Association of Nutritional Risk and Depressive Symptoms with Physical Performance in the Elderly: The Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge)

Circadian rhythms and objective measures of physical activity among middle-aged and older adults in Taiwan

BACKGROUND

To identify the association between daytime activity with objectively monitor and subjective variables at a different time-zone of day as well as the sex differences.

METHODS

Participants aged 50 years and older living in the community in Taiwan were recruited. The activity was measured by wearable actigraphy devices, diaries, and self-reported questionnaires. The study used nonparametric analysis to examine the association between mean activity level and demographic and subjective measurement variables.

RESULTS

Among the 55 participants enrolled in the study, data of 34 (62 %) participants who meet the criteria that wore a wearable actigraphy device for at least 7 completed days were analyzed. There is no significant relationship between each demographics and subjective measurement variables. However, actigraphy counts are significantly related to female's nutrition (Z = -2.367, p = 0.017*), and male's retirement status (Z = -2.132, p = 0.033*).

CONCLUSIONS

The activity in morning is highest of the day with significant correlation to evening activities. Moreover, actigraphy counts that indicating objective measure of physical activity in female is significantly related to physiological variables (nutritional status), while male are predicted by social variables (retired status).

Factors Associated with the Development of High Nutrition Risk: Data from the Canadian Longitudinal Study on Aging

This study aimed to determine which social network, demographic, and health-indicator variables were able to predict the development of high nutrition risk in Canadian adults at midlife and beyond, using data from the Canadian Longitudinal Study on Aging. Multivariable binomial logistic regression was used to examine the predictors of the development of high nutrition risk at follow-up, 3 years after baseline. At baseline, 35.0 per cent of participants were at high nutrition risk and 42.2 per cent were at high risk at follow-up. Lower levels of social support, lower social participation, depression, and poor self-rated healthy aging were associated with the development of high nutrition risk at follow-up. Individuals showing these factors should be screened proactively for nutrition risk.

Bidirectional longitudinal associations between balance performance and depressive symptoms in older adults: A cross-lagged panel model

BACKGROUND

Evidence on the temporal sequences between balance and depressive symptoms is limited, and no studies have compared the strength of each direction. This study aimed to assess the association between balance performance and depressive symptoms among community-dwelling older adults, and further to explore the driving factors in the dynamic association.

METHODS

Data were obtained from the English Longitudinal Study of Aging (ELSA). Overall, 3971 community-residing adults aged 50 years or older were assessed at 2004/05, 2008/09, and 2012/13. Balance was measured using three progressively more difficult tasks (side-by-side, semi-tandem, and full-tandem). Depressive symptoms were determined with a dichotomous eight-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Cross-lagged panel models were used to test the reciprocal relationships between balance and depressive symptoms.

RESULTS

Our analyses revealed that earlier poorer balance predicted later worse depressive symptoms consistently across waves (β_W2-W4 = -0.058, P < .05, β_W4-W6 = -0.067, P < .001). Conversely, the higher scores of depressive symptoms at wave 4 predicted lower level of balance at wave 6 (β_W4-W6 = -0.038, P = .018). The cross-lagged effects of balance on depressive symptoms were over all stronger than the reverse effects.

CONCLUSIONS

These findings add novel insights into the temporal directionality of balance and depressive symptoms among community-dwelling older adults, and suggest that a predominance of balance disorder effects. Interventional strategy should aim to increase balance ability from earlier stages to promote successful aging.

Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018

This study aimed to determine four-year outcomes of community-living older adults identified at ‘nutrition risk’ in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging

STUDY OBJECTIVES

To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and sleep-maintenance insomnia.

METHODS

We included those aged 45-85 years, living in 1 of 10 Canadian provinces between 2012 and 2015 (at the baseline), recruited via 3 population-based sampling methods. Insomnia symptoms were assessed using questions adapted/modified from the Pittsburgh Sleep Quality Index. A panel of potential prodromal neurodegenerative markers including self-reported symptoms and objective gait motor, cognitive, and autonomic variables were assessed cross sectionally. We compared those who endorsed insomnia symptoms ≥ 3 times per week to controls, adjusting for age, sex, and education via logistic regression.

