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Charlton K, Walton K, Brumerskyj K, Halcomb E, Hull A, Comerford T, do Rosario VA. Model of nutritional care in older adults: improving the identification and management of malnutrition using the Mini Nutritional Assessment-Short Form (MNA®-SF) in general practice. Aust J Prim Health 2021; 28:23-32. [PMID: 34911616 DOI: 10.1071/py21053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022]
Abstract
Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment-Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients' experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n = 25) identified that knowledge increased in 96% of staff (P < 0.001). Fifty-five older adults who were screened (two malnourished, 10 'at risk of malnutrition') reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).
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Affiliation(s)
- Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; and Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Karen Walton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; and Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | | | - Elizabeth Halcomb
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia; and School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Alycia Hull
- Grand Pacific Health, Wollongong, NSW 2500, Australia
| | - Teagan Comerford
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Vinicius Andre do Rosario
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; and Corresponding author
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Shakeri A, Hashempur MH, Beigomi A, Khiveh A, Nejatbakhsh F, Zohalinezhad ME, Emtiazy M. Strategies in traditional Persian medicine to maintain a healthy life in the elderly. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 18:29-36. [PMID: 32554835 DOI: 10.1515/jcim-2019-0273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/31/2019] [Indexed: 11/15/2022]
Abstract
As time goes on, a greater number of people experience an age of more than 60 years old and subsequently geriatric syndromes are increasingly more common. Despite recent improvements in modern healthy living, literature on traditional Persian medicine (TPM) about the prevention and treatment of such syndromes and healthy living of the elderly is hardly known. We aimed, in this study, to explore some traditional Persian sources and briefly explain their writers' beliefs on keeping healthy living for old people. We used several TPM sources and literature, and then based on these texts, we collected issues about geriatric temperament and syndromes and classified the results including exercise, nutrition, massage, bathing, aromatherapy, and sleeping. Our search yielded some recommendations about a healthy lifestyle for the elderly, which are in fact equivalent to primary, secondary, and tertiary preventive measures in modern medicine. Our results also showed that they believed such modifications would help the elderly to improve their geriatric conditions. In general, TPM provides some pieces of advice to prevent and treat geriatric syndromes that may be helpful in practice although the scope of their effectiveness remains to be examined in carefully designed randomized controlled trials.
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Affiliation(s)
- Afsaneh Shakeri
- Department of Traditional Medicine, The School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hashem Hashempur
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.,Department of Persian Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Ali Khiveh
- Department of Traditional Medicine, The School of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - Fatemeh Nejatbakhsh
- Department of Traditional Medicine, The School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahim Zohalinezhad
- Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Emtiazy
- Department of Traditional Medicine, The School of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran.,The Research Center of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol 2019; 73:7-13. [DOI: 10.1016/j.jjcc.2018.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/04/2018] [Accepted: 05/14/2018] [Indexed: 11/18/2022]
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Agarwal E, Marshall S, Miller M, Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas 2016; 92:70-78. [DOI: 10.1016/j.maturitas.2016.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023]
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Lim HY, Ho P. Direct Oral Anticoagulants in Dental Patients Including the Frail Elderly Population. Dent J (Basel) 2016; 4:E7. [PMID: 29563449 PMCID: PMC5851203 DOI: 10.3390/dj4010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/11/2016] [Accepted: 03/14/2016] [Indexed: 12/24/2022] Open
Abstract
Direct oral anticoagulants (DOACs) have led to a paradigm shift in the field of anticoagulation, providing safe and convenient anticoagulation without the need for regular blood testing. Currently, there are three major DOACs available-Factor Xa inhibitors (apixaban and rivaroxaban) and direct thrombin inhibitors (dabigatran)-that are available for use in atrial fibrillation and venous thromboembolism. While these agents have been shown to be as effective as warfarin, with a similar or better bleeding profile, there remains some concern of the use of these drugs in vulnerable populations, such as the frail elderly patients; particularly since reversal agents and drug monitoring are not routinely available. We aim to provide a review of the use of DOACs and the impact of DOACs on dental treatment in the elderly population.
