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Morley JE. Nutrition and Aging Well. J Am Med Dir Assoc 2017; 18:91-94. [DOI: 10.1016/j.jamda.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention. J Am Med Dir Assoc 2016; 17:852-9. [PMID: 27349626 DOI: 10.1016/j.jamda.2016.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Older people living in residential aged care facilities (RACFs) are at a higher risk of suffering fractures than the community-dwelling older population. The first Consensus Conference on Treatment of Osteoporosis in RACFs in Australia, held in Sydney in July 2009, aimed to address some of the issues relating to the treatment of older residents with osteoporosis in RACFs. Considering that the field of osteoporosis diagnosis and management has significantly advanced in the last 5 years and that new evidence has been generated from studies performed within RACFs, a Second Consensus Conference was held in Sydney in November 2014. METHODS An expert panel met in November 2014 in Penrith, NSW, Australia in an attempt to reach a consensus on diverse issues related to the treatment of osteoporosis at RACFs. Participants were selected by the scientific committee on the basis of their practice in an RACF and/or major published articles. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short, evidence-based presentation, when possible. RESULTS This article provides an update on the most relevant evidence on osteoporosis in older people living in RACFs graded according to its level, quality, and relevance. CONCLUSION As with the first consensus, it is hoped that this statement will constitute an important guide to aid physicians in their decision making while practicing at RACFs.
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, O’Donnell D, Giangregorio LM, Pickard LE, Papaioannou A. Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. Can J Aging 2015; 34:137-48. [PMID: 25850439 PMCID: PMC5104546 DOI: 10.1017/s0714980815000057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: -3.9, 12.0; p = .318), and 0.2 per cent (95% CI: -3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
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Affiliation(s)
- Courtney C. Kennedy
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - George Ioannidis
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University
- St Joseph’s Healthcare – Hamilton
| | - Jonathan D. Adachi
- Department of Medicine, McMaster University
- St Joseph’s Healthcare – Hamilton
- Alliance for Better Bone Health Chair in Rheumatology
| | | | | | - Laura E. Pickard
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
- Eli Lilly Canada Chair in Osteoporosis
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Kaasalainen S, Papaioannou A, Burgess J, Van der Horst ML. Exploring the nurse practitioner role in managing fractures in long-term care. Clin Nurs Res 2015; 24:567-88. [PMID: 25825270 DOI: 10.1177/1054773815577577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to assess the current level of involvement of nurse practitioners (NPs) in activities related to preventing and managing fractures in long-term care (LTC). This study used a sequential explanatory mixed methods design that included two phases-a cross-sectional survey followed by qualitative interviews. A final sample of 12 NPs completed the online survey for a response rate of 67%. Eleven of the 12 NPs who completed the survey agreed to participate in a follow-up interview. NPs reported that they were quite engaged in managing fractures in LTC; specifically, they were most active in caring for residents post-fracture. NPs described their role as being holistic in nature in their assessment and treatments related to managing fractures. The findings from this mixed method study add to the growing body of knowledge related to how NPs manage fractures in LTC.
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Affiliation(s)
| | | | - Jennifer Burgess
- Nurse-Led Outreach Team, Shalom Village, Hamilton, Ontario, Canada
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Morley JE. Chronic obstructive pulmonary disease: a disease of older persons. J Am Med Dir Assoc 2014; 15:151-153. [PMID: 24513223 DOI: 10.1016/j.jamda.2013.12.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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Moran ME. Modern Stone Science. Urolithiasis 2014. [DOI: 10.1007/978-1-4614-8196-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wall M, Lohfeld L, Giangregorio L, Ioannidis G, Kennedy CC, Moser A, Papaioannou A, Morin SN. Fracture risk assessment in long-term care: a survey of long-term care physicians. BMC Geriatr 2013; 13:109. [PMID: 24138565 PMCID: PMC3853074 DOI: 10.1186/1471-2318-13-109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background The majority of frail elderly who live in long-term care (LTC) are not treated for osteoporosis despite their high risk for fragility fractures. Clinical Practice Guidelines for the diagnosis and management of osteoporosis provide guidance for the management of individuals 50 years and older at risk for fractures, however, they cannot benefit LTC residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians and describe barriers to applying the recently published Osteoporosis Canada practice guidelines for fracture assessment and prevention in LTC. Methods A cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. The survey included questions that addressed members’ attitudes, knowledge, and behaviour with respect to fracture risk assessment in LTC. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses. Results We contacted 347 LTC physicians; 25% submitted completed surveys (81% men, mean age 60 (Standard Deviation [SD] 11) years, average 32 [SD 11] years in practice). Of the surveyed physicians, 87% considered prevention of fragility fractures to be important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by the OC guidelines for assessing fracture risk considered applicable included; glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (91%). Recommended clinical measurements considered applicable included: weight (84%), thyroid-stimulating hormone (78%) and creatinine (73%) measurements, height (61%), and Get-Up-and-Go test (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information, lack of access to tests (bone mineral density, x-rays) or obtaining medical history; resource constraints, and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy. Conclusion Perceived barriers to fracture risk assessment and osteoporosis management in LTC have not changed recently, contributing in part to the ongoing care gap in osteoporosis management. Our findings highlight the importance to adapt guidelines to be applicable to the LTC environment, and to develop partnerships with stakeholders to facilitate their use in clinical practice.
