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Jang JW, Kim Y, Choi YH, Lee JM, Yoon B, Park KW, Kim SE, Kim HJ, Yoon SJ, Jeong JH, Kim EJ, Jung NY, Hwang J, Kang JH, Hong JY, Choi SH. Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease. J Clin Neurol 2019; 15:292-300. [PMID: 31286699 PMCID: PMC6620466 DOI: 10.3988/jcn.2019.15.3.292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished. Methods Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated. Results After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area. Conclusions Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.
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Affiliation(s)
- Jae Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yong Ho Choi
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Jong Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Na Yeon Jung
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Jihye Hwang
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ju Hee Kang
- Department of Pharmacology and Medicinal Toxicology Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea.
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Morley JE. Depression in nursing home residents. J Am Med Dir Assoc 2010; 11:301-3. [PMID: 20511093 DOI: 10.1016/j.jamda.2010.03.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, Saint Louis, Missouri 63104, USA.
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Aoyama L, Weintraub N, Reuben DB. Is Weight Loss in the Nursing Home a Reversible Problem? J Am Med Dir Assoc 2006; 7:S66-72, 65. [PMID: 16500286 DOI: 10.1016/j.jamda.2005.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Linda Aoyama
- UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, CA 90095-1687, USA.
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Mjelde-Mossey LA, Chi I, Lou VWQ. Relationship between adherence to tradition and depression in Chinese elders in China. Aging Ment Health 2006; 10:19-26. [PMID: 16338810 DOI: 10.1080/13607860500308017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the relationship between adherence to tradition and depression in a large sample (N = 1502) of Chinese elders living in the People's Republic of China. In Chinese traditional culture, an elder's purpose, meaning and self-worth are derived, in large, from their social roles within the family and community. As the traditional culture declines so do these familiar roles, supports, and ways of coping. This constitutes a major loss which can have a variety of psychosocial consequences, one of which could be depression. The elders in our study responded to a nine-item measure of traditional mutual aid and intergenerational exchange. Depression was measured by the Center for Epidemiological Studies Depression Scale. Regression analysis found a significant and negative relationship between tradition and depression which suggests that adherence to tradition may have protective benefits. These findings have application with elders in China as well as with those who are immigrants to other societies.
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Affiliation(s)
- L A Mjelde-Mossey
- College of Social Work, The Ohio State University, Columbus 43210-1162, USA.
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Abstract
Frailty occurs in aging males for a variety of reasons. It is less common in males than females. Diseases which are particularly associated with frailty are diabetes mellitus, atherosclerosis, anemia and chronic obstructive pulmonary disease. Insulin resistance syndrome plays a pathogenetic role in the "fat-frail" syndrome. Sarcopenia occurs predominantly because of hormone deficiency and cytokine excess. Pain and anorexia are also associated with frailty. Stem cell research represents a potential promise for the treatment of frailty.
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Affiliation(s)
- J E Morley
- GRECC, VA Medical Center, Saint Louis University School of Medicine, Saint Louis, Missouri 63104, USA.
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Aoyama L, Weintraub N, Reuben DB. Is Weight Loss in the Nursing Home a Reversible Problem? J Am Med Dir Assoc 2005; 6:250-6. [PMID: 16005411 DOI: 10.1016/j.jamda.2005.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Linda Aoyama
- UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, CA 90095-1687, USA.
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Pepersack T. L'altération des fonctions sensorielles et de l'appétit est-elle une fatalité chez le sujet âgé ? NUTR CLIN METAB 2004. [DOI: 10.1016/j.nupar.2004.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Anorexia and weight loss represent a major cause of morbidity and mortality. At present in the United States two effective anorectic agents are commonly used, namely, megestrol acetate and dronabinol. These two agents are compared in Table 1. In persons with a large excess cytokine production. megestrol acetate should be tried at a does of 800 mg per day for no longer than 3 months. Megestrol acetate should be administered with testosterone in men. It should be avoided in persons who are bed-bound because of the risk of deep vein thrombosis. Dronabinol should be used for most anorectic patients. Dronabinol should initially be given in a low dose (2.5 mg) in the evening. The dose should be increased to 5 mg per day if no improvement in appetite is seen after 2 to 4 weeks. Dronabinol can be continued indefinitely. It seems to have a particularly good profile for persons with anorexia who are at the end of life. In persons with depression and anorexia. mirtazapine seems to be the antidepressant of choice. In addition, the use of taste enhancers can be considered in persons who complain that the food does not taste good. The appropriate use of anabolic agents in older persons with weight loss is controversial. Certainly all older men who are losing weight should have bioavailable testosterone measured and, if the testosterone level is low, should receive testosterone replacement therapy. Women who are losing weight may benefit from the use of low-dose testosterone (eg, Estratest). Anabolic agents, such as oxandrolone, should be reserved for those who have profound cachexia. An approach to the management of anorexia and weight loss in older persons is given in Fig. 1. Thomas et al have provided a more complex algorithm the management of weight loss in nursing home residents.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard M238, Saint Louis, MO 63104, USA.
