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Galicia Ernst I, Worf I, Tarantino S, Hiesmayr M, Volkert D. Obesity in European nursing homes participating in nutritionDay 2016-2021-Prevalence and resident characteristics. Clin Obes 2024:e12697. [PMID: 39098644 DOI: 10.1111/cob.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/27/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
The objective of this study is to assess obesity prevalence and characterize European nursing home (NH) residents with obesity comprehensively. Cross-sectional nutritionDay data from 2016 to 2021. Descriptive characterization of European NH residents ≥65 years with and without obesity. Binomial logistic regression to identify factors associated with obesity. A total of 11 327 residents (73.8% female, 86.4 ± 7.9 years, mean body mass index 25.3 ± 5.4 kg/m2) from 12 countries were analysed. Obesity prevalence was 17.7%, mostly class I (13.0%). Taking ≥5 drugs/day (OR 1.633; 95% confidence intervals 1.358-1.972), female sex (1.591; 1.385-1.832), being bed/chair-bound (1.357; 1.146-1.606), and having heart/circulation/lung disease (1.276; 1.124-1.448) was associated with increased obesity risk, older age (0.951; 0.944-0.958), mild (0.696; 0.601-0.805) and severe (0.591; 0.488-0.715) dementia, eating less than ¾ of lunch on nutritionDay (0.669; 0.563-0.793), needing assistance for eating (0.686; 0.569-0.825), and being identified by NH staff at risk for (0.312; 0.255-0.380) or with malnutrition (0.392; 0.236-0.619) decreased obesity risk. Almost one in five residents in European NH participating in nutritionDay is affected by obesity. Through a wide exploratory analysis, including data from 12 European countries, we confirmed previous findings and identified additional factors associated with obesity that should be considered in the daily care of affected residents.
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Affiliation(s)
- Isabel Galicia Ernst
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Isabella Worf
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Silvia Tarantino
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Michael Hiesmayr
- CeMSIIS - Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Wang X, Tian M, Zheng L, Qiao L, Liu Y, Yuan B. Characterization and prevention of flame burns caused by electric bicycle battery chargers: results from a 7-year experience. J Int Med Res 2024; 52:3000605241233955. [PMID: 38587839 PMCID: PMC11010761 DOI: 10.1177/03000605241233955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/29/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE With the recent exponential increase in express deliveries across China, the number of patients with flame burns caused by electric bicycle battery chargers (BEBBC) has markedly increased in burn units. In this study, we aimed to characterize BEBBC to systematically explore measures to prevent their occurrence. METHODS We performed a retrospective chart review of patients with flame burns who visited the Burn Department of Rui Jin Hospital between January 2015 and December 2021. RESULTS Sixty-three patients with BEBBC and 1412 with types of other flame burn were included in this study. Fifty-six of the 63 BEBBC cases occurred between 9 pm and 7 am. BEBBC incidents involved a higher incidence of group burn in which multiple individuals were affected. Non-local patients with BEBBC were significantly younger than their local counterparts. BEBBC had a higher mortality than types of other flame burn. CONCLUSIONS The rising incidence of BEBBC calls for greater attention because of the associated high mortality and heavy burden on society. Enacting related legislation, disseminating information to the public, and improving treatment to control infection can help prevent BEBBC, increase its cure rate, and reduce patient mortality.
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Affiliation(s)
- Xiqiao Wang
- Department of Burn, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Tian
- Department of Burn, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Qiao
- Department of Burn, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Department of Burn, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Yuan
- Department of Burn, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, Bradway CK. Characteristics of nursing homes with high percentages of falls and falls with injuries among residents with obesity. Geriatr Nurs 2023; 53:191-197. [PMID: 37540915 PMCID: PMC10976471 DOI: 10.1016/j.gerinurse.2023.07.017] [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: 06/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group. AIM We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity. METHOD We used resident assessment data and logistic regression analysis. RESULTS We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day. CONCLUSION Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity.
