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Karim KMR, Tasnim T, Shams SD, Zaher MA, Mamun S. Mini Nutritional Assessment and physical function of older people in residential aged care facility, Bangladesh. Nutr Health 2021; 28:443-452. [PMID: 34250851 DOI: 10.1177/02601060211030119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Malnutrition may decrease physical function and exacerbate health conditions and thus have a negative effect on health-related quality of life of older people. AIM The study was aimed at evaluating the extent of malnutrition, physical function and other associated risk factors for the older persons (>65 years) living in the residential aged care facilities in Bangladesh. METHODS A cross-sectional study was performed with a sample of 200 older people in various residential aged care facilities in Dhaka, Bangladesh. Nutritional status was evaluated using the Mini Nutritional Assessment. A structured questionnaire was used to assess the socioeconomic condition, dietary diversity, functional ability and other related risk factors for malnutrition. RESULTS According to the Mini Nutritional Assessment, 33.5% of participants living in residential aged care facilities were malnourished and 52.5% were at risk of malnutrition. Dietary diversity score differs significantly (p<0.001) among malnourished (3.78 ± 0.45), at risk of malnutrition (4.46 ± 0.98) and well-nourished (4.75 ± 1.11) groups. Twenty-five percent of the study participants reported limitations in mobility and 26.5% reported limitations in activities of daily living. Females were more vulnerable in terms of malnutrition and physical function than males. Mini Nutritional Assessment score is significantly correlated (p<0.05) with several risk factors for malnutrition such as body mass index, education level, meal, protein consumption, dietary diversity score, weight loss, reduced food intake, mobility and activities of daily living of the older people. CONCLUSIONS The study reaffirms that a high rate of malnutrition and risk of malnutrition is prevalent among aged care residents, who need special attention and may benefit from individualized nutrition interventions.
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Affiliation(s)
| | - Tasmia Tasnim
- Department of Nutrition and Food Engineering, 130058Daffodil International University, Bangladesh
| | - Sabrin Deeba Shams
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
| | | | - Sumaiya Mamun
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
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2
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Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res 2021; 2021:6650675. [PMID: 33936197 PMCID: PMC8056871 DOI: 10.1155/2021/6650675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.
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3
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Liu C, Eriksson T, Yi F. Offspring migration and nutritional status of left-behind older adults in rural China. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100996. [PMID: 33740754 DOI: 10.1016/j.ehb.2021.100996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Improvements in nutritional status is a principal pathway to good health. This study examines the effect of migration of adult children on the nutrient intake of left-behind older adults in rural China. We use data from four waves (2004-2011) of the China Health and Nutrition Survey and utilize individual fixed effects methods to panel data. Results show that the migration of offspring is associated with significantly higher nutritional status of their left-behind parents, especially higher intake of proteins, carbohydrates, vitamins B1-B3, phosphorus, magnesium, iron, selenium, and copper. The intake of some of these nutrients is below recommended levels. The magnitude of the estimated effects vary between 4% and 24 %. Older adults who live with their grandchildren in rural households or have a low income benefit more from having adult child migrants in the household. The improvement of nutrition outcomes of left-behind older adults is mainly due to increased consumption of cereals, meat, eggs, and fish.
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Affiliation(s)
- Chang Liu
- College of Economics and Management, Nanjing Forestry University, 159 Longpan Road, Nanjing, Jiangsu 210037, China
| | - Tor Eriksson
- Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark; School of Economics, Sichuan University, 610064 Chengdu, China
| | - Fujin Yi
- College of Economics and Management, Nanjing Agricultural University, 1 Weigang, Nanjing, Jiangsu 210095, China.
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4
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Olofsson JK. Olfaction and Aging: A Review of the Current State of Research and Future Directions. Iperception 2021; 12:20416695211020331. [PMID: 34249327 PMCID: PMC8239976 DOI: 10.1177/20416695211020331] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Olfaction, the sense of smell, is characterized by a notable age-dependency such that aging individuals are more likely to have poor olfactory abilities. These impairments are considered to be mostly irreversible and as having potentially profound effects on quality of life and food behavior, as well as constituting warning signs of mortality, cognitive dysfunction, and dementia. Here, we review the current state of research on aging and olfaction, focusing on five topics which we regard to be of particular relevance for the field: nutrition and health, cognition and dementia, mortality, environment and genetics, and training-based enhancement. Under each of these headlines, we provide a state-of-the-art overview and discuss gaps in our knowledge which might be filled by further research. Understanding how olfactory abilities are diminished in aging, and how they may be alleviated or recovered, involves a set of challenging tasks for researchers in the years to come.
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Affiliation(s)
- Jonas K. Olofsson
- Gösta Ekman Laboratory, Stockholm University, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden
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5
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Huang SW, Yin SM, Hsieh CH. Association of a Low Geriatric Nutritional Risk Index with Higher Adverse Outcome in the Elderly Patients with Fall Injuries: Analysis of a Propensity Score-Matched Population. Risk Manag Healthc Policy 2021; 14:1353-1361. [PMID: 33833598 PMCID: PMC8023402 DOI: 10.2147/rmhp.s298959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose We evaluate the association of Geriatric Nutritional Risk Index (GNRI) and the adverse outcome in elderly patients (≥65 years old) with fall injuries. Patients and Methods Total 1071 elderly patients with fall injuries were enrolled. Patients were divided into four groups: high risk, moderate risk, low risk and no risk (GNRI: <82, 82 to <92, 92 to ≤98 and >98) for patient demography, comorbidities, and adverse outcomes analysis. Results After 1:1 propensity score-matched analysis, 97 patients in high-risk group, 144 patients in moderate-risk group, and 114 patients in low-risk group were compared to no risk group. High-risk group patients had a 5.7-fold higher risk of mortality (p = 0.003) and prolong hospital stay (18.0 vs 12.3 days; p = 0.016) when compared to no-risk group patients. Significantly prolong hospital stay were also found in low-risk and moderate-risk group when compared to no risk group. Conclusion A lower GNRI is associated with prolonged hospital stay in the elderly patients with fall injuries. High nutritional risk (GNRI < 82) is associated with an increased in-hospital mortality rate.
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Affiliation(s)
- Szu-Wei Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shih-Min Yin
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
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6
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Abstract
"Aging alters the way the body digests food, absorbs nutrients, and metabolizes energy. Changes in deglutition, digestion, and metabolism in this population are well described and may lead to alterations in oral intake, body composition, and overall health status. Elderly persons are at high risk for developing sarcopenia as well as sarcopenic obesity characterized by accelerated reduction in lean muscle mass and enhancement of body fat. Nutritional screening is important to identify high-risk individuals and facilitate care management planning. The most common assessment tool in elderly patients is the Mini Nutritional Assessment, which analyzes oral intake, health status, and anthropometrics."
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Affiliation(s)
- Carolyn Newberry
- Division of Gastroenterology, Weill Cornell Medical Center, 1305 York Avenue, 4th Floor, New York, NY 10021, USA.
| | - Gregory Dakin
- Division of GI, Metabolic, & Bariatric Surgery, 525 East 68th Street, Box 294, New York, NY 10065, USA
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7
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Neuhouser ML, Hunt RP, Van Horn L, Shikany JM, Stefanick ML, Johnson KC, Brunner R, Cannell B, Hatsu IE, Tinker LF. Barriers to eating are associated with poor physical function in older women. Prev Med 2020; 139:106234. [PMID: 32795644 PMCID: PMC7494579 DOI: 10.1016/j.ypmed.2020.106234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
Older adults have physical and social barriers to eating but whether this affects functional status is unknown. We examined associations between eating barriers and physical function in the Women's Health Initiative (WHI). In 2012-14, a subset of alive and participating women (n = 5910) completed an in-home examination including the Short Physical Performance Battery (SPPB) (grip strength, balance, timed walking speed, chair stand). WHI participants complete annual mailed questionnaires; the 2013-14 questionnaire included items on eating alone, eating < two meals/day, dentition problems affecting eating, physical difficulties with cooking/shopping and monetary resources for food. Linear regression tested associations of these eating barriers with SPPB, adjusting for BMI, age, race/ethnicity, and medical multimorbidities. Over half (56.8%) of participants were ≥ 75 years, 98.8% had a BMI ≥ 25.0 kg/m2 and 66% had multimorbidities. Eating barriers, excluding eating alone, were associated with significantly lower total (all p < .001) and component-specific, multivariate-adjusted SPPB scores (all p < .05). Compared to no barriers, eating < two meals/day (7.83 vs. 8.38, p < .0002), dentition problems (7.69 vs. 8.38, p < .0001), inability to shop/prepare meals (7.74 vs. 8.38, p < .0001) and insufficient resources (7.84 vs. 8.37 p < .001) were significantly associated with multivariate-adjusted mean SPPB score < 8. Models additionally adjusting for Healthy Eating Index-2010 had little influence on scores. As barriers increased, scores declined further for grip strength (16.10 kg for 4-5 barriers, p = .001), timed walk (0.58 m/s for 4-5 barriers, p = .001) and total SPPB (7.27 for 4-5 barriers, p < .0001). In conclusion, in this WHI subset, eating barriers were associated with poor SPPB scores.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
| | - Rebecca P Hunt
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
| | - Linda Van Horn
- Departrment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive #1400, Chicago, IL 60611, USA.
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. S., MT 619, Birmingham, AL 35294-4410, USA.