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Abstract
A physiologic decline in food intake occurs with advancing age. The physiologic anorexia of aging and its associated weight loss predispose older persons to develop protein-energy malnutrition. In older persons a variety of social and psychologic factors, diseases, and medications can aggravate the physiologic anorexia and lead to severe weight loss. Many of these factors are amenable to treatment, resulting in a reversal of the underlying malnutrition. This article first reviews the physiologic factors responsible for anorexia in older persons. It then reviews the major pathologic processes responsible for producing protein-energy malnutrition in older persons.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 South Grand Boulevard, M238, St. Louis, MO 63104, USA.
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Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2001; 137:231-43. [PMID: 11283518 DOI: 10.1067/mlc.2001.113504] [Citation(s) in RCA: 717] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sarcopenia is a term utilized to define the loss of muscle mass and strength that occurs with aging. Sarcopenia is believed to play a major role in the pathogenesis of frailty and functional impairment that occurs with old age. Progressive muscle wasting occurs with aging. The prevalence of clinically significant sarcopenia is estimated to range from 8.8% in young old women to 17.5% in old old men. Persons who are obese and sarcopenic (the "fat frail") have worse outcomes than those who are sarcopenic and non-obese. There is a disproportionate atrophy of type IIa muscle fibers with aging. There is also evidence of an age-related decrease in the synthesis rate of myosin heavy chain proteins, the major anabolic protein. Motor units innervating muscle decline with aging, and there is increased irregularity of muscle unit firing. There are indications that cytokines-especially interleukin-1beta, tumor necrosis factor-alpha, and interleukin-6-play a role in the pathogenesis of sarcopenia. Similarly, the decline in anabolic hormones-namely, testosterone, dehydroepiandrosterone growth hormone, and insulin-like growth factor-I-is also implicated in the sarcopenic process. The role of the physiologic anorexia of aging remains to be determined. Decreased physical activity with aging appears to be the key factor involved in producing sarcopenia. An increased research emphasis on the factors involved in the pathogenesis of sarcopenia is needed.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, MO 63104, USA
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Abstract
Poor nutritional status is one of the major factors associated with functional decline and mortality in older persons. Older persons are at increased risk for malnutrition because of the physiologic anorexia of aging. During a stay in a subacute care facility, attention to nutrition is a major component of the rehabilitative process. The pathophysiology of malnutrition, diagnostic techniques available to diagnose malnutrition, causes and management of protein energy malnutrition, specific nutritional problems caused by vitamin and trace element deficiency, and nutritional management of specific diseases (e.g., hip fracture and diabetes mellitus) are reviewed.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education, and Clinical Center, St. Louis Veterans Affairs Medical Center, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, Missouri63104, USA
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Makowski TR, Maggard W, Morley JE. The Life Care Center of St. Louis experience with subacute care. Clin Geriatr Med 2000; 16:701-24. [PMID: 10984751 DOI: 10.1016/s0749-0690(05)70039-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Life Care Center of St. Louis is a 100-bed, freestanding, subacute care facility. The major differences between subacute care facilities and nursing homes are described. The problems associated with dealing with medically complex conditions in a subacute care facility are stressed. The center's approach to rehabilitation is reviewed in detail. The utility of the Functional Independence Measure in subacute care settings is discussed. Common conditions seen in subacute care facilities are briefly reviewed.
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Affiliation(s)
- T R Makowski
- Life Care Center of St. Louis, St. Louis, MO 63103, USA
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Affiliation(s)
- C MacIntosh
- Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Weatherall M. A randomized controlled trial of the Geriatric Depression Scale in an inpatient ward for older adults. Clin Rehabil 2000; 14:186-91. [PMID: 10763796 DOI: 10.1191/026921500672596145] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication. DESIGN Randomized controlled trial. SETTING Inpatient unit for assessment, treatment and rehabilitation of older adults in a district hospital. SUBJECTS Consecutive admissions to the inpatient unit were approached. Of 198 people, 100 gave consent and were randomized to receive the intervention. INTERVENTIONS The Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group. The Nottingham Instrumental Activities of Daily Living questionnaire and the Folstein Mini-mental State Examination were administered to the placebo group. The scores of these instruments and a copy of the completed instrument were placed in the subject's case notes. For those subjects randomized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes. MAIN OUTCOME MEASURES The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission. Other outcome measures were death, readmission and use of antidepressant medication three months after administration of the instruments. RESULTS There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52% in the 50 people administered this instrument. Six out of 46 people administered the Geriatric Depression Scale, who were discharged in the study period, were on antidepressant medication at discharge. Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge. The absolute difference in proportions was 6.7%, 95% confidence interval 19 to -5.3%. CONCLUSIONS A high proportion of patients admitted to an inpatient unit for assessment, treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale; however, use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication. This may be because the instrument is too nonspecific.
