1
|
Khatib SE, Malham CB, Andrieu S, Strumia M, Cestac P, Salameh P. Fall risk factors among poly-medicated older Lebanese patients in primary care settings: a secondary cross-sectional analysis of the "MGPIDP-L project". BMC Geriatr 2024; 24:327. [PMID: 38600461 PMCID: PMC11008041 DOI: 10.1186/s12877-024-04951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Falling is a major concern for the health of older adults and significantly affects their quality of life. Identifying the various risk factors and the differences between older patients can be challenging. The objective of this study was to identify the risk factors for falls among polymedicated community-dwelling older Lebanese patients following a medication review. METHODS In this analytical cross-sectional study, we examined the risk factors for falls in 850 patients aged ≥ 65 years who were taking ≥ 5 medications daily. The study involved conducting a medication review over the course of a year in primary care settings and using multivariate logistic regression analysis to analyze the data. RESULTS Our results showed that 106 (19.5%) of the 850 included patients had fallen at least once in the three months prior to the medication review. Loss of appetite and functional dependence were identified as the most significant predictors of falls ORa = 3.020, CI [2.074-4.397] and ORa = 2.877, CI [1.787-4.632], respectively. Other risk factors for falls included drowsiness ORa = 2.172, CI [1.499-3.145], and the use of beta-blockers ORa = 1.943, CI [1.339-2.820]. CONCLUSION Our study highlights the importance of addressing multiple risk factors for falls among Lebanese older adults and emphasizes the need for customized interventions and ongoing monitoring to prevent falls and improve health outcomes. This study sheds light on a critical issue in the Lebanese older population and provides valuable insight into the complex nature of falls among poly-medicated Lebanese community-dwelling older adults. TRIAL REGISTRATION 2021REC-001- INSPECT -09-04.
Collapse
Affiliation(s)
- Sarah El Khatib
- Paul Sabatier University III, 31063, Toulouse, France.
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France.
| | - Carmela Bou Malham
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
| | - Sandrine Andrieu
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Mathilde Strumia
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Philippe Cestac
- Paul Sabatier University III, 31063, Toulouse, France
- Aging and Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Toulouse University, Inserm, Paul Sabatier University, Faculty of Medecine, 37 Allées J.Guesde, 31000, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, 31059, Toulouse, France
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, 1401, Lebanon
- University of Nicosia Medical School, 1065, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, 1100, Lebanon
- Institut National de Santé Publique, Epidémiologie Clinique Et Toxicologie INSPECT-LB), Beirut, 1100, Lebanon
| |
Collapse
|
2
|
Medication Intake Is Associated with Lower Plasma Carotenoids and Higher Fat-Soluble Vitamins in the Cross-Sectional MARK-AGE Study in Older Individuals. J Clin Med 2020; 9:jcm9072072. [PMID: 32630295 PMCID: PMC7408954 DOI: 10.3390/jcm9072072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/16/2022] Open
Abstract
The regular use of medication may interfere with micronutrient metabolism on several levels, such as absorption, turnover rate, and tissue distribution, and this might be amplified during aging. This study evaluates the impact of self-reported medication intake on plasma micronutrients in the MARK-AGE Project, a cross-sectional observational study in 2217 subjects (age- and sex-stratified) aged 35-75 years from six European countries that were grouped according to age. Polypharmacy as possible determinant of micronutrient concentrations was assessed using multiple linear regression models adjusted for age-group, dietary fruit, vegetables, and juice intake, and other confounders. Younger participants reported taking fewer drugs than older participants. Inverse associations between medication intake and lutein (-3.31% difference per increase in medication group), β-carotene (-11.44%), α-carotene (-8.50%) and positive associations with retinol (+2.26%), α-tocopherol/cholesterol (+2.89%) and γ-tocopherol/cholesterol (+1.36%) occurred in multiple adjusted regression models. Combined usage of a higher number of medical drugs was associated with poorer status of carotenoids on the one hand and higher plasma concentrations of retinol, α- and γ-tocopherol on the other hand. Our results raise concerns regarding the safety of drug combinations via the significant and surprisingly multifaceted disturbance of the concentrations of relevant micronutrients.