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Affiliation(s)
- Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, USA.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences, 2708 South 48th Street, Springdale, Arkansas 72762, USA
| | - Jennifer L Vincenzo
- College of Health Professions, University of Arkansas for Medical Sciences, 1125 North College Avenue, Fayetteville, Arkansas 72703, USA
| | - Robert Weech-Maldonado
- School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, SHPB 558, Birmingham, AL 35294, USA
| | - Christine K Bradway
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Room 312, Philadelphia, PA 19104-4217, USA
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Cole CS, Blackburn J, Carpenter JS, Chen CX, Hickman SE. Pain and Associated Factors in Nursing Home Residents. Pain Manag Nurs 2023; 24:384-392. [PMID: 37003932 PMCID: PMC10440293 DOI: 10.1016/j.pmn.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Understanding factors associated with risk of pain allows residents and clinicians to plan care and set priorities, however, factors associated with pain in nursing home residents has not been conclusively studied. AIM To evaluate the association between pain and nursing home (NH) resident demographic and clinical characteristics. DESIGN Retrospective analysis of Minimum Data Set 3.0 records of nursing home residents residing in 44 Indiana NHs between September 27, 2011 and December 27, 2019 (N = 9,060). RESULTS Pain prevalence in this sample of NH residents was 23.7%. Of those with pain, 28.0% experienced moderate to severe/frequent pain and 54.6% experienced persistent pain. Risk factors for moderate to severe/frequent pain include female sex; living in a rural setting; intact, mildly, or moderately impaired cognition; arthritis; contracture; anxiety; and depression. In contrast, stroke and Alzheimer's disease and Alzheimer's-disease related dementias (AD/ADRD) were associated with decreased risk of reporting moderate to severe/frequent pain, likely representing both the under-assessment and under-reporting of pain among cognitively impaired NH residents. Risk factors for persistent pain included age <70, Black race, living in a rural location, intact cognition, contracture, and depression. CONCLUSIONS Pain remains a pressing problem for NH residents. In this study, we identified demographic and clinical factors associated with moderate to severe frequent pain and persistent pain. Residents with a diagnosis of AD/ADRD were less likely to report pain, likely representing the difficulty of evaluating pain in these residents. It is important to note that those with cognitive impairment may not experience any less pain, but assessment and reporting difficulties may make them appear to have less pain. Knowledge of factors associated with pain for NH residents has the potential for improving the ability to predict, prevent, and provide better pain care in NH residents.
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Affiliation(s)
- Connie S Cole
- School of Nursing, Indiana University, Indianapolis, Indiana; School of Medicine, University of Colorado, Aurora, Colorado; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana.
| | - Justin Blackburn
- Richard Fairbanks School of Public Health, Indiana University Purdue University, Indianapolis, Indiana
| | | | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, Indiana
| | - Susan E Hickman
- School of Nursing, Indiana University, Indianapolis, Indiana; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
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Bauer S, Eglseer D, Großschädl F. Obesity in Nursing Home Patients: Association with Common Care Problems. Nutrients 2023; 15:3188. [PMID: 37513604 PMCID: PMC10385003 DOI: 10.3390/nu15143188] [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: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: There is not much research about obesity in nursing homes although knowledge will help us to develop customized treatment plans and prevention strategies, which may help to decrease the burden for all persons involved. The objective of conducting this study was to describe the prevalence of obesity and the association between obesity and care problems in nursing home patients. (2) Methods: This study is a secondary data analysis of data collected in an annually performed cross-sectional study called "Nursing Quality Measurement 2.0". A standardized and tested questionnaire was used to collect data. (3) Results: In total, 1236 nursing home patients took part, and 16.7% of them were obese. The multivariate logistic regression analysis results show that urinary incontinence is significantly associated with the presence of obesity (OR 2.111). The other care problems of pressure injuries, fecal and double incontinence, physical restraints, falls, and pain were not associated with obesity. (4) Conclusions: The results indicate that, in the nursing home setting, healthcare staff should pay special attention to the patients' nutritional status and help patients to maintain a healthy weight and prevent a loss of muscle mass and function. Conducting more studies with larger sample sizes is recommended, as this will allow for differentiation among different obesity classes.