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Rd, Room X308, Stanford, CA 94305, USA.
| | - Karen C Johnson
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N Pauline, suite 633, Memphis, TN 38163, USA.
| | - Robert Brunner
- School of Medicine, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA.
| | - Brad Cannell
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, Dallas Campus, University of Texas Health Science Center, 6011 Harry Hines Blvd, Suite V8, Dallas, TX 75390, USA.
| | - Irene E Hatsu
- Human Nutrition, 341 Campbell Hall, 1787 Neil Ave, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
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Bardon LA, Streicher M, Corish CA, Clarke M, Power LC, Kenny RA, O'Connor DM, Laird E, O'Connor EM, Visser M, Volkert D, Gibney ER. Predictors of Incident Malnutrition in Older Irish Adults from the Irish Longitudinal Study on Ageing Cohort-A MaNuEL study. J Gerontol A Biol Sci Med Sci 2020; 75:249-256. [PMID: 30256900 DOI: 10.1093/gerona/gly225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 11/12/2022] Open
Abstract
Older adults are at increased risk of malnutrition, which is associated with poorer health, quality of life, and worse disease outcomes. This study identifies predictors of incident malnutrition using data from a subsample (n = 1,841) of The Irish Longitudinal Study on Ageing. Participants were excluded if they were less than 65 years, missing body mass index data at baseline or follow-up, missing baseline weight loss data or malnourished at baseline (body mass index <20 kg/m2 or unplanned weight loss ≥4.5 kg in the previous year). Logistic regression analysis was performed with incident malnutrition (body mass index <20 kg/m2 and/or calculated weight loss >10% over follow-up) as the dependent variable. Factors showing significant (p < .05) univariate associations with incident malnutrition were entered into a multivariate model. The analysis was then repeated, stratified by sex. The 2-year incidence of malnutrition was 10.7%. Unmarried/separated/divorced status (vs married but not widowed), hospitalization in the previous year, difficulties walking 100 m, or climbing stairs independently predicted incident malnutrition at follow-up. When examined by sex, hospitalization in the previous year, falls during follow-up, and self-reported difficulties climbing stairs predicted malnutrition in males. Receiving social support and cognitive impairment predicted malnutrition in females. The development of malnutrition has a range of predictors. These can be assessed using simple questions to identify vulnerable persons.
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Affiliation(s)
- Laura A Bardon
- UCD School of Agriculture and Food Science, University College Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Ireland
| | - Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Clare A Corish
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Ireland
| | - Michelle Clarke
- UCD School of Agriculture and Food Science, University College Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Ireland
| | - Lauren C Power
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.,Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin.,Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Deirdre M O'Connor
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.,Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin.,Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Eamon Laird
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Eibhlis M O'Connor
- Department of Biological Sciences, University of Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije University Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Eileen R Gibney
- UCD School of Agriculture and Food Science, University College Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Ireland
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9
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Azzolina D, Vedovelli L, Gallipoli S, French M, Ghidina M, Lamprecht M, Tsiountsioura M, Lorenzoni G, Gregori D. Nutrients and Caloric Intake Associated with Fruits, Vegetables, and Legumes in the Elderly European Population. Nutrients 2020; 12:nu12092746. [PMID: 32916924 PMCID: PMC7551243 DOI: 10.3390/nu12092746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Nutrition is emerging as a key factor in promoting healthy lifestyles in the growing elderly population across Europe. In this study, we examined the non-animal-derived food source consumption among the elderly European population to evaluate the actual contributions of these foods to the diet of the elders. We gathered 21 studies conducted in 17 European countries to evaluate the fruit, vegetable, and legume (along with their derived products) consumption among the elderly (>65 years) population. Foods' nutritional values were calculated and compared to the recommended intakes. A Bayesian multilevel hierarchical analysis was conducted to estimate the caloric intake of food categories and to compare the elderly and general adult populations. Although the lowest consumption was generally associated with the lowest nutrient and fiber intake, the reverse was not always the case. Concerning the general adult population, no differences in the related caloric intake of elders were noticed. Differences were instead evident when foods were divided into subclasses. Elderly populations consume fruit and fruit products, but they drink less fruit and vegetable juices and nectars. In conclusion, elderlies' fruit and vegetable consumption showed a peculiar pattern with respect to the general adult population, whose recognition could be helpful to address tailored policies. Constantly updated studies, including all the lifespan ages, are warranted to design tailored effective public health interventions.
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Affiliation(s)
- Danila Azzolina
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35143 Padova, Italy; (D.A.); (L.V.); (G.L.)
- Research Support Unit, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35143 Padova, Italy; (D.A.); (L.V.); (G.L.)
| | | | - Megan French
- Zeta Research, 34122 Trieste, Italy; (S.G.); (M.F.); (M.G.)
| | - Marco Ghidina
- Zeta Research, 34122 Trieste, Italy; (S.G.); (M.F.); (M.G.)
| | - Manfred Lamprecht
- The Juice Plus+® Science Institute, Collierville, TN 38017, USA; (M.L.); (M.T.)
- Otto Loewi Research Center, Division of Physiological Chemistry, Medical University of Graz, 8010 Graz, Austria
| | - Melina Tsiountsioura
- The Juice Plus+® Science Institute, Collierville, TN 38017, USA; (M.L.); (M.T.)
- Green Beat—Institute of Nutrient Research, 8010 Graz, Austria
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35143 Padova, Italy; (D.A.); (L.V.); (G.L.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35143 Padova, Italy; (D.A.); (L.V.); (G.L.)
- Correspondence:
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10
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Liang YH, Chou C, Chen YJ, Chou YF, Lin CY, Chou C, Wang TF. Impact of periodontal disease and chewing ability on the quality of life of the elderly in an affluent community. J Formos Med Assoc 2020; 119:1693-1701. [PMID: 31982268 DOI: 10.1016/j.jfma.2020.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Improvement of the medical and social environment is an important aspect of government policies in assuring the quality of life (QoL) of older adults. However, few studies have appraised the impact and relationship of QoL with clinical factors among elderly individuals in affluent residential areas. METHODS A total of 166 older adults from Chang Gung Health and Culture Village were enrolled. Oral health-related QoL was measured using the Geriatric Oral Health Assessment Index. Self-assessed chewing abilities and demographic characteristics were collected by questionnaire. Physical health was scored by activities of daily living (ADL) and instrumental ADL. Mini nutrition assessment questionnaire was used to evaluate the nutritional intake. Multiple linear regression was used to predict risk factors affecting QoL and to examine whether chewing ability was a mediator of oral health-related QoL. RESULTS Poor chewing ability was associated with older age (OR = 1.82 for 76-85 years and 3.58 for 86-95 years), sufficient economic status (OR = 5.55) and removable denture-wearing (OR = 7.52). On the other hand, poor chewing ability (OR = 0.11), removable denture-wearing (OR = 0.48), periodontal disease (OR = 0.38) had lower likelihood of good oral health-related QoL. Mediator analyses showed that chewing ability was a mediator for the association between oral health-related QoL and economic status or removable denture-wearing or having more than 20 teeth. Periodontal disease was an independent factor for oral health-related QoL. CONCLUSION Among older adults in an affluent community, periodontal disease is an independent risk factor directly related to oral health-related QoL, whereas chewing ability is a mediator between QoL and removable denture-wearing.
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Affiliation(s)
- Ya-Hong Liang
- School of Nursing, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Chyuan Chou
- Excellent Dental Center, Taipei, 1110, Taiwan
| | - Ying-Jen Chen
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
| | - Yen-Fang Chou
- Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, 33372, Taiwan
| | - Ching-Yi Lin
- Nutrition Department, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
| | - Caroline Chou
- Pre-Dental Advantage Program, University of the Pacific, Stockton, CA, 95211, USA
| | - Tze-Fang Wang
- School of Nursing, National Yang-Ming University, Taipei, 11221, Taiwan.
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11
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Bellanti F, Buglio AL, Stasio ED, Bello GD, Tamborra R, Dobrakowski M, Kasperczyk A, Kasperczyk S, Vendemiale G. An open-label, single-center pilot study to test the effects of an amino acid mixture in older patients admitted to internal medicine wards. Nutrition 2020; 69:110588. [PMID: 31629306 DOI: 10.1016/j.nut.2019.110588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Older patients are frequently subjected to prolonged hospitalization and extended bed rest, with a negative effect on physical activity and caloric intake. This results in a consistent loss of muscle mass and function, which is associated with functional decline and high mortality. The aim of this study was to investigate the effect of 1 wk of oral amino acid (AA) supplementation in older patients subjected to low mobility during hospitalization. METHODS Hospitalized older patients (69-87) were included in the control group (n = 50) or were administered 25 g of AA mixture (n = 44) twice daily throughout 7 d of low mobility. We collected data related to length of stay as primary outcome measure. In-hospital mortality, 90-d postdischarge mortality, 90-d postdischarge rehospitalization, and falls also were considered. Moreover, variations of anthropometric measures, body composition and muscle architecture/strength, circulating interleukins, and oxidative stress markers between the beginning and the end of the supplementation period were analyzed as secondary outcomes. RESULTS Similar values were reported between the two groups regarding age (76.6 ± 6.8 versus 79 ± 7.2 y old), body weight (61.5 ± 14.3 versus 62.1 ± 16.1 kg), and body mass index (28.7 ± 4.15 versus 28.1 ± 3.62 kg/m2). Although no difference in terms of in-hospital, 90-d postdischarge, or overall mortality rate was observed between the two groups, a reduction in length of stay, 90-d postdischarge hospitalization, and falls was observed in the AA supplementation group rather than in controls. Furthermore, the AA mixture limited muscle architecture/strength impairment and circulating oxidative stress, which occurred during hospitalization-related bed rest. The latter data was associated with increased circulating levels of anti-inflammatory cytokines interleukin-4 and -10. CONCLUSIONS These results suggest that the AA mixture limits several alterations associated with low mobility in older hospitalized patients, such as length of stay, 90-d postdischarge hospitalization, and falls, preventing the loss of muscle function, as well as the increase of circulating interleukins and oxidative stress markers.