RESULTS

Overall, 2,051/30,097 people screened positive for sleep-onset insomnia alone and 4,333 for sleep-maintenance insomnia alone, while 2,371 endorsed both subtypes. On objective gait tests, participants with sleep-onset insomnia, but not sleep-maintenance insomnia, had worse balance (odds ratio [OR] = 1.33, 95% confidence interval = [1.16, 1.52]) and slower gait speed (OR = 1.52 [1.34, 1.73]). Although participants with any insomnia subtype endorsed more motor symptoms, these were more severe in those with sleep-onset insomnia (OR onset vs maintenance = 1.13 [1.07, 1.18]). On objective cognitive tests, those with sleep-maintenance insomnia scored normally. However, participants with sleep-onset insomnia performed worse on tests of verbal fluency (OR = 1.24 [1.06, 1.43]), immediate memory (OR = 1.23 [1.08, 1.41]), and prospective memory task (OR = 1.29 [1.11, 1.50]). The sleep-onset insomnia group also had lower heart rate variability (OR = 1.23 [1.07, 1.43]). Secondary analyses found generally similar results in young vs older age of insomnia development.

CONCLUSIONS

Compared to maintenance insomnia, those with sleep-onset insomnia have more motor, cognitive, and autonomic signs/symptoms. When evaluating neurodegenerative risk, differentiating insomnia subtypes may increase precision.

CITATION

Yao CW, Pelletier A, Fereshtehnejad S-M, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med. 2022;18(2):345-359.

Dietary Protein Intake and Determinants in Māori and Non-Māori Octogenarians. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu: Life and Living in Advanced Age: A Cohort Study in New Zealand

Protein intake, food sources and distribution are important in preventing age-related loss of muscle mass and strength. The prevalence and determinants of low protein intake, food sources and mealtime distribution were examined in 214 Māori and 360 non-Māori of advanced age using two 24 h multiple pass recalls. The contribution of food groups to protein intake was assessed. Low protein intake was defined as ≤0.75 g/kg for women and ≤0.86 g/kg for men. A logistic regression model was built to explore predictors of low protein intake. A third of both women (30.9%) and men (33.3%) had a low protein intake. The main food group sources were beef/veal, fish/seafood, milk, bread though they differed by gender and ethnicity. For women and men respectively protein intake (g/meal) was lowest at breakfast (10.1 and 13.0), followed by lunch (14.5 and 17.8) and dinner (23.3 and 34.2). Being a woman (p = 0.003) and having depressive symptoms (p = 0.029) were associated with consuming less protein. In adjusted models the odds of adequate protein intake were higher in participants with their own teeth or partial dentures (p = 0.036). Findings highlight the prevalence of low protein intake, uneven mealtime protein distribution and importance of dentition for adequate protein intake among adults in advanced age.

Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit

BACKGROUND

Despite decades of research evaluating different predictive strategies to identify persons at risk for falls, nutritional issues have received little attention. Malnutrition leads to weight loss associated with muscle weakness and consequently increases the risk of falls.

AIMS

The current study assessed the association between nutritional state and fall risk scores in a geriatric in-patient unit in Ain Shams University Hospital, Cairo, Egypt.

METHODS

A cross-sectional study was conducted to assess the nutritional state of 190 older inpatients using a short form of the Mini-Nutritional Assessment (MNA-SF), and the risk of falls was assessed using the Morse Fall Scale (MFS), Johns Hopkins fall risk assessment tool (JH-FRAT), Schmid Fall Risk Assessment Tool (Schmid-FRAT), Hendrich II Fall Risk Model (HII-FRM) and Functional Assessment Instrument (FAI). The generalised linear models (GLM) and odds ratio (OR) were calculated to test the nutritional status as a risk factor for falls.