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Affiliation(s)
- M Weatherall
- Department of Medicine, Wellington School of Medicine, New Zealand.
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Abstract
In developed countries, medical conditions, rather than lack of food, are the main contributors to malnutrition. Undernutrition is especially common in older persons, occurring in 5-12% of community-dwelling older persons, in 30-61% of hospitalized older persons, and in 40-85% of persons in long-term care institutions. The multi-factorial nature of undernutrition in the elderly forces a structured differential diagnostic approach to determine underlying causes. Heightened physician awareness of nutritional problems and prompt risk assessment is imperative to prevent the sequelae of undernutrition. This structured approach to the differential diagnosis is essential to evaluate potentially reversible causes of malnutrition.
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Affiliation(s)
- D R Thomas
- Division of Gerontology and Geriatric Medicine, Saint Louis University, MO 63104, USA
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Hoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, Mervis JR, Fitten LJ, Rubenstein LZ. Development and testing of a five-item version of the Geriatric Depression Scale. J Am Geriatr Soc 1999; 47:873-8. [PMID: 10404935 DOI: 10.1111/j.1532-5415.1999.tb03848.x] [Citation(s) in RCA: 492] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and test the effectiveness of a 5-item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community-dwelling older population. DESIGN A cross-sectional study. SETTING A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California. PARTICIPANTS A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial. MEASUREMENTS Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5-item version of the GDS was created from the 15-item GDS by selecting the items with the highest Pearson chi2 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15-item GDS and the new 5-item scale. RESULTS Subjects had a mean GDS score of 6.2 (range 0-15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5-item GDS (compared with the 15-item GDS results shown in parentheses) had a sensitivity of .97 (.94), specificity of .85 (.83), positive predictive value of .85 (.82), negative predictive value of .97 (.94), and accuracy of .90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5-item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5- and 15-item GDS were .9 and 2.7 minutes, respectively. CONCLUSIONS The 5-item GDS was as effective as the 15-item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.
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Affiliation(s)
- M T Hoyl
- Geriatric Research, Education and Clinical Center, Veterans Administration Medical Center, Sepulveda, California 91343, USA
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Affiliation(s)
- J E Morley
- Geriatric Research, Education and Clinical Center, St Louis VAMC, MO 63125, USA.
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Abstract
This paper reviews research on the relationship between age and depression in adulthood, with a focus on depression in late life. Age differences in prevalence rates of major depression and depressive symptomatology raise questions about presentation and measurement of depression across adulthood, and suggest a changing salience of risk factors for depression from young adulthood through old age as well as to cohort differences in risk for depression. Applying a developmental perspective on biological change, psychological adaptation, and stress processes throughout adulthood shows that risk for depression onset in young adults is typified more through psychological vulnerability and stress, as well as genetic factors, while risk for depression in older adults typified more through comorbid medical and neurological disorder. Implications for research and clinical practice are discussed. This review of the relationship of age to depression shows that the study of psychopathology and adult development can inform each other.
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Affiliation(s)
- M J Karel
- Brockton/West Roxbury VA Medical Center, MA 02401, USA
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Ryan C, Shea ME. Recognizing depression in older adults: the role of the dietitian. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1996; 96:1042-4. [PMID: 8841167 DOI: 10.1016/s0002-8223(96)00275-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C Ryan
- College of Human Ecology, Louisiana Tech University, Ruston 71272, USA
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Bischmann DA, Witte KL. Food identification, taste complaints, and depression in younger and older adults. Exp Aging Res 1996; 22:23-32. [PMID: 8665985 DOI: 10.1080/03610739608253995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The relationships among the ability to identify food stimuli, self-assessed taste complaints and taste acuity, and depression were examined in younger and older adults. Subjects smelled, tasted, and subsequently identified 10 pureed foods while blindfolded. Subjects also completed a demographic questionnaire, the Beck Depression Inventory, and the Wechsler Adult Intelligence Scale-Revised Vocabulary subtest. Although an age difference in taste complaints was not found, older adults were poorer at identifying food items, rated their taste acuity as lower, and had higher depression scores than the younger adults. However, the age difference in identifying food items was not due to the age difference in depression, because depression was unrelated to food identification scores for both age groups.