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Affiliation(s)
- Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Elena Di Stasio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giorgia di Bello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosanna Tamborra
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michał Dobrakowski
- Department of Biochemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Sławomir Kasperczyk
- Department of Biochemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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12
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Gregorič M, Zdešar Kotnik K, Pigac I, Gabrijelčič Blenkuš M. A Web-Based 24-H Dietary Recall Could Be a Valid Tool for the Indicative Assessment of Dietary Intake in Older Adults Living in Slovenia. Nutrients 2019; 11:nu11092234. [PMID: 31527530 PMCID: PMC6770526 DOI: 10.3390/nu11092234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 01/11/2023] Open
Abstract
The methodology used in dietary surveys could, to a large extent, follow the instructions of the European Food Safety Authority (EFSA), where 24-h dietary recall (24HDR) is recommended for (sub) population studies. However, it is necessary to examine the suitability of 24HDR for indicative dietary intake in older adults. This study aimed to compare participants’ dietary intakes with the recommendations and to compare dietary intakes derived from a 24HDR using an OPEN web-based application to those obtained from reference weighed food records (WFRs). Forty-nine Slovenian residential home residents completed both assessments, and a comparison with dietary reference values was performed. Estimates from these two methods were compared and the correlations between them were assessed. The findings revealed that dietary intakes derived from the WFR method mostly differed from the recommended intakes. The 24HDR underestimated dietary intake compared to the WFR for 66% of monitored parameters, while 75% of these parameters were correlated, mostly at a moderate level (0.3–0.69). In conclusion, the diets of residential home residents in this study mostly differed from recommendations. Both methods for dietary intake assessment provided comparable results for most of the monitored parameters in expected deviations. A web-based 24HDR could be a valid tool for the indicative assessment of dietary intake in older adults. However, further validations are required.
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Affiliation(s)
- Matej Gregorič
- Health Survey and Health Promotion Centre, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
| | - Katja Zdešar Kotnik
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Večna pot 111, 1000 Ljubljana, Slovenia.
| | - Igor Pigac
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Večna pot 111, 1000 Ljubljana, Slovenia.
| | - Mojca Gabrijelčič Blenkuš
- Health Survey and Health Promotion Centre, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
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Saghafi-Asl M, Vaghef-Mehrabany E, Karamzad N, Daeiefarshbaf L, Kalejahi P, Asghari-Jafarabadi M. Geriatric nutritional risk index as a simple tool for assessment of malnutrition among geriatrics in Northwest of Iran: comparison with mini nutritional assessment. Aging Clin Exp Res 2018; 30:1117-1125. [PMID: 29340964 DOI: 10.1007/s40520-018-0892-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Older people are more likely to develop nutritional problems and timely diagnosis of malnutrition is crucial to prevent hazardous consequences following poor nutrition. AIMS To evaluate the efficacy of Geriatric Nutritional Risk Index (GNRI) to assess nutritional status among non-hospitalized elderly, compared to mini nutritional assessment (MNA) among Iranian seniors. METHODS One hundred and sixty-four subjects, aged ≥ 65 years old were recruited to our cross-sectional study from various districts of Tabriz (Tabriz, Iran). Anthropometric and biochemical measurements were performed, short- and long-form MNAs and GNRI were assessed in our study subjects. Sensitivity, specificity and predictive values of the three indices, agreement between them, and their correlation with anthropometric and biochemical parameters were evaluated. Receiver-operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off point for GNRI in our study population. RESULTS GNRI had lower sensitivity (50, 57%), but optimal specificity (94, 93%) and lower negative predictive value (NPV; 68, 71%) compared to MNA-LF and MNA-SF, respectively. We found a moderate agreement between GNRI and MNA-SF (K = 0.52) and MNA-LF (K = 0.46) scores. Significant correlations were observed between re-categorized MNAs as well as GNRI scores, and age, weight, MAC, CC, WC, albumin, and pre-albumin. The cut-off point of 110.33 was obtained for GNRI, according to the ROC curve. CONCLUSIONS Although GNRI may not be an efficient tool for screening malnutrition due to its lower sensitivity, it is moderately correlated with MNAs and also more useful when limited funding needs to target the truly malnourished seniors.
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Affiliation(s)
- Maryam Saghafi-Asl
- Department of Biochemistry and Diet Therapy, Talented Students Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Vaghef-Mehrabany
- Department of Biochemistry and Diet Therapy, Talented Students Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | - Lida Daeiefarshbaf
- Department of Biochemistry and Diet Therapy, Talented Students Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parinaz Kalejahi
- Department of Biochemistry and Diet Therapy, Talented Students Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, 5166614711, Iran
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Kuo HC, Wang RH, Wang JC, Yang YH. Assessing a conceptual model with both oral health and health related quality of life in community-dwelling elders. Arch Gerontol Geriatr 2018; 79:27-31. [PMID: 30081329 DOI: 10.1016/j.archger.2018.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/01/2018] [Accepted: 07/14/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to test a hypothesized conceptual model for both the clinical and non-clinical status of oral health and health related quality of life (OHRQoL & HRQoL) among community-dwelling elders. MATERIALS AND METHODS Study participants (n = 517), who were recruited as part of a Taiwanese elderly community survey, were collected via dental examinations and questionnaires. We collected measures of clinical variables, self-reported symptom status, OHRQoL, nutritional status and HRQoL. The 517 participants were randomly assigned to one of two samples, to provide one training sample for estimation and one testing sample for validation. The path analysis with all observed variables was conducted based on the proposed theoretical model delineating pathways. RESULTS All of the direct pathways hypothesized by the model were significant. Functional status (OHRQoL measured by OHIP-14T) mediated clinical occlusion, and symptom status mediated nutritional status (MNA) and HRQoL (WHOQOL-BREF). The model accounted for 29% of the variance in HRQoL and demonstrated a good fit with the data. CONCLUSIONS This conceptual model suggests that OHRQoL, as an important mediator, links clinical conditions, symptom status, nutritional status, and overall HRQoL. Therefore, when therapeutic efforts are made to improve the outcomes for patients with oral diseases, not only can the OHRQoL be enhanced, but also the HRQoL can be improved as a result.
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Affiliation(s)
- Hsiao-Ching Kuo
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Taiwan
| | - Ruey-Hsia Wang
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
| | - Jen-Chyan Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Taiwan; Division of Prosthodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Rd, Kaohsiung 807, Taiwan; Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Pao YC, Chen CY, Chang CI, Chen CY, Tsai JS. Self-reported exhaustion, physical activity, and grip strength predict frailty transitions in older outpatients with chronic diseases. Medicine (Baltimore) 2018; 97:e10933. [PMID: 29879035 PMCID: PMC5999477 DOI: 10.1097/md.0000000000010933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Effective screening instruments are necessary for evaluating the outcomes of early interventions for the prevention or delay of disability in older persons. This study examined how transitions in frailty items over 1 year and the baseline components of a comprehensive geriatric assessment were associated with improvements in frailty at a 2-year follow-up in a sample of older patients.This was a single-center prospective observational study of older patients aged 65 years and over with chronic diseases (n = 103), who were followed through a hospital-based program over 2 years. Frailty was evaluated via the modified Fried Frailty Index and a comprehensive geriatric assessment.We noted significant improvements in weight loss (P = .016) and self-reported exhaustion (P = .006), and a less decrease in grip strength (P = .009) at the 1-year follow-up. Furthermore, baseline cerebral vascular accident diagnosis (P = .022), high polypharmacy (P = .037), a higher Geriatric Depression Scale score (P = .033), and a lower Mini Nutritional Assessment score (P = .039) were significantly associated with improved frailty at the 2-year follow-up. Furthermore, improvement in self-reported exhaustion (odds ratio [OR]: 4.7, 1.4-16.1, P = .014) and physical activity (OR: 3.8, 1.0-13.7, P = .046), and a less decrease in grip strength (OR: 4.0, 1.3-12.5, P = .017) at the 1-year follow-up were significantly associated with improved frailty at the 2-year follow-up.Self-reported exhaustion, physical activity, and grip strength are easy, quick, and feasible screening tests for improvements in frailty in clinical practice.