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Fatima N, Faisal SM, Zubair S, Siddiqui SS, Moin S, Owais M. Emerging role of Interleukins IL-23/IL-17 axis and biochemical markers in the pathogenesis of Type 2 Diabetes: Association with age and gender in human subjects. Int J Biol Macromol 2017; 105:1279-1288. [PMID: 28757426 DOI: 10.1016/j.ijbiomac.2017.07.155] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 01/10/2023]
Abstract
Chronic hyperglycaemia in type 2 diabetes (T2D) is associated with increased oxidative stress and inflammation. Keeping the above fact into consideration we analyse the effect of age and gender on oxidative stress biomarkers and pro-inflammatory cytokines in T2D patients. The study included 148 diabetic and 110 healthy subjects, grouped on the basis of age and gender. Plasma malondialdehyde, protein carbonyl content and nitric oxide levels were elevated significantly in diabetic patients, with significant decrease in Ferric reducing ability of plasma, vitamin C, reduced glutathione, erythrocyte thiol groups and erythrocyte antioxidant enzyme activity and these changes were even more pronounced as age progressed. Serum IL-1β, IL-6, IL-17A, IL-22 levels and TNF-α mRNA expression was significantly upregulated in all the age groups whereas IL-23 mRNA was upregulated only in the higher age group. Female diabetic patients experienced higher oxidative stress and greater serum IL-6 levels and TNF-α mRNA expression as compared to their male counterparts. This study suggested that diabetes onset is accompanied with increased oxidative stress and elevated levels of inflammatory mediators. The effect was more prominent in aged patients. Female patients experienced greater oxidative stress as compared to males of those age groups with slightly higher levels of inflammatory cytokines.
Collapse
Affiliation(s)
- Naureen Fatima
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Syed Mohd Faisal
- Molecular Immunology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Swaleha Zubair
- Women's College, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Sheelu Shafiq Siddiqui
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Shagufta Moin
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Mohammad Owais
- Molecular Immunology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India.
| |
Collapse
|
5
|
Are the Recommended Dietary Allowances for Vitamins Appropriate for Elderly People? J Acad Nutr Diet 2015; 115:1789-97. [DOI: 10.1016/j.jand.2015.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 04/10/2015] [Indexed: 11/19/2022]
|
6
|
Comhaire F, Mahmoud A. The andrologist's contribution to a better life for ageing men: part 2. Andrologia 2015; 48:99-110. [PMID: 26395368 DOI: 10.1111/and.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 02/06/2023] Open
Abstract
The long-term intake of a judiciously composed nutriceutical containing low-dose vitamins, antioxidants, minerals and particular herbal preparations seems justified for older persons who take medication, or who consume an unbalanced diet, or who are exposed to environmental toxins. Recent reports suggest these nutriceuticals may delay age-related diseases and the occurrence of cancer, and reduce mortality in apparently healthy ageing men. Food supplementation with a nutriceutical that was formulated particularly for ageing men should result in an increase of at least one quality-adjusted life year and may lower the financial and social burden of disease in elderly people.
Collapse
Affiliation(s)
- F Comhaire
- Department of Endocrinology, University Hospital Gent, Gent, Belgium
| | - A Mahmoud
- Department of Endocrinology, University Hospital Gent, Gent, Belgium
| |
Collapse
|
7
|
Comhaire FH, Depypere HT. Hormones, herbal preparations and nutriceuticals for a better life after the menopause: part II. Climacteric 2015; 18:364-71. [DOI: 10.3109/13697137.2014.985646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
8
|
Rauh-Pfeiffer A, Handel U, Demmelmair H, Peissner W, Niesser M, Moretti D, Martens V, Wiseman S, Weichert J, Heene M, Bühner M, Koletzko B. Three-month B vitamin supplementation in pre-school children affects folate status and homocysteine, but not cognitive performance. Eur J Nutr 2014; 53:1445-56. [PMID: 24481688 DOI: 10.1007/s00394-013-0647-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/18/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Suboptimal vitamin B status might affect cognitive performance in early childhood. We tested the hypothesis that short-term supplementation with folic acid and selected B vitamins improves cognitive function in healthy children in a population with relatively low folate status. METHODS We screened 1,002 kindergarten children for suboptimal folate status by assessing the total urinary para-aminobenzoylglutamate excretion. Two hundred and fifty low ranking subjects were recruited into a double blind, randomized, controlled trial to receive daily a sachet containing 220 μg folic acid, 1.1 mg vitamin B2, 0.73 mg B6, 1.2 μg B12 and 130 mg calcium, or calcium only for 3 months. Primary outcomes were changes in verbal IQ, short-term memory and processing speed between baseline and study end. Secondary outcomes were urinary markers of folate and vitamin B12 status, acetyl-para-aminobenzoylglutamate and methylmalonic acid, respectively, and, in a subgroup of 120 participants, blood folate and plasma homocysteine. RESULTS Pre- and post-intervention cognitive measurements were completed by 115 children in the intervention and 122 in the control group. Compared to control, median blood folate increased by about 50% (P for difference, P < 0.0001). Homocysteine decreased by 1.1 μmol/L compared to baseline, no change was seen in the control group (P for difference P < 0.0001) and acetyl-para-aminobenzoylglutamate was 4 nmol/mmol higher compared to control at the end of the intervention (P < 0.0001). We found no relevant differences between the groups for the cognitive measures. CONCLUSION Short-term improvement of folate and homocysteine status in healthy children does not appear to affect cognitive performance.