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Affiliation(s)
- D A Bischmann
- Department of Psychology, University of Arkansas, Fayetteville 72701, USA
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Miller DK, Brunworth D, Brunworth DS, Hagan R, Morley JE. Efficiency of geriatric case-finding in a private practitioner's office. J Am Geriatr Soc 1995; 43:533-7. [PMID: 7730536 DOI: 10.1111/j.1532-5415.1995.tb06101.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- D K Miller
- Division of Geriatric Medicine, St. Louis University Health Sciences Center, MO, USA
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Morley JE, Flood JF, Silver AJ, Kaiser FE. Effects of peripherally secreted hormones on behavior. Neurobiol Aging 1994; 15:573-7. [PMID: 7969743 DOI: 10.1016/0197-4580(94)90100-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J E Morley
- Geriatric Research Education and Clinical Center, St. Louis, MO 63125
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Abstract
OBJECTIVE To determine the causes of weight loss in nursing home residents. DESIGN Retrospective chart review of all weights over the previous 6 months and an in-depth examination of all residents who lost 5 or more pounds over that period. SETTING A for-profit community nursing home in an urban area. SUBJECTS All residents who had been in the nursing home for 3 or more months. Their mean age was 80.1 years, and 89% were female. RESULTS Weight loss of 5 pounds or more occurred in 19% of subjects. Only 15% of subjects had lost 5% of body weight, and 4% had lost more than 10% of their body weight. Depression accounted for 36% of the weight loss. Other causes of anorexia included medications, psychotropic drug reduction, swallowing disorders, paranoia, dementia with apraxia, gallstones, and obsessive-compulsive disorder. Increased energy utilization as a cause of weight loss was seen in two residents who wandered incessantly, one with tardive dyskinesia and one with chronic obstructive pulmonary disease. Dehydration was the cause of weight loss in two residents, and one resident had international weight loss for obesity. Cancer was the cause of weight loss in two residents. Four of 30 residents had more than one cause of weight loss. One of 25 tube-fed residents displayed weight loss. CONCLUSIONS A single cause of weight loss can be identified in most nursing home residents. Depression is the most common cause of weight loss. Psychotropic drug reduction may cause weight loss. The majority of causes of weight loss in a community nursing home are potentially treatable.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, MO
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Abstract
Evidence for and against the notion of a specific subtype of depressive illness in the elderly is reviewed. There is little to support a distinction based on clinical features, neurobiological markers, treatment response or prognosis, but subtle organic cerebral change may predispose to late-onset depression in a significant minority of cases.
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Affiliation(s)
- R C Baldwin
- Consultant Psychiatrist for the Elderly, York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9BX, UK
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, St. Louis University School of Medicine, MO 63104
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Methylphenidate Treatment of Minor Depression in Very Old Patients. Am J Geriatr Psychiatry 1993; 1:171-174. [PMID: 28531033 DOI: 10.1097/00019442-199300120-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/1992] [Revised: 10/05/1992] [Accepted: 11/13/1992] [Indexed: 11/26/2022]
Abstract
Seven patients age 80-106 who presented with signs and symptoms of depression were successfully treated with 1.25-10 mg of methylphenidate per day without evidence of toxicity or tolerance. Treatment was continued for up to 24 months with sustained benefits.
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Abstract
This article explores the mechanisms by which peripheral gastrointestinal hormones produce central nervous system effects on memory and feeding. Cholecystokinin produces its satiety effects and memory-enhancing effects by stimulating ascending vagal fibers. Hyperglycemia has been demonstrated to be a cause of memory dysfunction in persons with diabetes mellitus. A number of other hormones, such as amylin and bombesin, modulate both memory processing and feeding. The causes of the anorexia of aging are briefly reviewed.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education, and Clinical Center, St. Louis Department of Veterans Affairs, Missouri
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Abstract
Nearly 50% of individuals with type II diabetes mellitus are over the age of 65 years. There are numerous reasons to maintain blood glucose levels below 11.1 nmol/L (200 mg/dl) in older persons, and there are a number of changes often seen with advancing age that persons, and there are a number of changes often seen with advancing age that may interfere with the management of diabetes mellitus, e.g. hypodipsia, anorexia, visual disturbance, altered renal and hepatic function, depression, impaired basoreceptor response and multiple medications. Hyperglycaemia appears to produce cognitive impairment which may lead to poor compliance. It is often difficult to manipulate diet in older people, and in fact dietary changes can lead to severe protein energy malnutrition. High maximum voluntary oxygen intake has been correlated with increased glucose disposal, but there is little evidence that physical exercise can improve diabetic control in the elderly. Oral sulphonylurea hypoglycaemic agents are extremely useful in the treatment of diabetes in these patients, but it should be remembered that they are more liable to develop hypoglycaemia than are younger diabetics. The role of metformin in the management of older diabetic patients is poorly studied. Many older persons can cope well with insulin therapy, but those with visual disturbances often make errors when drawing up insulin and require special attention. Combination therapy of insulin with oral hypoglycaemic agents is not recommended in this group of patients, and serum fructosamine is preferred to glycated haemoglobin to monitor control. Successful management of elderly diabetic patients thus requires an interdisciplinary team approach.