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Affiliation(s)
- Michelle Wall
- McGill University Health Center Research Institute, Montreal, Canada.
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Morley JE. JAMDA Impact Factor. J Am Med Dir Assoc 2013; 14:629-31. [DOI: 10.1016/j.jamda.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 01/10/2023]
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SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia. J Am Med Dir Assoc 2013; 14:531-2. [DOI: 10.1016/j.jamda.2013.05.018] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 12/25/2022]
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Morley JE. Scientific overview of hormone treatment used for rejuvenation. Fertil Steril 2013; 99:1807-13. [DOI: 10.1016/j.fertnstert.2013.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 01/08/2023]
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Abstract
Frailty is now a definable clinical syndrome with a simple screening test. Age-related changes in hormones play a major role in the development of frailty by reducing muscle mass and strength (sarcopenia). Selective Androgen Receptor Molecules and ghrelin agonists are being developed to treat sarcopenia. The role of Activin Type IIB soluble receptors and Follistatin-like 3 mimetics is less certain because of side effects. Exercise (resistance and aerobic), vitamin D and protein supplementation, and reduction of polypharmacy are keys to the treatment of frailty.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
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Morley JE. Hypogonadism, testosterone, and nursing home residents. J Am Med Dir Assoc 2013; 14:381-3. [PMID: 23647780 DOI: 10.1016/j.jamda.2013.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 01/10/2023]
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Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
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Affiliation(s)
- Y Rolland
- Department of Geriatric Medicine, CHU Toulouse, Institute of aging, F-31059 Toulouse, France.
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Morley JE. Frailty, Falls, and Fractures. J Am Med Dir Assoc 2013; 14:149-51. [DOI: 10.1016/j.jamda.2012.12.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 12/24/2022]
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Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
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Vanchinathan V, Lim HW. A dermatologist's perspective on vitamin D. Mayo Clin Proc 2012; 87:372-80. [PMID: 22425213 PMCID: PMC3498088 DOI: 10.1016/j.mayocp.2011.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 12/12/2011] [Accepted: 12/21/2011] [Indexed: 12/19/2022]
Abstract
Vitamin D is a fat-soluble steroid hormone that is crucial for human health and has recently generated controversy regarding its role in human health and disease. In this Special Article, we discuss our dermatologic perspective on vitamin D in a question-and-answer format. We discuss methods of obtaining vitamin D, including cutaneous photobiosynthesis, diet, and supplements and include the recent US Institute of Medicine recommendations. Other reviewed topics include the associations among skin pigmentation, climate, photoprotection, and vitamin D levels. We also elaborate on the popular interest in sun exposure as a method of normalizing vitamin D levels in the context of the risks of solar and artificial radiation. We also discuss groups at risk for vitamin D inadequacy, the need for testing serum vitamin D levels, and the role of phototherapy in patients with malabsorption conditions and hypervitaminosis D, with a focus on patients with sarcoidosis. Finally, we summarize our recommendations on vitamin D.
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Key Words
- 25(oh)d, 25-hydroxyvitamin d
- 1,25(oh2)d, 1,25-dihydroxyvitamin d
- ai, allowable intake
- iom, institute of medicine
- iu, international units
- med, minimal erythema dose
- ng/ml, nanograms/milliliter
- nm, nanometer
- nmol/l, nanomoles/liter
- spf, sun protection factor
- rda, recommended dietary allowance
- uv, ultraviolet
- uv-a, ultraviolet a
- uv-b, ultraviolet b
- vbp, vitamin d binding protein
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Affiliation(s)
| | - Henry W. Lim
- Correspondence: Address to Henry W. Lim, MD, Department of Dermatology, Henry Ford Medical Center, New Center One, 3031 W Grand Blvd, Ste 800, Detroit, MI 48202
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Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment. J Am Med Dir Assoc 2012; 13:87-90. [DOI: 10.1016/j.jamda.2011.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 11/21/2022]
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Geriatric Principles: Evidence-Based Medicine at Its Best. J Am Med Dir Assoc 2012; 13:1-2.e1-2. [DOI: 10.1016/j.jamda.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/20/2022]
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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Morley JE. Osteoporosis and Fragility Fractures. J Am Med Dir Assoc 2011; 12:389-92. [DOI: 10.1016/j.jamda.2011.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 02/01/2023]
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AMDA—A Leader in Developing International Long-Term Care. J Am Med Dir Assoc 2011; 12:319-20. [DOI: 10.1016/j.jamda.2011.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 11/23/2022]
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Morley JE. Undernutrition: a major problem in nursing homes. J Am Med Dir Assoc 2011; 12:243-6. [PMID: 21527163 DOI: 10.1016/j.jamda.2011.02.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 11/16/2022]
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