Collapse
Affiliation(s)
- Astrid Rauh-Pfeiffer
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Lindwurmstraße 4, 80337, Munich, Germany,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Fabian E, Bogner M, Kickinger A, Wagner KH, Elmadfa I. Vitamin status in elderly people in relation to the use of nutritional supplements. J Nutr Health Aging 2012; 16:206-12. [PMID: 22456774 DOI: 10.1007/s12603-011-0159-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to evaluate the status of several vitamins and to investigate the effect of regular individual supplementation on their status in this population. DESIGN An observational study. SETTING State of Burgenland, Austria. PARTICIPANTS A total of 102 non-institutionalized subjects (49% supplementing regularly, 51% without supplementation) aged between 70-90 years were recruited. MEASUREMENTS Plasma levels of vitamins A, D, E, K and C were determined by HPLC. The functional parameters of vitamins B1, B2 and B6, i.e. the activities of the erythrocyte enzymes transketolase, glutathione reductase and glutamic oxaloacetic transaminase, were analyzed photometrically; plasma folate and vitamin B12 were determined by RIA. RESULTS The status of vitamins A, E and C was generally satisfactory. Eighty-eight percent and 42% of participants were deficient in vitamins D and K, respectively, as were 29% for B6; up to 10% of participants were deficient in vitamins B1, B2, B12 and folate. A considerable percentage of participants was, however, at risk for vitamin deficiencies (vitamins B1, B6, B12, folate: 20-30%, vitamin B2: 60%). Except for vitamins A and K, regular intake of supplements had a significant positive influence on vitamin levels. CONCLUSION These results indicate that use of supplements significantly improved the status of several vitamins in elderly people. Due to age-related problems concerning the intake and digestion of nutrients, a moderate, regular supplementation might be a useful option for older people who are otherwise unable to satisfy their micronutrient requirements.
Collapse
Affiliation(s)
- E Fabian
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria.
| | | | | | | | | |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Increasing use of drugs among elderly people has raised concerns about possible negative health outcomes, including malnutrition, associated with polypharmacy. Evidence about the association of polypharmacy with nutritional status is scarce. This review summarizes the relevant evidence regarding polypharmacy and nutritional status in elderly people. RECENT FINDINGS The probability of nutritional problems as a consequence of drugs is highest in elderly people suffering from several diseases. Drug treatment may contribute to poor nutritional status by causing loss of appetite, gastrointestinal problems, and other alterations in body function. Some recently published studies add evidence on possible association between increasing number of drugs and malnutrition. Studies indicate also an association between polypharmacy and weight changes. In addition, there are available studies that have shown deficits in the intake of specific macronutrients and micronutrients (e.g. fiber, glucose, and specific vitamins) for those with a high number of drugs in use. SUMMARY On the basis of available evidence, the role of polypharmacy on nutritional status among elderly people is unclear. Some diseases promote malnutrition; thus, the independent role of drugs for nutritional status is challenging to determine. Longitudinal studies with careful adjustment for underlying diseases are needed to explore association between polypharmacy and malnutrition. Nutritional evaluation should be a routine part of comprehensive geriatric assessment that is conducted ideally in multiprofessional teams, including physician, pharmacist, and dietitian.
Collapse
|