RESULTS

Malnutrition was significantly associated with high fall risk as assessed by MFS and HII-FRM (OR = 2.833, 95% CI 1.358-5.913, P = 0.006; OR = 3.477, 95% CI 1.822-6.636, P < 0.001), with the highest OR for JH-FRAT (OR = 5.455, 95% CI 1.548-19.214, P = 0.008). After adjusting for age, the adjusted Charlson Comorbidity Index (ACCI), number of fall risk-increasing drugs (FRIDs), risk of malnutrition or malnourished were significantly associated with high fall risk as assessed by MFS (OR = 2.761, 95% CI 1.306-5.836, P = 0.008), JH-FRAT (OR = 4.938, 95% CI 1.368-17.828, P = 0.015), and HII-FRM (OR = 3.486, 95% CI 1.783-6.815, P < 0.001).

CONCLUSIONS

This study demonstrated a significant association between malnutrition and fall risk assessment scores, especially JH-FRAT, in hospitalised older patients.

Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on Aging

BACKGROUND

The most common methods for measuring mobility in older adulthood include performance-based tests, such as the Timed-Up-and-Go and gait speed. While these measures have strong predictive validity for adverse outcomes, they are limited to assessing what older adults do in standardized settings, rather than what they do in their daily life. Life-space mobility, which is the ability to move within environments that expand from one's home to the greater community, has been proposed as a more comprehensive measure of mobility. The aim of this study was to determine the association between modifiable factors and life-space mobility in older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA).

METHODS

Life-space mobility was measured using the Life Space Index (LSI). Explanatory factors included physical, psychosocial and cognitive determinants, as well as pain, fatigue, driving status, nutrition, body mass index, smoking status, and vision. To estimate the association between the LSI and explanatory variables, univariate and multivariable ordinary least squares regression analyses were performed.

RESULTS

All adults 65 years and older (n = 12,646) were included in the analysis. Fifty percent were women and the mean age was 73.0 (SD5.7). The mean LSI score was 80.5, indicating that, on average, the sample was able to move outside of their neighborhood independently. All explanatory variables were significantly associated with the LSI except for balance and memory. The top 3 variables that explained the most variation in the LSI were driving, social support and walking speed.

CONCLUSION

To our knowledge, this was the first study to examine the association between life-space mobility and a comprehensive set of modifiable factors that were selected based on a theoretical framework and existing research evidence. This study had two important messages. First, driving, social support and walking speed emerged as the most significant correlates of life-space mobility in older adults. Second, life-space mobility is multifactorial and interventions that are pragmatic in their design and testing are needed that consider the complexity involved. A multi-disciplinary approach to examining life-space mobility in older adults is needed to optimize opportunities for healthy aging and develop strategies that support mobility in older adulthood.

Even mealtime distribution of protein intake is associated with greater muscle strength, but not with 3-y physical function decline, in free-living older adults: the Quebec longitudinal study on Nutrition as a Determinant of Successful Aging (NuAge study)

Background: Functional status declines with aging, thus impeding autonomy. Recently, a more even mealtime distribution of dietary protein was positively associated with muscle mass, but the relation of this distribution to physical performance remains unknown.Objective: We examined the relation between mealtime protein-intake distribution and physical performance and its 3-y decline in community-dwelling older adults.Design: Three-year follow-up data from 827 men and 914 women (67-84 y) in the longitudinal study on nutrition and aging [Quebec longitudinal study on Nutrition as a Determinant of Successful Aging (NuAge study); Quebec, Canada] were analyzed. Physical performance, which was measured yearly, was grouped into the following 2 functional composite scores: muscle strength (handgrip, arm, and leg) and mobility (timed-up-and-go, chair stand, and walking speed). Dietary data were collected in 2 sets of three 24-h food recalls at baseline and year 2. The individual mealtime protein distribution was calculated as the CV (i.e., SD divided by the mean) of grams of protein per meal. A mixed model analysis was used to examine trajectories of muscle strength and mobility across time by sex as conditioned by the protein distribution and adjusted for potential covariates.Results: Physical performance deteriorated over 3 y with muscle strength declining more than the mobility score in men (-1.51 ± 1.68 compared with -0.66 ± 2.81) and women (-1.35 ± 1.77 compared with -0.78 ± 2.63) (means ± SD, P < 0.001). More-evenly distributed protein intake, independent of the total quantity, was associated with a higher muscle-strength score in both sexes throughout follow-up. It was also associated with a greater mobility score, but only in men and only before adjustment for covariates. Strength and mobility rates of decline were not affected by protein-intake distribution in either sex.Conclusions: In addition to the previously observed association with lean mass, an even distribution of daily protein intake across meals is independently associated with greater muscle strength, but not with the mobility score, in older adults. A longer-term investigation of the role of protein intake and its distribution on physical performance is warranted, as are intervention studies, to support future recommendations.