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Affiliation(s)
- Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
| | - Franziska Großschädl
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
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Williamson K, Blane DN, Grieve E, Lean MEJ. Overlooked and under-evidenced: Community health and long-term care service needs, utilization, and costs incurred by people with severe obesity. Clin Obes 2023; 13:e12570. [PMID: 36447339 DOI: 10.1111/cob.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
Numbers of people with severe obesity (BMI ≥ 40 kg/m2 ), with need for community health and long-term care (LTC) services, are increasing, but documentation is lacking. We identified individuals with severe obesity known to community health and care professionals in a representative United Kingdom region and used an investigator-administered questionnaire to record needs and use of community health and LTC services. Data were verified against health and LTC records. Local and published sources informed detailed micro-costing. Twenty-five individuals (15 women) consented, aged 40-87 (mean = 62) years, BMI 40-77 (mean = 55) kg/m2 : 20 participants (80%) were housebound. Twenty-two different cross-sector community health and LTC services were used, including community equipment service (n = 23), district nursing (n = 20), occupational therapy (n = 14), and LTC (n = 12). Twenty-four (96%) participants used three or more services, with longest care episode lasting over 14 years. Total annual service costs incurred by participants varied from £2053 to £82 792; mean £26 594 (lower estimate £80 064; mean £22 462/upper estimate £88 870; mean £30 726), with greatest costs being for LTC. Individual costs for equipment (currently provided) and home adaptations (ever provided) ranged widely, from zero to £35 946. Total mean annual costs increased by ascending BMI category, up to BMI 70 kg/m2 . This study provides a framework with which to inform service provision and economic analysis of weight management interventions. People with severe obesity may need sustained care from multiple community care services.
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Affiliation(s)
- Kath Williamson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- NRS Clinician, Weight Management Team, NHS Lothian, Edinburgh, UK
| | - David N Blane
- General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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Kapoor A, Patel J, Chen Z, Crawford S, McManus D, Gurwitz J, Shireman TI, Zhang N. Geriatric conditions do not predict stroke or bleeding in long-term care residents with atrial fibrillation. J Am Geriatr Soc 2021; 70:1218-1227. [PMID: 34902164 DOI: 10.1111/jgs.17605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term care (LTC) providers prescribe anticoagulation (AC) less frequently in residents with atrial fibrillation (AF) and geriatric conditions independent of CHA2 DS2 -VASc stroke risk score. Geriatric conditions include recent fall, activities of daily living dependency, mobility impairment, cognitive impairment, low body mass index, and weight loss. Multiple publications have suggested that patients with geriatric conditions are at increased risk for stroke. Understanding better the risk of stroke and bleeding in residents with AF and geriatric conditions would be valuable to LTC providers for AC decision-making. METHODS AND RESULTS We measured the association of geriatric conditions with composite of stroke/transient ischemic attack (TIA)/systemic embolism and bleeding in residents with AF and elevated stroke risk (CHA2 DS2 -VASc score ≥ 2) living in American LTC facilities in 2015. After merging nursing home assessments (Minimum Data Set) with medication and hospital utilization records, we identified 209,413 eligible residents. Using generalized estimating equations, we found that the incidence of stroke/TIA/systemic embolism ranged from 0.13% to 0.26% over 30 days (1.43%-3.08%/year) in residents off AC with and without geriatric conditions adjusting for other resident characteristics including CHA2 DS2 -VASc score and propensity to receive AC. Similarly, the monthly incidence of bleeding on AC ranged from 0.22% to 0.28% (2.61%-3.31%/year) without increased risk with geriatric conditions. Residents with a CHA2 DS2 -VASc score of ≥7 had a 2.4-fold increased risk of stroke compared with those with score of 2-4 (0.30% vs. 0.12%/month). CONCLUSION Calculating a CHA2 DS2 -VASc score can be helpful in AC decision-making for residents with and without geriatric conditions.