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Affiliation(s)
- Yu-Ching Pao
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Chin-Ying Chen
- Department of Family Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
| | - Ching-I. Chang
- Division of Geriatrics Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
- Division of Geriatrics Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital and National Taiwan University, Taipei
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Donini LM, Marrocco W, Marocco C, Lenzi A. Validity of the Self- Mini Nutritional Assessment (Self- MNA) for the Evaluation of Nutritional Risk. A Cross- Sectional Study Conducted in General Practice. J Nutr Health Aging 2018; 22:44-52. [PMID: 29300421 DOI: 10.1007/s12603-017-0919-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Malnutrition is a frequent condition in the elderly especially in hospitals and in nursing homes, and even among the free-living elders the prevalence is not negligible (5-10%). Awareness towards malnutrition is still limited. The lack of time for nutritional assessment by the overcommitted healthcare personnel, including the general practitioners (GPs), may represent one possible explanation for limited recognition of malnutrition. Therefore, a self-administered instrument could be useful in raising alert on the GPs and allow early detection of malnutrition and early care provision. The aim of the present study was to analyze the validity of the Self-MNA that takes cue from the Mini Nutritional Assessment- Short Form (MNA-SF) and has been adapted to be self-administered by free-living elderly subjects. METHODS Participants were recruited from patients referring to the GP offices in Italy. Nutritional evaluation was performed through the administration of Full-MNA, MNA-SF and Self-MNA. The comorbidity level was assessed through the Cumulative Illness Rating Scale (CIRS). The level of difficulty in filling out the test was reported by the participants, and the time spent to complete the Self-MNA was also registered. RESULTS A total of 226 subjects, 125 women and 101 men (75.1 ±8 and 75.3 ± 8 years old, respectively; p=0.89) were enrolled, and 214 (94.7%) of them completed the Self-MNA. According with the Full-MNA test score, 8.4% of women and 3.5% of men were classified as malnourished, whereas 32.7% of women and 31.4% of men were at risk of malnutrition. Agreement between Self-MNA and Full-MNA, and Self-MNA vs. MNA-SF was classified as "moderate" (k = 0.476 and 0.496 respectively; p < 0.001). Self-MNA showed a fair predictive value compared to the Full-MNA and MNA-SF tests (76.6 and 79.9%, respectively) with a barely adequate sensitivity (70.9 and 75.4%, respectively). The analysis of the characteristics of FN (false negative: subjects who were considered at risk of malnutrition or malnourished at Full-MNA but not at Self-MNA) showed that the clinical and functional aspects of these subjects (age, comorbidity and severity, time necessary to complete the Self-MNA, decrease in food intake, severe illness in the past 3 months, dementia and depression, fluid intake, need for feeding assistance, arm and calf circumferences) were very similar to the characteristics of true positive subjects. Patients required 6.7 ± 4.5 minutes to complete the test and 25 subjects (11.7%) needed more than 10 minutes, up to a maximum of 30 minutes. Patients who stated a greater difficulty were older (79.8 ± 7 vs. 73.5 ± 7 years; p<0.001), they were more «malnourished» at Full-MNA (10.7 vs. 1,7%; p= 0.006) and clinical status was characterized by a higher severity index (1.72 ± 0.6 vs. 1.41 ± 0.4; p= 0.008). CONCLUSION In the present study we investigated the validity of the Self-MNA in a sample of free-living elderly subjects. The results obtained confirm the validity of the test that may represent a useful tool for the GPs, although some important limitations need to be considered, limiting its use in clinical practice.
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Affiliation(s)
- L M Donini
- Lorenzo M Donini, MD, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy, phone: +39 06 4969 0216, fax: +39 06 4991 0699,
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Lin WQ, Wang HHX, Yuan LX, Li B, Jing MJ, Luo JL, Tang J, Ye BK, Wang PX. The Unhealthy Lifestyle Factors Associated with an Increased Risk of Poor Nutrition among the Elderly Population in China. J Nutr Health Aging 2017; 21:943-953. [PMID: 29083434 DOI: 10.1007/s12603-017-0881-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The associations between nutritional status and lifestyle factors have not been well established. This study aimed to investigate the prevalence of poor nutrition and to examine the relationships between nutritional status and unhealthy lifestyle and other related factors among the elderly. METHODS This cross-sectional study was conducted in Liaobu Town, Dongguan city, China. A total of 708 community-dwelling older adults aged ≥60 years were recruited by stratified random sampling. Data on sociodemographic characteristics, health and lifestyle factors, and the Mini Nutritional Assessment (MNA) scores were collected using structured questionnaires via face-to-face interviews. A multivariate logistic regression model was constructed to identify the risk factors of poor nutrition. RESULTS The prevalence of malnutrition among the elderly adults in this study was 1.3%, and 24.4% were at risk of malnutrition (RM). Poor nutrition was significantly associated with female gender, older age, lower education, a high number of self-reported chronic diseases, and hospitalization in the last year. Unhealthy lifestyle factors associated with poor nutrition included current smoking status, higher alcohol consumption, lack of physical activity, longer duration of sitting, negative attitude towards life, and a poor family relationship. CONCLUSIONS While the prevalence of malnutrition was low, RM was high in the elderly population in China. The determinants of malnutrition were explored and the relationships between nutritional status and unhealthy lifestyle factors were examined. The results of this study provide information for future longitudinal studies with multi-factorial interventional design in order to determine the effects of the causal relationships.
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Affiliation(s)
- W-Q Lin
- Pei-Xi Wang, Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510180, China,
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Win AZ, Ceresa C, Arnold K, Allison TA. High Prevalence of Malnutrition among Elderly Veterans in Home Based Primary Care. J Nutr Health Aging 2017; 21:610-613. [PMID: 28537323 DOI: 10.1007/s12603-017-0918-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Elderly Veterans enrolled in VA Home Based Primary Care (HBPC) programs suffer from many diseases including malnutrition. Nutrition screening tools exist in the VA system but they are inconsistently utilized across ambulatory care programs and are neither research validated nor comparable with non-VA populations. The Mini-Nutritional Assessment short-form (MNA-SF) has been validated in international studies in a variety of settings. The primary aim of this study was to find the prevalence of malnutrition among Veterans enrolled in HBPC programs. The secondary objective was to determine the feasibility of adopting a validated nutrition screening tool (Mini-Nutritional Assessment short-form (MNA-SF)). METHODS 2252 veterans age 65 and older from 18 HBPC programs from across the country participated in the study. The study period was between April and September 2012. WinPepi (version 11.25) was used for descriptive analysis. RESULTS We found that the prevalence of malnutrition was 15% (344/2252) and the prevalence of at risk for malnutrition was 40.3% (909/2252). DISCUSSION The MNA-SF is an efficient nutrition screening tool and it can be successfully used for the elderly veterans. The prevalence of malnutrition among veterans was high compared to the community dwelling U.S. civilian elderly population. By preventing and treating malnutrition, health care systems should be able to reduce overall health care costs.
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Affiliation(s)
- A Z Win
- Aung Zaw Win, MD, MA, MPH, Research Assistant, Nutrition and Food Services, San Francisco VA Medical Center, 4150 Clement Street, San Francisco CA 94121; (415) 672 6209 (phone); (650) 756 2778 (fax);
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Alghadir AH, Gabr SA, Al-Eisa ES. Assessment of the effects of glutamic acid decarboxylase antibodies and trace elements on cognitive performance in older adults. Clin Interv Aging 2015; 10:1901-7. [PMID: 26664103 PMCID: PMC4671766 DOI: 10.2147/cia.s95974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Homeostatic imbalance of trace elements such as iron (Fe), copper (Cu), and zinc (Zn) demonstrated adverse effects on brain function among older adults. Objective The present study aimed to investigate the effects of trace elements and the presence of anti-glutamic acid decarboxylase antibodies (GADAs) in human cognitive abilities among healthy older adults. Methods A total of 100 healthy subjects (65 males, 35 females; age range; 64–96 years) were recruited for this study. Based on Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score, the participants were classified according to cognitive performance into normal (n=45), moderate (n=30), and severe (n=25). Cognitive functioning, leisure-time physical activity (LTPA), serum trace elements – Fe, Cu, Zn, Zn/Cu, and GADAs were assessed using LOTCA battery, pre-validated physical activity (PA) questionnaire, atomic absorption, and immunoassay techniques, respectively. Results Approximately 45% of the study population (n=45) had normal distribution of cognitive function and 55% of the study population (n=55) had abnormal cognitive function; they were classified into moderate (score 62–92) and severe (score 31–62). There was a significant reduction in the level of Zn and Zn/Cu ratio along with an increase in the level of Fe, Cu, and anti-GADAs in subjects of severe (P=0.01) and moderate (P=0.01) cognitive performance. LOTCA-cognitive scores correlated positively with sex, HbA1c, Fe, Cu, Zn, and Zn/Cu ratio, and negatively with age, PA, body mass index, and anti-GADAs. Significant inter-correlation was reported between serum trace element concentrations and anti-GADAs which suggest producing a cognitive decline via oxidative and neural damage mechanism. Conclusion This study found significant associations among trace elements, anti-GADAs, and cognitive function in older adults. The homeostatic balance of trace elements should be recommended among older adults for better cognitive performance.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sami A Gabr
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia ; Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Einas S Al-Eisa
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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The diagnostic accuracy of the Revised Mini Nutritional Assessment Short Form for older people living in the community and in nursing homes. J Nutr Health Aging 2015; 18:725-9. [PMID: 25286451 DOI: 10.1007/s12603-014-0460-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the diagnostic accuracy of the CC-SF, which was developed to use calf circumference (CC) instead of BMI in the MNA-SF, for elderly people living in the community and in nursing homes. It also aimed separately to determine the correlation of CC-SF and BMI-SF with the full MNA. STUDY DESIGN AND METHODS The study included 640 elderly people living in their community and 243 elderly people living in nursing homes. Accuracy was assessed by determining the sensitivity and selectivity of the nutritional assessments. The correlations between the MNA-SFs and the full MNA were analyzed. RESULTS The correlation between MNA-SFs and full MNAs was strong, significant and almost identical both in the community and in nursing homes (r=0.86-0.88; p<0.001). The observed agreement between the BMI-SF and the full MNA was 82.2% in the community and 77.8% in the nursing homes. There was a substantial agreement by kappa values in the comparison of community and nursing homes (the Kappa value of the BMI-SF was 0.63 in the community and 0.62 in the nursing homes, and the kappa value of the CC-SF was 0.62 in the community and 0.63 in the nursing homes). When compared to the full MNA the MNA-SFs tended to underestimate nutritional status. Both MNA-SFs had similarly high sensitivity and selectivity, both in the community and nursing homes. (when dichotomized as "malnourished-at risk of malnutrition" versus " well nourished" and "malnourished" versus "at risk of malnutrition-well nourished") (over 80%). CONCLUSION In cases where BMI cannot be determined, the CC-SF is a good substitute for the BMI-SF.