Functional mobility and its contributing factors for older adults in different cities in Taiwan

BACKGROUND/PURPOSE

Impaired mobility is one of the primary causes of declined functional capacity in old age. The timed up-and-go test (TUG), a common mobility test, has been studied extensively in Western countries. The purposes of this study were to compare and identify factors associated with TUG performance in older adults with impaired mobility and living in different cities in Taiwan.

METHODS

Older adults living in Taipei, Tainan, and Niaosong cities were screened for mobility impairments and then recruited. A series of questionnaires and physical and functional tests were used to obtain information and measurements for potential contributing factors and TUG. Regression analysis was conducted to determine factors contributing to TUG.

RESULTS

A total of 413 older adults participated in the study. The mean TUG was 14.3 seconds for participants across the three cities, and was significantly shorter in Tainan. Age, number of medications, fear of falling, depression, high intensity activity time, reaction time, single leg stance time, and functional reach distance were found to have significant contribution. These factors accounted for approximately half of the variance in TUG. The regression equations were not equal for the different cities, with depression being the only common determinant.

CONCLUSION

Taiwanese older adults with mobility problems living in different cities performed differently in TUG and the contributing factors were also different. These findings indicate a need of further studies examining older adults in different environments.

Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study

Falling and fractures are a public health problem in elderly people. The aim of our study was to investigate whether nutritional status is associated with the risk of falling or fracture in community-dwelling elderly. Poor nutritional status was significantly associated with a higher risk of both falling and fractures.

INTRODUCTION

Nutrition could play a role to prevent falls and fractures. The purpose of this study is to investigate whether a poor nutritional status is associated with the risk of falling and of fracture in community dwelling elderly.

METHODS

Baseline nutritional status of participants was assessed using the Mini Nutritional Assessment (MNA). After a follow-up of 12 years, 6040 individuals with available data for falls and 6839 for fracture were included. People who presented the outcomes at baseline were excluded. Cox models were used to evaluate the associations between nutritional status and the risks of fall or fracture.

RESULTS

The frequency of poor nutritional status (MNA ≤ 23.5), at baseline, was respectively 12.0% in the "fall study sample" and 12.8% in the "fracture study sample." Incident fall and fracture over 12 years were reported in 55.8 and 18.5% of the respective samples, respectively. In multivariate models controlled for sociodemographic data and several baseline health indicators, poor nutritional status was significantly associated with a higher risk of falling (hazard ratio (HR) = 1.66, 95% confidence interval (95% CI) 1.35-2.04 in men and HR = 1.20, 95% CI 1.07-1.34 in women) and with a higher risk of fracture (HR = 1.28, 95% CI 1.09-1.49).

CONCLUSION

Poor nutritional status was associated with a higher risk of both falling and fractures in French elderly community-dwellers. Early screening and management of the nutritional status may be useful to reduce the frequency of these events in older people.

Health and Social Factors Associated with Nutrition Risk: Results from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)

OBJECTIVES

To establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Māori and non-Māori in advanced age.

DESIGN

A cross sectional analysis of inception cohorts to LiLACS NZ.

SETTING

Bay of Plenty and Lakes region of the North Island, New Zealand.

PARTICIPANTS

255 Māori and 400 non- Māori octogenarians.

MEASUREMENTS

Nutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15.

RESULTS

Half (49%) of Māori and 38% of non-Māori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Māori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Māori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002).

CONCLUSION

Traditional risk factors apply to both Māori and non-Māori whilst education as indicative of low socioeconomic status is an additional risk factor for Māori. High nutrition risk impacts health related quality of life for non-Māori. Interventions which socially facilitate eating are especially important for women and for Māori to maintain cultural practices and could be initiated by routine screening.