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Affiliation(s)
- Alok Kapoor
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jay Patel
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Zhiyong Chen
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Zem Data Science, LLC, North Potomac, Maryland, USA
| | - Sybil Crawford
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - David McManus
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jerry Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Theresa I Shireman
- Department of Health Services, Policy and Practice, Center for Gerontology & Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ning Zhang
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Bitto A, Tatom N, Krivak T, Grotz P, Kaeberlein M. Evidence that C/EBP-β LAP Increases Fat Metabolism and Protects Against Diet-Induced Obesity in Response to mTOR Inhibition. FRONTIERS IN AGING 2021; 2:738512. [PMID: 35822052 PMCID: PMC9261321 DOI: 10.3389/fragi.2021.738512] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 01/07/2023]
Abstract
Aging and obesity are common risk factors for numerous chronic pathologies, and the compounding effects of old age and increased adiposity pose a serious threat to public health. Starting from the assumption that aging and obesity may have shared underpinnings, we investigated the antiobesogenic potential of a successful longevity intervention, the mTORC1 inhibitor rapamycin. We find that rapamycin prevents diet-induced obesity in mice and increases the activity of C/EBP-β LAP, a transcription factor that regulates the metabolic shift to lipid catabolism observed in response to calorie restriction. Independent activation of C/EBP-β LAP with the antiretroviral drug adefovir dipivoxil recapitulates the anti-obesogenic effects of rapamycin without reducing signaling through mTORC1 and increases markers of fat catabolism in the liver. Our findings support a model that C/EBP-β LAP acts downstream of mTORC1 signaling to regulate fat metabolism and identifies a novel drug that may be exploited to treat obesity and decrease the incidence of age-related disease.
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Fayemendy P, Mabiama G, Vernier T, Massoulard-Gainant A, Villemonteix C, Desport JC, Jésus P. Nutritional status, dementia, and mobility among nursing home's residents: First exhaustive cross-sectional study in Limousin territory (France). PLoS One 2021; 16:e0250595. [PMID: 33930046 PMCID: PMC8087088 DOI: 10.1371/journal.pone.0250595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Aging is accompanied by a drop in the level of health and autonomy, within Western countries more and more people being cared for in nursing homes (NH). The nutritional data in NH in France remain poor, not exhaustive and not representative. The objective of the study was to assess the nutritional status, dementia and mobility patterns among residents of NH in the Limousin territory of France. METHODS The study was cross-sectional, descriptive and exhaustive, conducted with the residents of 13 voluntary NH. Undernutrition was identified using French High Authority for Health criteria, and obesity if Body Mass Index >30, in the absence undernutrition criterion. The Mini Mental State examination scores was used for dementia assessment at the threshold of 24. The Mini Nutritional AssessmentTM was used for mobilitity assessment. The statistics were significant at the 5% threshold. RESULTS 866 residents (70.6% women) included with an average age of 85.3 ± 9.3 years. Undernutrition was 27.5%, obesity 22.9%, dementia 45.7% and very low mobility 68.9%. Women were older than men, more often undernourished, more often demented and more often had very low mobility (p<0.01). Undernutrition (p<0.0001) and low mobility (p<0.0001) were significantly higher among those with dementia versus those without dementia. Very low mobility was higher among undernourished (p<0.05). CONCLUSIONS Undernutrition and obesity are important problems in NH in France. Being a woman, having dementia and having a very low mobility may induce undernutrition.
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Affiliation(s)
- Philippe Fayemendy
- Nutrition Unit and Specialized Centre for Obesity of the Limousin territory, University Hospital, Limoges, France
- Inserm U1094, Limoges University, IRD, Tropical Neuroepidemiology, Epidemiology and Neurology Tropical Institute, GEIST, Limoges, France
- Health Regional Agency Network Limousin Nutrition (LINUT), Isle, France
| | - Gustave Mabiama
- Nutrition Unit and Specialized Centre for Obesity of the Limousin territory, University Hospital, Limoges, France
- Inserm U1094, Limoges University, IRD, Tropical Neuroepidemiology, Epidemiology and Neurology Tropical Institute, GEIST, Limoges, France
- Microbiology, Immunology-Hematology and Morphologic Sciences Laboratory (LMIHSM), Doctoral Training Unit in Health Sciences (UFD-SCS), Doctoral School, Douala University, Douala, Cameroun
- * E-mail:
| | - Thibault Vernier
- Nutrition Unit and Specialized Centre for Obesity of the Limousin territory, University Hospital, Limoges, France
| | - Aude Massoulard-Gainant
- Health Regional Agency Network Limousin Nutrition (LINUT), Isle, France
- Home Hospitalization and Geriatric Service, University Hospital, Limoges, France
| | | | - Jean-Claude Desport
- Nutrition Unit and Specialized Centre for Obesity of the Limousin territory, University Hospital, Limoges, France