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Salles J, Cardinault N, Patrac V, Berry A, Giraudet C, Collin ML, Chanet A, Tagliaferri C, Denis P, Pouyet C, Boirie Y, Walrand S. Bee pollen improves muscle protein and energy metabolism in malnourished old rats through interfering with the Mtor signaling pathway and mitochondrial activity. Nutrients 2014; 6:5500-16. [PMID: 25470375 PMCID: PMC4276980 DOI: 10.3390/nu6125500] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022] Open
Abstract
Although the management of malnutrition is a priority in older people, this population shows a resistance to refeeding. Fresh bee pollen contains nutritional substances of interest for malnourished people. The aim was to evaluate the effect of fresh bee pollen supplementation on refeeding efficiency in old malnourished rats. Male 22-month-old Wistar rats were undernourished by reducing food intake for 12 weeks. The animals were then renourished for three weeks with the same diet supplemented with 0%, 5% or 10% of fresh monofloral bee pollen. Due to changes in both lean mass and fat mass, body weight decreased during malnutrition and increased after refeeding with no between-group differences (p < 0.0001). Rats refed with the fresh bee pollen-enriched diets showed a significant increase in muscle mass compared to restricted rats (p < 0.05). The malnutrition period reduced the muscle protein synthesis rate and mTOR/p70S6kinase/4eBP1 activation, and only the 10%-pollen diet was able to restore these parameters. Mitochondrial activity was depressed with food restriction and was only improved by refeeding with the fresh bee pollen-containing diets. In conclusion, refeeding diets that contain fresh monofloral bee pollen improve muscle mass and metabolism in old, undernourished rats.
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Affiliation(s)
- Jérôme Salles
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | | | - Véronique Patrac
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Alexandre Berry
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Christophe Giraudet
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Marie-Laure Collin
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Audrey Chanet
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Camille Tagliaferri
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Philippe Denis
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Corinne Pouyet
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Yves Boirie
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
| | - Stéphane Walrand
- INRA, UMR1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand F-63000, France.
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The diagnostic accuracy of the revised mini nutritional assessment short form for older people living in the community and in nursing homes. J Nutr Health Aging 2014. [DOI: 10.1007/s12603-014-0536-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Keshavarzi S, Ahmadi SM, Lankarani KB. The impact of depression and malnutrition on health-related quality of life among the elderly Iranians. Glob J Health Sci 2014; 7:161-70. [PMID: 25948441 PMCID: PMC4802080 DOI: 10.5539/gjhs.v7n3p161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/26/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The present study aimed to assess the association between nutritional status and depressive symptoms among elderly Iranians and to explore their impact on their Health-Related Quality of Life (HRQoL). METHODS In this cross-sectional study, 447 elders aging from 55 to 85 years were randomly selected and completed the Iranian version of Geriatric Depression Scale-15 (GDS), Mini Nutritional Assessment (MNA), and the Iranian version of Short Form Health Survey (SF-36). RESULTS Out of the 447 elderly, 72.1% were female with the mean age of 65.99 ± 7.89 years. The prevalence of depression was 38.1%. In addition, the SF-36 sub-scores tended to be lower among the elders with depressive symptoms according to GDS. The Physical Functioning (PF), Bodily Pain (BP), Role Physical (RP), Role Emotional (RE), and Mental Health (MH) dimensions of the SF-36 were also statistically poorer in the elders with depression. The mean MNA score was 24.6 ± 2.7; 35.4% of the participants were malnourished or at risk of malnutrition and 64.6% were adequately nourished. The sub scores of SF-36 were significantly lower in the elders with impaired nutritional status. CONCLUSIONS Considering the importance of the association among psychological and nutritional problems and HRQoL in caring for and promoting the welfare of the elders, this study provided fundamental information and a basis for further evaluation of this issue in developing and undeveloped countries.
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Affiliation(s)
| | - Seyed Mehdi Ahmadi
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
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Scandrett KG, Zuckerbraun BS, Peitzman AB. Operative risk stratification in the older adult. Surg Clin North Am 2014; 95:149-72. [PMID: 25459549 DOI: 10.1016/j.suc.2014.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As the population ages, the health care system must to adapt to the needs of the older population. Hospitalization risks are particularly significant in the frail geriatric patients, with costly and morbid consequences. Appropriate preoperative assessment can identify sources of increased risk and enable the surgical team to manage this risk, through "prehabilitation," intraoperative modification, and postoperative care. Geriatric preoperative assessment expands usual risk stratification and careful medication review to include screening for functional disability, cognitive impairment, nutritional deficiency, and frailty. The information gathered can also equip the surgeon to develop a patient-centered and realistic treatment plan.
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Affiliation(s)
- Karen G Scandrett
- Department of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian S Zuckerbraun
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Wu HS, Lin LC. Comparing cognition, mealtime performance, and nutritional status in people with dementia with or without ideational apraxia. Biol Res Nurs 2014; 17:199-206. [PMID: 24924352 DOI: 10.1177/1099800414536773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence rate of ideational apraxia (IA) affecting self-feeding in people with dementia, confirm the stage of dementia at which IA most commonly occurs, and compare mealtime performance and nutritional status between people with dementia (PWD) with and without IA. METHOD A cross-sectional design with between-subject comparison was used. Among the 395 potential participants recruited from dementia special care units at nine long-term care facilities in central and northern Taiwan, 98 met the operational definition of IA and were included in the PWD with IA group. From the remaining pool, 98 participants, matched for age and sex with the PWD with IA group, were randomly allocated to the PWD without IA group. Eating Behavior Scale (EBS) scores, food intake, total eating time, meal assistance, body mass index, Mini-Nutritional Assessment (MNA), and Mini-Mental State Examination scores were collected. RESULTS The prevalence rate of IA affecting self-feeding in our study population of PWD was 24.8%. PWD with IA had significantly lower EBS scores, had more food intake (p < .001), spent more time being fed by caregivers, needed more verbal and feeding assistance, and had lower MNA scores than PWD without IA. Decline in the self-feeding ability of PWD affected by IA most commonly occurred in the severe stage of dementia. CONCLUSION When dementia progresses to the late stage, staff should pay special attention to residents' mealtime performance and nutritional status. For PWD with IA, reassigning staff at mealtimes based on eating ability and providing memory training are recommended.
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Affiliation(s)
- Hua-Shan Wu
- School of Nursing, Asia University, Taichung, Taiwan
| | - Li-Chan Lin
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
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Cankurtaran M, Saka B, Sahin S, Varlı M, Doventas A, Yavuz B, Halil M, Curgunlu A, Ulger Z, Tekin N, Akcicek F, Karan M, Atli T, Beger T, Erdincler D, Ariogul S. Turkish nursing homes and care homes nutritional status assessment project (THN-malnutrition). Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tsai HJ. Nutrition risk, functional dependence, and co-morbidities affect depressive symptoms in Taiwanese aged 53 years and over: a population-based longitudinal study. J Psychosom Res 2013; 75:173-7. [PMID: 23915775 DOI: 10.1016/j.jpsychores.2013.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/14/2013] [Accepted: 04/29/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study examined cross-sectional and longitudinal associations of nutritional risk, functional dependence and co-morbidities with depressive symptoms in people aged 53 years and over in Taiwan. METHODS Study data were obtained from a population-based longitudinal study, the Taiwan Longitudinal Study of Aging (TLSA), with a nationally representative sample of nearly-old and old Taiwanese. RESULTS The prevalence of having depressive symptoms and being at risk of malnutrition/malnourishment in 1999 was 23% and 21%. Mini-Nutritional Assessment (MNA) score, being at risk of malnutrition/malnourishment, number of self-reported co-morbidities, and activities of daily living (ADL) score were all cross-sectionally correlated with depressive symptoms (all p<.05). Being at risk of malnutrition/malnourishment and number of co-morbidities were also longitudinally associated with increased risk of subsequent depressive symptoms over four and eight years (all p<.05). The relationship between nutritional risk and subsequent depressive symptoms was stronger than the relationship between co-morbidities and ADL score and subsequent depressive symptoms. CONCLUSIONS These results suggested that nutritional risk, co-morbidities and functional dependence are all associated with increased risks of depressive symptoms in people aged 53 years and above. Nutritional risk contributes significantly to subsequent depressive symptoms and is a strong and consistent predictor of subsequent depressive symptoms in nearly-old and old Taiwanese.