The BRIGHT Trial: what are the factors associated with nutrition risk?

OBJECTIVES

To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial).

DESIGN

A cluster randomised controlled trial.

SETTING

Three main centres in New Zealand.

PARTICIPANTS

A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori).

MEASUREMENTS

Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established.

RESULTS

Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account.

CONCLUSION

Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Indicadores antropométricos de estado nutricional como preditores de capacidade em idosos

INTRODUÇÃO: Trata-se de estudo seccional que analisou dados de pesquisa epidemiológica de base populacional e domiciliar conduzida em um município do nordeste do Brasil.OBJETIVO: Identificar os indicadores antropométricos de estado nutricional que apresentam melhor capacidade preditiva de capacidade funcional em idosos.MÉTODOS: A população foi constituída por 316 idosos que foram avaliados por meio de questionário contendo informações sociodemográficas, atividade física e condições de saúde, seguido de avaliação antropométrica. A capacidade funcional foi avaliada por meio das escalas de Katz e de Lawton e Brody para atividades básicas e instrumentais da vida diária, respectivamente. Foram utilizados como indicadores de estado nutricional, o índice de massa corporal, a área muscular do braço e o perímetro da panturrilha. Estimou-se modelos simples e múltiplos de regressão logística multinomial, tendo a capacidade funcional como variável dependente e os indicadores antropométricos como variáveis de interesse.RESULTADOS: Participaram do estudo 173 mulheres (54,7%) e 143 homens (45,3%). Os resultados da regressão múltipla mostraram que o perímetro da panturrilha foi o único preditor de capacidade funcional em mulheres (≤ P25: OR = 5,77, p = 0,028, para dependência nas atividades instrumentais), enquanto que nos homens o índice de massa corporal foi o único indicador associado (baixo peso: OR = 11,36, p = 0,006; sobrepeso: OR = 22,06, p = 0,002; para dependência nas atividades básicas e instrumentais).CONCLUSÃO: Os resultados permitem concluir que os indicadores antropométricos preditores de capacidade funcional em idosos variam de acordo com o sexo, com o perímetro da panturrilha sendo mais adequada às mulheres e o índice de massa corporal aos homens.

Nutritional status, physical performance and functional capacity in an elderly population in southern Brazil

Objective: to investigate the association between nutritional status and functional limitation and disability in an elderly population in southern Brazil. Methods: epidemiological, cross-sectional household-based study carried out with 477 elderly of both sexes (60 to 100 years). Body mass index (BMI) served to assess the nutritional status: underweight (BMI < 22 kg/m2) and overweight (BMI > 27 kg/m2). The sum score (0-5) obtained in three tests: "chair stand" and "pick up a pen" (measured by time) and standing balance (four static measurements) assessed the functional limitation. The disability was evaluated by the difficulty in performing one or more self-reported tasks related to basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Crude and adjusted analyzes (3 models) were carried out using Poisson regression; prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. Results: crude analyzes showed a positive association between underweight and functional limitation (PR = 2.71, 95% CI = 1.63 to 4.51); overweight and disability in ADLs (PR = 2.20, CI 95% = 1.44 to 3.35); overweight and disability in IADLs (PR = 1.56, CI 95% = 1.20 to 2.03). The additional adjustments for gender, age, level of education, living arrangements, current work, cognitive function and number of morbidities reduced the strength of the associations, without changing the statistical strength. Conclusion: nutritional status is a factor that is independently and positively associated with functional limitation and disability. We recommend the use of this indicator to monitor the health of the elderly.

Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample

Background

Falls are common in older people and may lead to functional decline, disability, and death. Many risk factors have been identified, but studies evaluating effects of nutritional status are limited. To determine whether nutritional status is a predictor of falls in older people living in the community, we analyzed data collected through the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET).

Methods

SHLSET include a series of interview surveys conducted by the government on a random sample of people living in community dwellings in the nation. We included participants who received nutritional status assessment using the Mini Nutritional Assessment Taiwan Version 2 (MNA-T2) in the 1999 survey when they were 53 years or older and followed up on the cumulative incidence of falls in the one-year period before the interview in the 2003 survey.