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Affiliation(s)
- Hui Yin Lim
- Department of Haematology, Northern Health, 185 Cooper Street, Epping VIC 3076, Australia.
- Department of Haematology, Austin Health, Studley Road, Heidelberg VIC 3084, Australia.
| | - Prahlad Ho
- Department of Haematology, Northern Health, 185 Cooper Street, Epping VIC 3076, Australia.
- Department of Haematology, Austin Health, Studley Road, Heidelberg VIC 3084, Australia.
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Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr 2016; 62:9-25. [DOI: 10.1016/j.archger.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/04/2023]
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Harris ML, Dolja-Gore X, Kendig H, Byles JE. First incident hospitalisation for Australian women aged 70 and beyond: A 10 year examination using competing risks. Arch Gerontol Geriatr 2015; 64:29-37. [PMID: 26952374 DOI: 10.1016/j.archger.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
Abstract
There are increasing concerns regarding high hospital use among older adults and the capacity to manage the economic impact of the ageing population trend on healthcare systems. First hospitalisation in old age may act as a catalyst for ongoing intensification of health problems and acute care use. This study examined factors associated with first incident hospitalisation in women aged over 70, accounting for the health inequalities associated with geographic location. Survey data from 3780 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the Admitted Patients Data Collection and National Death Index. Days to first event (hospitalisation or death) were modelled using competing risks methods. A total of 3065 (80.3%) women had at least one hospital admission. More than half of the top 15 reasons for first hospitalisation were related to cardiovascular disease, with atrial fibrillation the most common. Proportional subdistribution hazards models showed that first hospital admission was driven by enabling and need factors including asthma/bronchitis diagnosis (HR=1.16; p=0.047), private health insurance (HR=1.16; p=0.004) more than two prescribed medications in previous month (HR=1.31; p=0.001), more than four general practitioner visits in previous year (HR=1.50; p=0.034), lower physical functioning (HR=0.99; p<0.001) and living in an inner regional area (HR=1.17; p=0.003). First overnight hospitalisation was primarily related with potentially preventable and treatable chronic diseases. Primary and secondary strategies aimed at chronic disease generally, and better chronic disease management particularly for cardiovascular and respiratory diseases, may play a vital role in disease prevention or delay in readmissions among this population.
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Affiliation(s)
- Melissa L Harris
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Australia.
| | - Xenia Dolja-Gore
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing, College of Medicine, Biology and Environment, Australian National University, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), Australia
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Hamirudin AH, Charlton K, Walton K, Bonney A, Potter J, Milosavljevic M, Hodgkins A, Albert G, Ghosh A, Dalley A. Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study. BMC FAMILY PRACTICE 2014; 15:186. [PMID: 25421546 PMCID: PMC4247715 DOI: 10.1186/s12875-014-0186-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/03/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group. METHODS Nine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling. RESULTS Four key themes were determined regarding the feasibility of performing MNA -SF: ease of use; incorporation into existing practice; benefit to patients' health; and patients' perception of MNA-SF. Two key themes related to the nutrition resource kit: applicability and improvement. These findings were supported by open ended questionnaire responses. Knowledge scores of staff significantly improved from baseline (52% to 66%; P < 0.05). Of the 143 patients that had been screened, 4.2% (n = 6) were classified as malnourished, 26.6% (n = 38) 'at risk' of malnutrition and 69.2% (n = 99) as well-nourished. CONCLUSION It is feasible to include the MNA-SF and a nutrition resource kit within routine general practice, but further refinement of patients' electronic clinical records in general practice software would streamline this process.
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Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas 2013; 76:296-302. [DOI: 10.1016/j.maturitas.2013.07.013] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 01/04/2023]
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Wylie K, Nebauer M. “The Food Here Is Tasteless!” Food taste or tasteless food? Chemosensory Loss and the Politics of Under-Nutrition. Collegian 2011; 18:27-35. [DOI: 10.1016/j.colegn.2010.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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