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Affiliation(s)
- Hsin-Jen Tsai
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan.
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Vitamin B12 and folic acid levels are not related to length of stay in elderly inpatients. Nutrition 2013; 29:757-9. [DOI: 10.1016/j.nut.2012.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 09/07/2012] [Accepted: 10/10/2012] [Indexed: 11/23/2022]
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Serra-Prat M, Mans E, Palomera E, Clavé P. Gastrointestinal peptides, gastrointestinal motility, and anorexia of aging in frail elderly persons. Neurogastroenterol Motil 2013; 25:291-e245. [PMID: 23240772 DOI: 10.1111/nmo.12055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty. METHODS Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non-frail elderly (>70 years) persons, and (c) healthy adults (aged 25-65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0-60 min) and late (60-240 min) postprandial periods. KEY RESULTS Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non-gallbladder contractors showed no CCK peak in younger and non-frail groups, but the same high CCK peak as contractors in the frail. CONCLUSIONS & INFERENCES Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.
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Affiliation(s)
- M Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
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Wu HS, Lin LC. The moderating effect of nutritional status on depressive symptoms in veteran elders with dementia: a spaced retrieval combined with Montessori-based activities. J Adv Nurs 2013; 69:2229-41. [PMID: 23444942 DOI: 10.1111/jan.12097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2013] [Indexed: 11/29/2022]
Abstract
AIM To examine the long-term effects of fixed/individualized spaced retrieval combined with Montessori-based activities on nutritional status and body mass index and nutritional improvement's moderating effect on depressive symptoms for people with dementia during a specific follow-up period. BACKGROUND The decrease in food intake, often combined with poor nutrition, may induce depressive symptoms in people with dementia. DESIGN A single-blind, quasi-experimental study with repeated measures. METHODS Twenty-five fixed group participants received spaced retrieval combined with Montessori-based activities over 24 sessions. Thirty-eight individualized group participants received the same intervention with different sessions, which was adjusted according to each participant's learning response. Twenty-seven control group participants just received routine care. The Chinese version of the Mini-Nutritional Assessment and Cornell Scale for Depression in Dementia scores and body mass index were recorded at pre-test, posttest and 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010. RESULTS The Mini-Nutritional Assessment scores and body mass index of the fixed and individualized groups could be significantly increased over time. Additionally, the Cornell Scale for Depression in Dementia scores could be significantly reduced as a result of the improvement of the Mini-Nutritional Assessment scores arising from the individualized intervention. CONCLUSION The depressive symptoms of residents with dementia could be moderated by the individualized intervention through nutritional improvement. Trained clinical nurse specialists can use this individualized intervention for residents with dementia who also have poor nutrition and depressive symptoms.
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Affiliation(s)
- Hua-Shan Wu
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
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Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU). Clin Nutr 2013; 32:752-7. [PMID: 23340043 DOI: 10.1016/j.clnu.2012.12.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/09/2012] [Accepted: 12/28/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS The nutritional status of elderly patients requiring ICU admission is largely unknown. This study evaluated the prevalence of malnutrition in elderly patients (>65 years) admitted to the surgical and medical ICUs, agreement between assessment techniques and associations between malnutrition and adverse outcomes. METHODS For this prospective cohort, nutritional status was classified concurrently using the Mini Nutrition Assessment (MNA), Subjective Global Assessment (SGA), Nutrition Risk Score 2002 (NRS 2002) and MNA-short form (MNA-SF). Demographic and relevant medical information were collected from the medical record prior to the nutrition interview and/or following hospital discharge. Descriptive statistics, inter-rater agreement and regression analyses were conducted. RESULTS The average patient was 74.2 (±6.8) years of age with a mean APACHE II score of 11.9 (±3.6). Malnutrition was prevalent in 23-34% of patients (n = 260) with excellent agreement between raters. Compared to MNA, NRS 2002 had the highest sensitivity, while SGA and MNA-SF had higher specificity. Malnutrition at ICU admission was associated with longer hospital LOS, a lower propensity for being discharged home and a greater need for hospice care or death at discharge (all p values <0.05). These relationships were diminished when controlling for severity of illness. CONCLUSIONS Future work in this elderly population needs to explore the role of disease acuity, inflammation and body composition in the nutrition assessment process and in the examination of outcomes.
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Chung LMY, Chung JWY. Associations of social participation, demographic, socioeconomic and disease factors with nutritional risk in a group of older Hong Kong adults. Health (London) 2013. [DOI: 10.4236/health.2013.53051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bouillanne O, Curis E, Hamon-Vilcot B, Nicolis I, Chrétien P, Schauer N, Vincent JP, Cynober L, Aussel C. Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: a randomized controlled trial. Clin Nutr 2012; 32:186-92. [PMID: 22992307 DOI: 10.1016/j.clnu.2012.08.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/02/2012] [Accepted: 08/21/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding. METHODS This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score. RESULTS Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m(2); 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m(2); 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m(2); 95% CI, [0; 0.34] and -0.11 kg/m(2); 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m(2); 95% CI, [0.08; 0.52] and -0.04 kg/m(2); 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score. CONCLUSIONS This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients.
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Andre MB, Dumavibhat N, Ngatu NR, Eitoku M, Hirota R, Suganuma N. Mini Nutritional Assessment and functional capacity in community-dwelling elderly in rural Luozi, Democratic Republic of Congo. Geriatr Gerontol Int 2012; 13:35-42. [PMID: 22530787 DOI: 10.1111/j.1447-0594.2012.00852.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Good nutrition is beneficial both for the health and the functional capacity of the elderly. However, malnutrition is a serious health problem among the elderly, particularly the elderly living in rural areas in many developing countries. The aim of the present study was to carry out a cross-sectional study of the elderly in the city of Luozi, Democratic Republic of Congo, through the use of the long and the short forms of the Mini Nutritional Assessment (MNA) scale. METHODS We carried out a cross-sectional study in the city of Luozi, a city facing serious socioeconomic problems as a result of wartime conditions in the country. The study included 370 volunteer community-dwelling elderly people aged 65-88 years, both male and female. Investigations took into account the MNA, the activities of daily living, and the instrumental activities of daily living, falls, current diseases and lifestyle. RESULTS Approximately 57.8% of the participants were at risk of malnutrition, whereas 28.4% were malnourished according to the MNA scale. MNA scores were significantly lower (Student's t-test, P=0.03) in those with a fall history (MNA score 18.3±4.0) compared with those who did not (MNA score, 21.0±2.7). All the participants with malnutrition suffered from at least one chronic disease. The percentage of participants with dependency was significantly higher in the malnourished participants (87.6%) than in well-nourished participants (50.9%). CONCLUSION These findings provide information that malnutrition is a serious health concern among elderly people in the city of Luozi, and shows the need for adequate nutrition and social programs for the elderly.
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Affiliation(s)
- Muzembo Basilua Andre
- Division of Social Medicine, Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan.
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Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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Loveday H, Smales C, Tsiami A, Browne J. The effectiveness of nutritional interventions to reduce the risk of healthcare-associated infection in the undernourished elderly: a systematic review. ACTA ACUST UNITED AC 2012; 10:1-18. [PMID: 27820446 DOI: 10.11124/jbisrir-2012-276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Heather Loveday
- 1. JBI Collaborating Centre, College of Nursing, Midwifery and Healthcare, University of West London London, UK 2. JBI Collaborating Centre, School of Psychology, Social Care and Human Sciences, University of West London, London, UK. 3. JBI Collaborating Centre, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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Drazin D, Shirzadi A, Rosner J, Eboli P, Safee M, Baron EM, Liu JC, Acosta FL. Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 2011; 31:E3. [DOI: 10.3171/2011.7.focus11145] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Object
The elderly population (age > 60 years) is the fastest-growing age group in the US. Spinal deformity is a major problem affecting the elderly and, therefore, the demand for surgery for spinal deformity is becoming increasingly prevalent in elderly patients. Much of the literature on surgery for adult deformity focuses on patients who are younger than 60 years, and therefore there is limited information about the complications and outcomes of surgery in the elderly population.
In this study, the authors undertook a review of the literature on spinal deformity surgery in patients older than 60 years. The authors discuss their analysis with a focus on outcomes, complications, discrepancies between individual studies, and strategies for complication avoidance.
Methods
A systematic review of the MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery” and “adult spine deformity surgery.” Exclusion criteria included patient age younger than 60 years. Data on major Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, patient-reported outcomes, and complications were recorded.
Results
Twenty-two articles were obtained and are included in this review. The mean age was 74.2 years, and the mean follow-up period was 3 years. The mean preoperative ODI was 48.6, and the mean postoperative reduction in ODI was 24.1. The mean preoperative VAS score was 7.7 with a mean postoperative decrease of 5.2. There were 311 reported complications for 815 patients (38%) and 5 deaths for 659 patients (< 1%).
Conclusions
Elderly patient outcomes were inconsistent in the published studies. Overall, most elderly patients obtained favorable outcomes with low operative mortality following surgery for adult spinal deformity.