Results

At the beginning of follow-up, the 4440 participants had a mean age of 69.5 (standard deviation  = 9.1) years, and 467 participants were “not well-nourished,” which was defined as having an MNA-T2 score of 23 or less. In the one-year study period, 659 participants reported having at least one fall. After adjusting for other risk factors, we found the associated odds ratio for falls was 1.73 (95% confidence interval, 1.23, 2.42) for “not well-nourished,” 1.57 (1.30, 1.90) for female gender, 1.03 (1.02, 1.04) for one-year older, 1.55 (1.22, 1.98) for history of falls, 1.34 (1.05, 1.72) for hospital stay during the past 12 months, 1.66 (1.07, 2.58) for difficulties in activities of daily living, and 1.53 (1.23, 1.91) for difficulties in instrumental activities of daily living.

Conclusion

Nutritional status is an independent predictor of falls in older people living in the community. Further studies are warranted to identify nutritional interventions that can help prevent falls in the elderly.

Malnutrition is related to functional impairment in older adults receiving home care

OBJECTIVES

The aims of this work were (a) to provide a detailed description of the association between nutritional (Mini Nutritional Assessment; MNA®) and functional status in a sample of older adults receiving home care, using both questionnaire- and performance-based functional methods, and (b) to investigate the impact of different MNA subscales on this association.

DESIGN

Multi-centre, cross-sectional.

SETTING

Home care.

PARTICIPANTS

296 persons ≥65 years in need of care (80.7±7.7 y).

MEASUREMENTS

Nutritional status was determined by the MNA and functional status by two questionnaires (Instrumental and Basic Activities of Daily Living; IADL, ADL) and three performance tests (handgrip strength, HGS; Short Physical Performance Battery, SPPB; Timed 'Up and Go' Test, TUG). A categorical and a covariance analytical approach were used to test for differences in functional status between MNA groups (well nourished, risk of malnutrition, malnourished). In addition, functional parameters were correlated with total MNA, a modified MNA version (modMNA), where functional items were excluded, and MNA subscales ('functionality', 'general assessment', 'anthropometry', 'dietary assessment', and 'subjective assessment').

RESULTS

57% of the participants were at risk of malnutrition and 12% malnourished. 35% reported severe limitations in IADL, 18% in ADL. 40%, 39% and 35% had severe limitations in HGS, SPPB and TUG; 9%, 28% and 34% were not able to perform the tests. Functional status deteriorated significantly from the well nourished to the malnourished group in all functional measures. The modMNA was weak but still significantly related to all functional parameters except TUG. The subscale 'functionality' revealed strongest correlations with functional measures. All other MNA subscales showed only weak or no associations.

CONCLUSION

More than one half of the seniors receiving home care were at nutritional risk and poor functional level, respectively. Malnutrition according to MNA was significantly associated to both questionnaire- and performance-based functional measures even after exclusion of functional MNA items.

Baseline determinants of global diet quality in older men and women from the NuAge cohort

Judicious food choices are of prime importance during aging.

OBJECTIVES

This study was conducted to identify individual and collective attributes determining global diet quality (DQ).

METHODOLOGY

Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses.

RESULTS

Among men, the final model showed higher education (β=0.23, p=.01), diet knowledge (β=0.96, p<.0001), number of daily meals (β=1.91, p=.02) and perceived physical health (β=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (β=-2.25, p=.05), wearing dentures (β=-2.31, p=.01) and eating regularly in restaurants (β=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (β=0.29, p=.002), diet knowledge (β=0.54, p=.002), number of daily meals (β=3.61, p<.0001), and hunger (β=0.61, p<.0001) were positive determinants of global DQ; greater BMI (β=-0.16, p=.03) and chewing problems (β=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%).

DISCUSSION

These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.

High nutritional risk is associated with worse health-related quality of life in patients with heart failure beyond sodium intake

BACKGROUND

The most desirable outcome in heart failure (HF) management is to improve health-related quality of life (HRQoL) as a patient-centred health outcome. Nutrition is assumed to be important in HF management, whereas there is little evidence that nutritional risk affects HRQoL, except for sodium.

