mortality in nursing home residents. Residents with dysphagia accompanied by weight loss are at a particularly high risk of mortality and should therefore receive special attention.
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Affiliation(s)
- Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany.
| | - Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | | | | | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Clinical application of the basic definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN): Comparison with classical tools in geriatric care. Arch Gerontol Geriatr 2018; 76:210-214. [DOI: 10.1016/j.archger.2018.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/03/2018] [Accepted: 03/04/2018] [Indexed: 12/11/2022]
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38
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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]
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39
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Haga T, Ito K, Ono M, Maruyama J, Iguchi M, Suzuki H, Hayashi E, Sakashita K, Nagao T, Ikemoto S, Okaniwa A, Kitami M, Inuo E, Tatsumi K. Underweight and hypoalbuminemia as risk indicators for mortality among psychiatric patients with medical comorbidities. Psychiatry Clin Neurosci 2017; 71:807-812. [PMID: 28715136 DOI: 10.1111/pcn.12553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 01/19/2023]
Abstract
AIM Medical comorbidities are a major cause of death among patients with mental illness. The purpose of this study was to clarify the risk factors for mortality among psychiatric patients with medical comorbidities. METHODS We retrospectively reviewed the clinical files of patients transferred to Tokyo Metropolitan Matsuzawa Hospital from a psychiatric hospital to treat medical comorbidities during the 3-year period from January 2014 to December 2016. We analyzed the clinical differences between the expired and alive patients. RESULTS Of the 287 patients included, 29 (10.1%) had expired at the time of hospital discharge, while 258 (89.9%) were living. A multivariable analysis to determine the prognostic factors related to mortality from medical comorbidities showed that body mass index <18.5 had the highest odds ratio among the predictive factors (5.1; 95% confidence interval, 1.5-17.1; P < 0.05), followed by a serum albumin level < 3.0 mg/dL (3.0; 95% confidence interval, 1.1-8.1; P < 0.05). CONCLUSION We found that underweight and hypoalbuminemia were risk factors for mortality among psychiatric patients with medical comorbidities. Physicians at psychiatric hospitals should consider transferring patients with medical comorbidities to a general medical hospital in the presence of underweight and/or hypoalbuminemia.
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Affiliation(s)
- Takahiro Haga
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kae Ito
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Masahiro Ono
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Jiro Maruyama
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Mari Iguchi
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Hitoe Suzuki
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Eiji Hayashi
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kentaro Sakashita
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Tomoko Nagao
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Shohei Ikemoto
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Asuka Okaniwa
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Makiko Kitami
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Eriko Inuo
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care. J Am Med Dir Assoc 2017; 18:941-947. [DOI: 10.1016/j.jamda.2017.05.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 12/30/2022]
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Abstract
Approximately half of neurological and geriatric inpatients suffer from oropharyngeal dysphagia. This often leads to pneumonia, malnutrition and dehydration; however, the underlying dysphagia is frequently not diagnosed and treated. This is particularly the case for patients with so-called silent aspiration. Knowledge on the physiology of swallowing, including the central nervous system control of swallowing and the therapeutic options have achieved considerable progress in recent years. In particular, the increasing implementation of flexible endoscopic evaluation of swallowing (FEES) has significantly contributed to this knowledge. It provides the ability to identify the individual pattern of oropharyngeal dysphagia leading to a suitable selection of therapeutic and compensatory strategies for individual patients. The various therapeutic options range from modification of the consistency of the diet, over diverse logopedic strategies and stimulation techniques up to interventional procedures.