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Donini LM, De Felice MR, Savina C, Coletti C, Paolini M, Laviano A, Scavone L, Neri B, Cannella C. Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status. J Nutr Health Aging 2011; 15:586-92. [PMID: 21808937 DOI: 10.1007/s12603-011-0030-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
UNLABELLED In elderly subjects, past researches have already underlined the role of nutritional status as a basic factor able to influence the prognosis either in acute wards or in rehabilitation and long-term care settings. Aim of the study is that of retrospectively verify, through a multivariate analysis, the factors able to condition mortality in long-term care, paying particular attention to the nutritional status. METHODS The survey included 513 patients aged more than 65 years admitted to a long-term care unit during a three years period. Exitus within the first three months of hospitalization was considered the outcome variable, while baseline functional, cognitive, clinical and nutritional status were considered the independent variables eventually related to mortality. RESULTS The univariate analysis found that some variables were significantly correlated with the outcome: comorbidity, ADL, cognitive status, pressure sores, albumin, transferrin, CRP, mucoprotein, cholesterol, cholinesterase, MAMC and MNA. The predictive value of the block model of the logistic regression analysis was 77.9% (specificity = 85.3%, sensitivity = 63.9%). With the forward stepwise analysis only MNA, cholinesterase, CRP and mucoprotein were considered in the final model. In this case the predictive value of the model was 79.3% (specificity = 84.6%, sensitivity = 69.46%).
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Affiliation(s)
- L M Donini
- Department of Medical Physiopathology (Food Science Section) - “Sapienza” University of Rome, Italy.
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Tsai AC, Chang MZ. Long-form but not short-form Mini-Nutritional Assessment is appropriate for grading nutritional risk of patients on hemodialysis--a cross-sectional study. Int J Nurs Stud 2011; 48:1429-35. [PMID: 21640347 DOI: 10.1016/j.ijnurstu.2011.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/29/2011] [Accepted: 05/05/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Routine screening/assessment of protein-energy status is essential for preventing uremic malnutrition in patients on hemodialysis (HD). A simple, low cost, reliable and non-invasive tool is greatly desired. OBJECTIVE This study aimed to evaluate the appropriateness of using the long-form (LF) and the short-form (SF) Mini Nutritional Assessment (MNA) for grading the risk of protein-energy malnutrition in patients on HD. DESIGN AND SAMPLING: A cross-sectional study with purposive sampling. SETTING A hospital-managed hemodialysis center. PARTICIPANTS 152 adult ambulatory patients on hemodialysis. METHODS The nutritional status of each patient was graded with MNA-LF and MNA-SF, each in two versions--a normalized-original (content-equivalent) version (by adopting population-specific anthropometric cut-off points) and an alternative version that replaced calf circumference for BMI in the scale. The SGA, serum albumin and serum creatinine served as references. Cross-tabulation test was used to evaluate the consistency of the versions. RESULTS MNA-SF versions rated fewer HD subjects malnourished or at risk of malnutrition (32.2% and 24.3% for T1 and T2, respectively) compared to MNA-LF versions (40.8% and 36.2%) or the SGA (47.4%). MNA-SF versions (kappa=0.450 and 0.446) also did not perform as well as MNA-LF versions (kappa=0.734 and 0.666) in predicting the risk of malnutrition in HD patients using the SGA as the reference. MNA-SF also did not perform as well as the MNA-LF using serum albumin or serum creatinine as the reference. CONCLUSIONS The MNA-LF is appropriate for predicting protein-energy malnutrition in HD patients but MNA-SF may under-rate these patients. Effort should be made to improve the MNA-SF for HD patients since the short-form is more time-efficient and thus, greatly desired in clinical practice.
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Affiliation(s)
- Alan C Tsai
- Department of Healthcare Administration, Asia University, Wufeng, Taichung 41354, Taiwan.
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Meesterberends E, Halfens RJG, Heinze C, Lohrmann C, Schols JMGA. Pressure ulcer incidence in Dutch and German nursing homes: design of a prospective multicenter cohort study. BMC Nurs 2011; 10:8. [PMID: 21526990 PMCID: PMC3111358 DOI: 10.1186/1472-6955-10-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pressure ulcers are a common and serious health care problem in all health care settings. Results from annual national pressure ulcer prevalence surveys in the Netherlands and Germany reveal large differences in prevalence rates between both countries over the past ten years, especially in nursing homes. When examining differences in prevalence and incidence rates, it is important to take into account all factors associated with the development of pressure ulcers. Numerous studies have identified patient related factors, as well as nursing related interventions as risk factors for the development of pressure ulcers. Next to these more process oriented factors, also structural factors such as staffing levels and staff quality play a role in the development of pressure ulcers. This study has been designed to investigate the incidence of pressure ulcers in nursing homes in the Netherlands and Germany and to identify patient related factors, nursing related factors and structural factors associated with pressure ulcer development. The present article describes the protocol for this study. METHODS/DESIGN A prospective multicenter study is designed in which a cohort of newly admitted nursing home residents in 10 Dutch and 11 German nursing homes will be followed for a period of 12 weeks. Data will be collected by research assistants using questionnaires on four different levels: resident, staff, ward, and nursing home. DISCUSSION The results of the study will provide information on the incidence of pressure ulcers in Dutch and German nursing homes. Furthermore, information will be gathered on the influence of patient related factors, nursing related factors and structural factors on the incidence of pressure ulcers. The present article describes the study design and addresses the study's strengths and weaknesses.
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Affiliation(s)
- Esther Meesterberends
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
| | - Ruud JG Halfens
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
| | - Cornelia Heinze
- Charité Universitätsmedizin Berlin, Department of Nursing Science, Berlin, Germany
| | - Christa Lohrmann
- Medical University of Graz, Department of Nursing Science, Graz, Austria
| | - Jos MGA Schols
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
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Timpini A, Facchi E, Cossi S, Ghisla MK, Romanelli G, Marengoni A. Self-reported socio-economic status, social, physical and leisure activities and risk for malnutrition in late life: a cross-sectional population-based study. J Nutr Health Aging 2011; 15:233-8. [PMID: 21369673 DOI: 10.1007/s12603-010-0286-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our goal was to evaluate the proportion of community-dwelling elderly people at risk for malnutrition and the effect of different socioeconomic status (SES) indicators as well as social, physical and leisure activities in late life on the risk for malnutrition. DESIGN A cross-sectional population-based study. SETTING A sub-urban area in Northern Italy. PARTICIPANTS 698 community-dwelling older persons. MEASUREMENTS The nutritional status of participants was assessed through the Mini Nutritional Assessment-Short Form (MNA-SF). SES was defined by means of early-life education, longest occupation, and late-life financial conditions. The following indicators were also evaluated: social contacts, and performing mental, physical and leisure activities during late-life. Chronic diseases, functional, cognitive and affective status were considered as potential confounders when examining the risk for malnutrition by logistic regression models. RESULTS 8% of the participants (average age 75.6 years, 408 women) were at risk for malnutrition (MNA-SF ≤ 11). Low education, poor financial condition, and lack of physical and leisure activities showed a crude association with risk for malnutrition. Multi-adjusted logistic regression models showed that only low education (OR=2.9; 95% CI=1.2-6.8) and lack of physical activity (OR=4.4;95%CI=2.0-9.7) were independently associated with the risk for malnutrition. CONCLUSIONS Low education and lack of physical activity in late-life may affect the risk for malnutrition in the elderly. Further studies are needed to clarify the cause-effect relationship between lack of physical activity and malnutrition.
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Affiliation(s)
- A Timpini
- Department of Medical and Surgery Sciences, University of Brescia, Italy.
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Tsai HJ, Tsai AC, Hung SY, Chang MY. Comparing the predictive ability of population-specific Mini-Nutritional Assessment with Subjective Global Assessment for Taiwanese patients with hemodialysis: A cross-sectional study. Int J Nurs Stud 2011; 48:326-32. [DOI: 10.1016/j.ijnurstu.2010.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 07/26/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
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Abstract
As a population subgroup, older people are more vulnerable to malnutrition especially those who are institutionalised. Recognition of deteriorating or poor nutritional status is key in reversing the effects of undernutrition and reinforces the value of regular weight checks and/or the use of screening tools. Commercially produced supplements are often the first option used to address undernutrition in both acute and community settings. They can be expensive and, although regularly prescribed, have undergone only limited evaluation of their effectiveness in community settings. An alternative but less researched approach to improve the nutritional status of undernourished people is food fortification. This approach may be particularly useful for older people, given their often small appetites. The ability to eat independently has been significantly related to decreased risk of undernutrition. Assisting people who have difficulty feeding themselves independently should become a designated duty and may be crucial in optimising nutritional status. Lack of nutrition knowledge has been identified as the greatest barrier to the provision of good nutritional care. Education and training of care staff are pivotal for the success of any intervention to address undernutrition. The development of undernutrition is a multi-factorial process and a package of approaches may be required to prevent or treat undernutrition. Nutrition must be at the forefront of care if national care standards are to be met.