PURPOSE

We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake.

METHODS

A total of 134 consecutive patients with HF [age 63 ± 11 years, 35% female, 45% New York Heart Association (NYHA) class III/IV, ejection fraction (EF) 33 ± 13%] completed the Nutrition Screening Initiative (NSI) to assess nutritional risk and a 24-h urine sodium excretion assessment to estimate daily sodium intake at baseline. The Minnesota Living with HF Questionnaire was used to evaluate HRQoL at baseline and 6 months later. Hierarchical linear regressions were used to determine whether nutritional risk predicted HRQoL at baseline and 6 months later.

RESULTS

Seventy-eight (58.2%) patients had high nutritional risk as indicated by a total NSI score ≥ 6. Increased nutritional risk was independently associated with worse HRQoL at baseline and 6 months later (β = 0.33, p < 0.001; β = 0.35, p < 0.001, respectively), after controlling for age, gender, aetiology, body mass index, NYHA class, EF, total comorbidity score, prescribed medications, and daily sodium intake.

CONCLUSION

These findings show that higher nutritional risk beyond sodium intake affects worse HRQoL in patients with HF. Further work is required to provide specific dietary guidelines to improve health outcomes for patients with HF.

Subthreshold depression and successful aging in older women

OBJECTIVES

Subthreshold depression (StD) is common in older adults and is associated with poor self-rated health. However, the impact of StD on broader indicators of successful aging, such as positive psychological constructs, cognitive functioning, or quality of well-being, has not been assessed. The authors compared persons with scores above and below a predetermined threshold on the Center for Epidemiological Studies Scale for Depression (CES-D) with nondepressed (ND) persons on measures of multiple domains associated with successful aging.

DESIGN

Cross-sectional survey-based psychological assessments.

PARTICIPANTS

A total of 1,979 community-dwelling older women participating in the Women's Health Initiative study.

MEASUREMENTS

ND was defined as a CES-D score below 8, StD as a score between 8 and 15, and CES-D Depression (CD) as a score of 16 or above. The study questionnaire consisted of multiple self-reported measures of positive psychological functioning (e.g., optimism and resilience), cognitive functioning and complaints, and quality of well-being. The authors also obtained a history of diagnosis, treatment, and hospitalization related to mental health problems.

RESULTS

Overall 20.2% of women met CES-D criteria for StD and 7% for CD. Women with StD had worse self-rated successful aging, worse physical and emotional functioning, lower optimism, more negative attitudes toward aging, lower personal mastery and self-efficacy, and greater anxiety and hostility than ND women but scored better on all these measures than women with CD. Subjects with StD also had higher self-reported rates of previous diagnosis, treatment, and hospitalization for mental health problems than the ND group. Subjects with StD with depressed mood and/or anhedonia were largely similar to those without these symptoms.

CONCLUSIONS

Mild-moderate levels of depressive symptoms that likely fall under a general category of StD were common and were associated with worse functioning on virtually every component of successful aging that the authors examined. StD represents a clinical entity that may affect the longitudinal course of successful aging for large numbers of persons and is a potential target for clinical intervention.

Nutritional problems in the elderly

Despite the high prevalence of malnutrition among elderly patients, nutritional problems are still not recognized as a priority forthem by health professionals. The need for nutritional assessment and intervention is particularly crucial in this age group, in whom the incidence of chronic illness is high and a myriad of socio-economic factors enhance the likelihood of malnutrition. Malnutrition could be considered as an element of frailty among the old, leading to increased risk of many geriatric syndromes such as falls, delirium, functional decline, depressed immunity, etcetera. However, detection of nutritional risk and nutritional intervention are effective in frail patients. Nutritional assessment should be part of routine clinical practice in elderly hospitalized patients. A comprehensive screening tool for assessment of nutritional status that is clinically relevant and cost effective to perform is therefore needed. If malnutrition is suggested by such screening tests, then a supplemental conventional nutritional assessment should be performed before treatment is planned.