- Inserm U1094, Limoges University, IRD, Tropical Neuroepidemiology, Epidemiology and Neurology Tropical Institute, GEIST, Limoges, France
- Health Regional Agency Network Limousin Nutrition (LINUT), Isle, France
| | - Pierre Jésus
- Nutrition Unit and Specialized Centre for Obesity of the Limousin territory, University Hospital, Limoges, France
- Inserm U1094, Limoges University, IRD, Tropical Neuroepidemiology, Epidemiology and Neurology Tropical Institute, GEIST, Limoges, France
- Health Regional Agency Network Limousin Nutrition (LINUT), Isle, France
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Alvero-Cruz JR, Fernandez Vazquez R, Martinez Blanco J, Rosety I, Diaz AJ, Rosety MA, Rosety-Rodriguez M, Ordonez FJ. Proposed cut-off points for anthropometric and bioelectrical measures based on overweight and obesity criteria in Spanish institutionalised elderly people. PLoS One 2021; 16:e0248028. [PMID: 33684155 PMCID: PMC7939364 DOI: 10.1371/journal.pone.0248028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
The increasing prevalence of obesity among the institutionalised elderly population and its severe consequences on health requires an early and accurate diagnosis that can be easily achieved in any clinical setting. This study aimed to determine new cut-off values for anthropometric and bioelectrical impedance measures that are superior to body mass index criteria for overweight and obesity status in a sample of Spanish institutionalised elderly population. A total of 211 institutionalised older adults (132 women, aged 84.3±7.3 years; 79 men, aged 81.5±7.3 years) were enrolled in the current cross-sectional study. Anthropometric and bioelectrical impedance measures included the body mass index, waist circumference, gluteal circumference, waist-hip ratio, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio. In women, the waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat index presented strongly significant specificity and sensitivity (area under the curve [AUC], p<0.0001) and elevated discriminative values (receiver operating characteristic [ROC] curves: 0.827 to 0.867) for overweight and obesity status. In men, the waist-hip ratio, waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio were strongly significant AUC (p<0.0001), with moderate-to-high values (ROC curves: 0.757-0.871). In conclusion, our findings suggest that gluteal circumference, waist circumference, and sagittal-abdominal diameter in women and trunk fat, visceral-fat ratio, and waist circumference in men may represent more suitable cut-off values superior to body mass index criteria for overweight and obesity in the Spanish institutionalised elderly population.
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Affiliation(s)
- Jose Ramon Alvero-Cruz
- Department of Physiology, Histology, Pathological Anatomy and Sport Sciences, School of Medicine, University of Malaga, Málaga, Spain
| | - Rosalia Fernandez Vazquez
- Department of Physiology, Histology, Pathological Anatomy and Sport Sciences, School of Medicine, University of Malaga, Málaga, Spain
| | | | - Ignacio Rosety
- Department of Human Anatomy, School of Medicine, University of Cádiz, Cádiz, Spain
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Temkin-Greener H, Wang S, Caprio T, Mukamel DB, Cai S. Obesity among Nursing Home Residents: Association with Potentially Avoidable Hospitalizations. J Am Med Dir Assoc 2020; 21:1331-1335.e1. [PMID: 32631800 PMCID: PMC7483884 DOI: 10.1016/j.jamda.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Studies show that in nursing homes (NHs), the prevalence of moderate-to-severe obesity has doubled in the last decade and continues to increase. Obese residents are often complex and costly, and this increase in prevalence has come at a time when NHs struggle to decrease hospitalizations, particularly those that are potentially avoidable. This study examined the association between obesity and hospitalizations. DESIGN We linked 2011-2014 national data using Medicare NH assessments, hospital claims, and the NH Compare. SETTING AND PARTICIPANTS Individuals aged ≥65 years, newly admitted to NHs, who became long-term residents between July 1, 2011 and March 26, 2014. The analytical sample included 490,086 residents. METHODS NH-originating hospitalization was the outcome; a categorical variable defined as no hospitalization, potentially avoidable hospitalization (PAH), and other hospitalization (non-PAH). The main independent variable was body mass index (BMI) defined as normal weight (30 >BMI ≥18.5 kg/m2), mildly obese (35 >BMI ≥30 kg/m2), or moderately-to-severely obese (BMI ≥35 kg/m2). Covariates included individual and NH characteristics. Multinomial models with NH random effects and state dummies were estimated. RESULTS After adjusting for individual level covariates, the risk of non-PAH for the mildly and moderate/severely obese was not different from normal weight residents. But the risk of PAH remained significantly higher for the moderate/severely obese (relative risk ratio = 1.055; 95% confidence interval 1.018, 1.094). Several NH-level factors also influenced hospitalization risk. CONCLUSIONS AND IMPLICATIONS Obese residents are more likely to experience PAH but not non-PAH. Efforts to improve care for these residents may need to broadly consider the ability of NHs to commit additional resources to fully integrate care for this growing segment of the population.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry. Rochester, NY.