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Affiliation(s)
- J E Morley
- Geriatric Research Education and Clinical Center, St Louis VA Medical Center, Missouri
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Sakauye K, Maletta GJ. Pharmacokinetic and Pharmacodynamic Considerations in Psychotropic Medication Use in the Elderly: An Overview. Psychiatr Ann 1991. [DOI: 10.3928/0048-5713-19910101-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pierron RL, Perry HM, Grossberg G, Morley JE, Mahon G, Stewart T. The aging hip. St. Louis University Geriatric Grand Rounds. J Am Geriatr Soc 1990; 38:1339-52. [PMID: 2254574 DOI: 10.1111/j.1532-5415.1990.tb03458.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R L Pierron
- Department of Orthopedics, St. Louis University Medical School, Missouri
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Grossberg GT, Hassan R, Szwabo PA, Morley JE, Nakra BR, Bretscher CW, Zimny GH, Solomon K. Psychiatric problems in the nursing home. St. Louis University Geriatric Grand Rounds. J Am Geriatr Soc 1990; 38:907-17. [PMID: 2387957 DOI: 10.1111/j.1532-5415.1990.tb05709.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G T Grossberg
- Department of Geriatric Psychiatry, St. Louis University Medical Center, St. Louis, MO 63104
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Miller DK, Morley JE, Rubenstein LZ, Pietruszka FM, Strome LS. Formal geriatric assessment instruments and the care of older general medical outpatients. J Am Geriatr Soc 1990; 38:645-51. [PMID: 2358626 DOI: 10.1111/j.1532-5415.1990.tb01423.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To improve identification of cognitive, affective, gait, and nutritional problems in older medical outpatients, non-physician clinic personnel administered formal geriatric assessment tools to 183 medical outpatients age 70 years and older. Definite impairments were demonstrated in 7% to 23% of patients (depending on the function being assessed), and borderline abnormal results were common as well. Overall, 56% of patients had at least one meaningful impairment identified. Few of these problems had been recognized before the survey. Assessment required 10 to 15 minutes of interviewer time per patient (approximately 22 minutes for each problem newly uncovered). A simple education and information intervention led to physicians addressing the newly identified problem in 30% to 55% of cases. These results suggest that formal geriatric assessment instruments provide an efficient mechanism for case finding in older medical outpatients. Further studies are necessary to determine whether such interventions will lead to improved outcomes in older medical outpatients.
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Affiliation(s)
- D K Miller
- Division of Geriatric Medicine, St. Louis University Medical Center, MO 63104
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Affiliation(s)
- M A Lee
- Department of Medicine, Oregon Health Sciences University, Portland
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Bianchetti A, Rozzini R, Carabellese C, Zanetti O, Trabucchi M. Nutritional intake, socioeconomic conditions, and health status in a large elderly population. J Am Geriatr Soc 1990; 38:521-6. [PMID: 2332573 DOI: 10.1111/j.1532-5415.1990.tb02401.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The nutritional intake of a large population of noninstitutionalized older people living in an urban area was studied in relation to socioeconomic conditions (living environment, income, and education) and health status (affective, functional, and physical health) to identify the subgroups at risk for malnutrition. Twenty-four-hour dietary recall was used to determine the percentage of older subjects with dietary intake of specific nutrients below two thirds of the 1980 Recommended Dietary Allowances. Ninety percent of the older people examined showed inadequate intake of thiamine and vitamin B6, and 30% to 40% demonstrated deficiencies of vitamin A, vitamin C, niacin, vitamin B12, calcium, and iron; only 10% of subjects had inadequate intake of protein. Poor nutritional intake was correlated more strongly with socioeconomic conditions, functional level, and affective status than with physical health status.
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