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Affiliation(s)
- R Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - R Dziewas
- Klinik für Allgemeine Neurologie, Universitätsklinik Münster, Münster, Deutschland
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Laffon de Mazières C, Morley JE, Levy C, Agenes F, Barbagallo M, Cesari M, De Souto Barreto P, Donini LM, Fitten J, Franco A, Izquierdo M, Kane RA, Martin FC, Onder G, Ouslander J, Pitkälä K, Saliba D, Sinclair A, Manas LR, Vellas B, Rolland Y. Prevention of Functional Decline by Reframing the Role of Nursing Homes? J Am Med Dir Assoc 2017; 18:105-110. [PMID: 28126135 DOI: 10.1016/j.jamda.2016.11.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
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Keller HH, Carrier N, Slaughter S, Lengyel C, Steele CM, Duizer L, Brown KS, Chaudhury H, Yoon MN, Duncan AM, Boscart VM, Heckman G, Villalon L. Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes. BMC Geriatr 2017; 17:15. [PMID: 28086754 PMCID: PMC5234152 DOI: 10.1186/s12877-016-0401-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. METHODS A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. DISCUSSION This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB E1A 3E9, Canada
| | - Susan Slaughter
- Faculty of Nursing, University of Alberta, Edmonton, T6G 1C9, AB, Canada
| | - Christina Lengyel
- Faculty of Agricultural & Food, Sciences, University of Manitoba, 405 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada
| | - Catriona M Steele
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, #12-101, Toronto, M5G 2A2, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - K Steve Brown
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, 2800-515 W. Hastings St, Vancouver, BC, V6B 5K3, Canada
| | - Minn N Yoon
- School of Dentistry, University of Alberta, 5-575, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Veronique M Boscart
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.,Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, #12-101, Toronto, M5G 2A2, ON, Canada.,Conestoga College, School of Health Sciences and Community Services, Kitchener, ON, N2G 4M4, Canada
| | - George Heckman
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Lita Villalon
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB E1A 3E9, Canada
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Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. nutritionDay in Nursing Homes-The Association of Nutritional Intake and Nutritional Interventions With 6-Month Mortality in Malnourished Residents. J Am Med Dir Assoc 2016; 18:162-168. [PMID: 27742584 DOI: 10.1016/j.jamda.2016.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population. DESIGN One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007. SETTING A total of 507 NH units from 15 countries. PARTICIPANTS NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index <20 kg/m2 or weight loss >5 kg in the last year or at risk of malnutrition or malnourished according to NH staff). MEASUREMENTS Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents' nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents' nutritional status, general residents' characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P < .01) included in a multivariate analysis. RESULTS Six-month mortality rate of the included 4857 NH residents was 20.3%. Univariate analysis identified residents' diet, use of ONS, intake at lunch, and 14 confounders as predictors of mortality. Intake at lunch and 7 confounders remained in the multivariate model [area under the receiver operating curve = 0.687; 95% confidence interval (CI) 0.669-0.706; P < .001]. The less residents ate for lunch, the higher was the risk of mortality, with the highest odds ratio (OR) for residents who ate nothing (OR 3.38; 95% CI 2.58-4.42). Mortality risk was OR 2.36; 95% CI 1.91-2.92, and OR 1.64; 95% CI 1.29-2.07 times higher for immobile and partially mobile compared with mobile residents. Cancer, dysphagia, weight loss >5 kg in the last year, body mass index <20 kg/m2, residents' country region, and increasing age were also associated with a higher mortality risk. CONCLUSIONS Poor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.
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Affiliation(s)
- Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Michael Themessl-Huber
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Vienna, Austria
| | - Karin Schindler
- Medical Clinic III, Division Endocrinology, Medical University Vienna, Vienna, Austria
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Michael Hiesmayr
- Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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45
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Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Who receives oral nutritional supplements in nursing homes? Results from the nutritionDay project. Clin Nutr 2016; 36:1360-1371. [PMID: 27692932 DOI: 10.1016/j.clnu.2016.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 09/06/2016] [Accepted: 09/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS. METHODS Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p < 0.05) subsequently included in a multivariate analysis (backwards LR). RESULTS 13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R2 = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85-56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52-16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86-3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86-5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93-2.84]; 16.0%) and 1.38 ([1.23-1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units with a nutritional expert (67.1%) and units performing a nutritional assessment at least once a month (71.6%), the odds of receiving ONS were also significantly increased (1.89 [1.71-2.10] and 1.17 [1.06-1.29]). CONCLUSION In NHs who participated in the nutritionDay, ONS are used for residents with poor nutritional and functional status and often in combination with other nutritional interventions. Future studies need to clarify the role of NH staff in the prescription and distribution of ONS and focus on the reasons for and adequacy of the use of ONS in NHs.