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Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, Arioğul S. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr 2010; 29:507-11. [PMID: 20117863 DOI: 10.1016/j.clnu.2010.01.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 12/22/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Older adults are poorly assessed for malnutrition risk although malnutrition is not an uncommon problem in this population. The aim of this study was to determine the malnutrition risk and its correlates in geriatric outpatients. METHOD The study was performed in 2327 patients > or =65 years old who were admitted to our Geriatric Medicine outpatient clinic. Together with comprehensive geriatric assessment, nutritional assessment with short version of mini nutritional assessment test (MNA-SF) was performed. MNA-SF score < or =11 was determined as malnutrition risk. RESULTS Mean age of patients was 72.14+/-6.11 and 1479 (63.6%) were female. Mean MNA-SF score was 12.31+/-2.18. The number of patients with MNA-SF score < or =11 was 651 (28%). Depression, haematocrit, plasma fasting glucose, albumin, erythrocyte sedimentation rate, instrumental activities of daily living scores and bone mineral density measured from total femur were found to be significantly associated with malnutrition risk. CONCLUSION In this study malnutrition risk was detected in 651 (28%) patients. This ratio was similar to the literature. In older adults malnutrition risk is found to be increased due to majority of chronic illnesses and physical dependency. In conclusion, nutritional assessment should be a part of comprehensive geriatric assessment.
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Affiliation(s)
- Zekeriya Ülger
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 06100 Sihhiye, Ankara, Turkey.
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Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009; 13:782-8. [PMID: 19812868 DOI: 10.1007/s12603-009-0214-7] [Citation(s) in RCA: 1180] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation. METHODS A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. RESULTS Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. CONCLUSION The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.
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Affiliation(s)
- M J Kaiser
- Institute for the Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nurnberg, Heimerichstrasse 58, 90419 Nuremberg, Germany
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Abstract
Malnutrition and depression are highly prevalent in the institutionalised elderly and can lead to unfavourable outcomes. The aim of the present study was to assess associations between nutritional status and depressive symptoms and to explore their impact on self-caring capacity and quality of life (QoL) in elderly nursing-home residents (NHR). We conducted a cross-sectional study with 114 NHR (eighty-six female) with a mean age of 84.6 (sd 9.1) years. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Depressive symptoms were rated with the Geriatric Depression Scale (GDS). Self-caring capacity was measured with the Barthel index (BI) and QoL was assessed with the short-form thirty-six-item (SF-36) questionnaire. Of the NHR, twenty-six (22.8 %) were malnourished according to the MNA and sixty-six (57.9 %) were at nutritional risk. Of the residents, seventy-five could be assessed with the GDS, whereof sixteen (21.3 %) had major and twenty-six (34.7 %) had minor depressive symptoms. GDS scores tended to be higher in patients with impaired nutritional status (5.4 (sd 3.6) in well-nourished subjects and 6.9 (sd 3.2) in residents with malnutrition or at risk of malnutrition). The MNA correlated significantly with the GDS (r - 0.313; P = 0.006) and the GDS emerged as the only independent risk factor for malnutrition in a multiple regression analysis, whereas age, sex, care level, number of prescriptions and self-caring capacity had no influence. The BI was not reduced in patients with a high GDS. QoL was affected in malnourished residents as well as in study participants with depressive symptoms. The results of the present study point towards an association between malnutrition and depressive symptoms. However, the relationship is complex and it remains unclear whether depression in NHR is the cause or consequence of impaired nutritional status. Further studies are needed to identify the direction of this relationship and to assess the effect of depression treatment on nutritional and functional status as well as on QoL.
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Risonar MGD, Rayco-Solon P, Ribaya-Mercado JD, Solon JAA, Cabalda AB, Tengco LW, Solon FS. Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community. Nutr J 2009; 8:19. [PMID: 19409110 PMCID: PMC2689250 DOI: 10.1186/1475-2891-8-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 05/04/2009] [Indexed: 11/20/2022] Open
Abstract
Background Aging is a process associated with physiological changes such as in body composition, energy expenditure and physical activity. Data on energy and nutrient intake adequacy among elderly is important for disease prevention, health maintenance and program development. Methods This descriptive cross-sectional study was designed to determine the energy requirements and adequacy of energy and nutrient intakes of older persons living in private households in a rural Filipino community. Study participants were generally-healthy, ambulatory, and community living elderly aged 60–100 y (n = 98), 88 of whom provided dietary information in three nonconsecutive 24-hour food-recall interviews. Results There was a decrease in both physical activity and food intake with increasing years. Based on total energy expenditure and controlling for age, gender and socio-economic status, the average energy requirement for near-old (≥ 60 to < 65 y) males was 2074 kcal/d, with lower requirements, 1919 and 1699 kcal/d for the young-old (≥ 65 to < 75 y) and the old-old (≥ 75 y), respectively. Among females, the average energy requirements for the 3 age categories were 1712, 1662, and 1398 kcal/d, respectively. Actual energy intakes, however, were only ~65% adequate for all subjects as compared to energy expenditure. Protein, fat, and micronutrients (vitamins A and C, thiamin, riboflavin, iron and calcium) intakes were only ~24–51% of the recommended daily intake. Among this population, there was a weight decrease of 100 g (p = 0.012) and a BMI decrease of 0.04 kg/m2 (p = 0.003) for every 1% decrease in total caloric intake as percentage of the total energy expenditure requirements. Conclusion These community living elderly suffer from lack of both macronutrient intake as compared with energy requirements, and micronutrient intake as compared with the standard dietary recommendations. Their energy intakes are ~65% of the amounts required based on their total energy expenditure. Though their intakes decrease with increasing age, so do their energy expenditure, making their relative insufficiency of food intake stable with age.
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Lam PK, Kritz-Silverstein D, Barrett-Connor E, Milne D, Nielsen F, Gamst A, Morton D, Wingard D. Plasma trace elements and cognitive function in older men and women: the Rancho Bernardo study. J Nutr Health Aging 2008; 12:22-7. [PMID: 18165841 PMCID: PMC2647138 DOI: 10.1007/bf02982160] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study examines the sex-specific associations of plasma concentrations of iron, copper, and zinc with cognitive function in older community-dwelling adults. DESIGN Cross-sectional study. SETTING 1988-92 follow-up clinic visit. PARTICIPANTS 602 men and 849 women (average age=75 +/- 8 years) who were community-dwelling and not clinically demented. MEASUREMENTS Blood samples were assayed for trace elements and 12 cognitive function tests were administered. Sex-specific analyses were adjusted for age, education, alcohol consumption, smoking, exercise, and estrogen use in women. RESULTS Men and women differed significantly in education and alcohol intake (p's < 0.001), concentrations of plasma iron, copper and zinc (p's < 0.001) and scores on 11 of 12 cognitive function tests (p=0.04 to < 0.001). Regression analyses showed significant inverted U-shaped associations in men; both low and high iron levels were associated with poor performance on total and long-term recall and Serial 7's (p's=0.018, 0.042 and 0.004, respectively) compared to intermediate concentrations. In women, iron and copper concentrations had inverse linear associations with Buschke total, long and short-term recall and Blessed scores (p's < 0.05). Zinc was positively associated with performance on Blessed Items (p=0.008). Analyses comparing cognitive function using categorically defined mineral concentrations yielded similar sex specific results. CONCLUSION Optimal trace element concentrations may exist for optimal cognitive function in older adults, and these levels may differ by sex and cognitive function domain.
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Affiliation(s)
- Phung K. Lam
- Division of Epidemiology, Department of Family & Preventive Medicine, University of California, San Diego
| | - Donna Kritz-Silverstein
- Division of Epidemiology, Department of Family & Preventive Medicine, University of California, San Diego
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family & Preventive Medicine, University of California, San Diego
| | - David Milne
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, North Dakota
| | - Forrest Nielsen
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, North Dakota
| | - Anthony Gamst
- Division of Biostatistics, Department of Family & Preventive Medicine, University of California, San Diego
| | - Deborah Morton
- Division of Epidemiology, Department of Family & Preventive Medicine, University of California, San Diego
| | - Deborah Wingard
- Division of Epidemiology, Department of Family & Preventive Medicine, University of California, San Diego
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Pasetto LM, Lise M, Monfardini S. Preoperative assessment of elderly cancer patients. Crit Rev Oncol Hematol 2007; 64:10-8. [PMID: 17826628 DOI: 10.1016/j.critrevonc.2007.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 08/02/2007] [Indexed: 10/22/2022] Open
Abstract
The incidence of most types of cancers is age-dependent and progressive ageing is rapidly increasing the number of elderly people who need treatment for cancer. It is an ethical dilemma how aggressive one should be when it comes to treating cancer in the older population. Presumed fear of increased postoperative morbidity and mortality often results in delivery of sub-optimal cancer surgery. A careful evaluation of the general and organ-related conditions of the patients is absolutely necessary for planning the right treatment. Nevertheless, preoperative removal of risk factors and postoperative rehabilitation are as important as the use of the best techniques of anaesthesia and surgery to achieve good postoperative outcomes in these patients. In this review article we take into consideration physiology of the aged and tools available to assess surgical risks in elderly patients, in the aim of increasing awareness on optimising surgical management of elderly patients with cancer. MEDLINE and EMBASE.com (search terms: "elderly", "preoperative", "surgery"), bibliographies of articles retrieved and the authors' reference files have been used as data sources. Independent extraction has been performed by the authors using predefined criteria, including study quality indicators.
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Affiliation(s)
- Lara Maria Pasetto
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy.
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Roberts KC, Wolfson C, Payette H. Predictors of nutritional risk in community-dwelling seniors. Canadian Journal of Public Health 2007. [PMID: 17896747 DOI: 10.1007/bf03405413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors. METHODS Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS) tool was administered and subjects were assigned a level of "nutritional risk" based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months. RESULTS At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR = 3.30, p < 0.05). CONCLUSION Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.
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Affiliation(s)
- Karen C Roberts
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC
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