| | - Sijiu Wang
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry. Rochester, NY
| | - Thomas Caprio
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Dana B Mukamel
- Department of Medicine, Director, iTEQC Research Program, University of California at Irvine, Irvine, CA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry. Rochester, NY
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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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Williamson K, Nimegeer A, Lean M. Rising prevalence of BMI ≥40 kg/m 2 : A high-demand epidemic needing better documentation. Obes Rev 2020; 21:e12986. [PMID: 32017386 PMCID: PMC7078951 DOI: 10.1111/obr.12986] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m2 since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD-RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights.
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Affiliation(s)
- Kath Williamson
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
- NHS LothianEdinburghUK
| | - Amy Nimegeer
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Michael Lean
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
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Kapoor A, Foley G, Zhang N, Zhou Y, Crawford S, McManus D, Gurwitz J. Geriatric Conditions Predict Discontinuation of Anticoagulation in Long-Term Care Residents With Atrial Fibrillation. J Am Geriatr Soc 2020; 68:717-724. [PMID: 31967319 DOI: 10.1111/jgs.16335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anticoagulation (AC) for stroke prevention in long-term care (LTC) residents with atrial fibrillation (AF) involves a challenging risk-benefit evaluation. We measured the association of geriatric conditions with discontinuation of AC. DESIGN Retrospective cohort analysis. SETTING LTC facilities across the United States. PARTICIPANTS A total of 48 545 individuals residing in LTC facilities in 2015 with AF and sufficient information to establish their status as someone who stopped AC vs someone who continued AC. MEASUREMENTS We measured the association of six geriatric conditions-recent fall, severe activity of daily living (ADL) dependency (21-28 on a 28-point scale), mobility impairment, cognitive impairment, body mass index (BMI) less than 18.5 kg/m2 , and weight loss (≥5% in 1 month or ≥10% in 6 months)-with discontinuation of AC. To identify cases of discontinuation, we required a pattern of being on AC over two consecutive recordings of the Minimum Data Set, the nursing home quality control data set recorded every 90 days, followed by two assessments being off AC-pattern of "on-on-off-off." By contrast, we required a pattern of "on-on-on-on" for continuers. We then constructed six logistic regression models to measure the independent association between each geriatric condition and discontinuation of AC, adjusted for CHA2 DS2 -VASc stroke risk score, recent bleeding hospitalization, and other confounders. RESULTS There were 4172 discontinuers and 44 373 continuers. Recent fall predicted a 1.9-fold increase in the odds of discontinuation (odds ratio = 1.91; 95% confidence interval = 1.66-2.20), whereas mobility and cognitive impairment only increased the odds by 14% to 17%. Severe ADL dependency, BMI less than 18.5 kg/m2 , and weight loss of 10% each increased odds of discontinuation by 55% to 68%. CHA2 DS2 -VASc score did not predict discontinuation. CONCLUSION Several geriatric conditions predicted discontinuation of AC, whereas CHA2 DS2 -VASc score did not. Future research should examine the association of geriatric conditions and discontinuation of warfarin discrete from newer anticoagulants and association of geriatric conditions with development of stroke and bleeding. J Am Geriatr Soc 68:717-724, 2020.
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Affiliation(s)
- Alok Kapoor
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gray Foley
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - Ning Zhang
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Yanhua Zhou
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - Sybil Crawford
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - David McManus
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
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