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Affiliation(s)
- Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | | | | | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | | | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Yalcin A, Aras S, Atmis V, Cengiz OK, Cinar E, Atli T, Varli M. Sarcopenia and mortality in older people living in a nursing home in Turkey. Geriatr Gerontol Int 2016; 17:1118-1124. [DOI: 10.1111/ggi.12840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/25/2016] [Accepted: 05/09/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Ahmet Yalcin
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Sevgi Aras
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Volkan Atmis
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Ozlem Karaarslan Cengiz
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Esat Cinar
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Teslime Atli
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
| | - Murat Varli
- Department of Geriatric Medicine; Ankara University School of Medicine İbn-i, Sina Hospital; Altındağ Ankara Turkey
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Zanini M, Bagnasco A, Aleo G, Timmins F, Sasso L. Returning to the sacred - the importance of careful attention to patients’ nutritional needs in hospital settings. J Adv Nurs 2016; 73:523-526. [DOI: 10.1111/jan.12879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Milko Zanini
- Department of Health Sciences; University of Genoa; Italy
| | | | - Giuseppe Aleo
- Department of Health Sciences; University of Genoa; Italy
| | - Fiona Timmins
- School of Nursing and Midwifery; Trinity College Dublin; Ireland
| | - Loredana Sasso
- Department of Health Sciences; University of Genoa; Italy
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NutriLive: An Integrated Nutritional Approach as a Sustainable Tool to Prevent Malnutrition in Older People and Promote Active and Healthy Ageing—The EIP-AHA Nutrition Action Group. ADVANCES IN PUBLIC HEALTH 2016. [DOI: 10.1155/2016/5678782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present document describes a nutritional approach that is nested in the European Innovation Partnership for Active and Healthy Aging (EIP-AHA) and aims to provide the first common European program translating an integrated approach to nutritional frailty in terms of a multidimensional and transnational methodology. The document has been developed by the A3 Nutrition Action Area of the EIP-AHA and aims at providing a stepwise approach to malnutrition in older citizens, identifying adequate interventions based on a unified assessment and ICT-supported solutions. “NutriLive” is an integrated nutritional approach, represented by a structured Screening-Assessment-Monitoring-Action-Pyramid-Model (SAM-AP). Its core concept is the stratification of the nutritional needs, considered by the working group as the key for targeted, effective, and sustainable interventions. “NutriLive” tries to close gaps in epidemiological data within an aging population, creating a unified language to deal with the topic of nutrition and malnutrition in Europe. By assembling all the validated screening, assessment, and monitoring tools on malnutrition in a first pyramid, which is interrelated to a second intervention pyramid, the A3 Nutrition WG identifies a common, integrated vision on the nutritional approach to frailty, which applies to the various health care settings.
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Sugai T, Suzuki Y, Yamazaki M, Shimoda K, Mori T, Ozeki Y, Matsuda H, Sugawara N, Yasui-Furukori N, Minami Y, Okamoto K, Sagae T, Someya T. High prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia: a nationwide survey. BMJ Open 2015; 5:e008720. [PMID: 26656016 PMCID: PMC4679887 DOI: 10.1136/bmjopen-2015-008720] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia. DESIGN Cross-sectional study. SETTING A questionnaire conducted in inpatient and outpatient facilities in Japan. PARTICIPANTS The population of adult patients with schizophrenia in Japan (N=23,116). MAIN OUTCOME MEASURES The prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia. RESULTS We conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15,461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (p<0.001). The proportion of underweight inpatients with schizophrenia was significantly higher than that among outpatients (p<0.001). Age-specific analysis revealed that the proportion of underweight individuals aged ≥ 40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (p<0.001). There was a significant difference in the severity of underweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients. CONCLUSIONS The prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice.
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Affiliation(s)
- Takuro Sugai
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | - Yutaro Suzuki
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | | | - Kazutaka Shimoda
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Takao Mori
- Japan Psychiatric Hospital Association, Tokyo, Japan
| | - Yuji Ozeki
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | | | - Norio Sugawara
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | | | - Toyoaki Sagae
- Faculty of Health and Nutrition, Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, Yonezawa, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
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