Tackling malnutrition among older people in the community

Screening for social determinants of health in clinical care: moving from the margins to the mainstream

Background

Screening for the social determinants of health in clinical practice is still widely debated.

Methods

A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care.

Results

Over the last two decades, a growing number of screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems).

Conclusion

There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. There is also a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels.

Is serum albumin a marker of malnutrition in chronic disease? The scleroderma paradigm

BACKGROUND

Malnutrition is common in many chronic diseases, but physicians may rely on a low albumin value before deciding that malnutrition is present.

OBJECTIVE

To determine the relationship between serum albumin and malnutrition in systemic sclerosis (SSc) as a paradigm for other chronic diseases.

DESIGN

Cross-sectional, multicenter study of patients from the Canadian Scleroderma Research Group Registry. We used the Malnutrition Universal Screening Tool (MUST) to evaluate patients for malnutrition. Disease extent was measured in several ways, including physician global assessment. Multiple linear regression was performed to identify independent predictors of serum albumin.

RESULTS

Two hundred fifty-eight patients were studied. The mean (SD) serum albumin level was 44.4 (4.2) g/L. Only 2% of the values were below normal and all these patients were in MUST category > or =2, or high risk for malnutrition, which included 21.3% of the cohort. MUST, shorter disease duration, greater disease severity (physician global assessment of disease severity and modified Rodnan skin score), and greater disease activity (physician global assessment of disease activity, C-reactive protein, and Scleroderma Disease Activity Index) all correlated significantly but weakly with albumin. Multivariate analysis demonstrated that a higher MUST score and worse disease severity were independently associated with lower serum albumin, but only 7% of the variance of albumin was explained in the adjusted model.

CONCLUSIONS

Serum albumin is not useful as a marker for malnutrition in SSc and should not be assumed to be useful as a marker in other chronic diseases. More attention should be paid to clinical features of malnutrition, including assessment of body mass index and unplanned weight loss, and overall disease severity.

Apple juice improved behavioral but not cognitive symptoms in moderate-to-late stage Alzheimer's disease in an open-label pilot study

Preclinical studies demonstrate that apple juice exerts multiple beneficial effects including reduction of central nervous system oxidative damage, suppression of Alzheimer's disease (AD) hallmarks, improved cognitive performance, and organized synaptic signaling. Herein, we initiated an open-label clinical trial in which 21 institutionalized individuals with moderate-to-severe AD consumed 2 4-oz glasses of apple juice daily for 1 month. Participants demonstrated no change in the Dementia Rating Scale, and institutional caregivers reported no change in Alzheimer's Disease Cooperative Study (ADCS)-Activities of Daily Living (ADL) in this brief study. However, caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion. This pilot study suggests that apple juice may be a useful supplement, perhaps to augment pharmacological approaches, for attenuating the decline in mood that accompanies progression of AD, which may also reduce caregiver burden.

Percutaneous endoscopic gastrostomy feeding: indications and management

Percutaneous endoscopic gastrostomy (PEG) has become one of the most useful and established enteral nutrition techniques available to patients requiring nutritional support worldwide. Good nutrition and the receiving of essential nutrients and electrolytes are vital for growth, healing, repair and delivery of essential energy to carry out daily tasks. The article looks specifically at PEG as a form of enteral nutrition delivery, how it is undertaken, and the care needs of the patient post-insertion of a PEG tube.

An overview of the role of diet during the ageing process

The UK is experiencing an ageing population but this is not matched by a similar increase in healthy life expectancy. Some of the major biological life changes associated with ageing result from the accumulation of lifelong molecular damage to cells, but many health problems are attributable to lifestyle and environmental factors. Diet is one factor believed to play a key role in the prevention and treatment of chronic diseases associated with ageing. Diets that are high in total fat, saturated fat and salt, and low in fibre, fruits and vegetables, are central to the development of CVD, type 2 diabetes and cognitive decline among elderly people. In contrast, under nutrition is also a major problem in this age group, with many elderly people having low intakes of essential vitamins and minerals. Good nutrition is essential for healthy ageing and a multi-disciplinary, life-course, approach to ageing is vital in minimising its implications for quality of life and public health.

Malnutrition: supplements and food fortification in the older population

There is an important relationship between positive nutritional status, dietary intake and a healthy population. Lifelong adoption of healthy eating patterns is essential for life and can help reduce the risk of development of many illnesses. Malnutrition remains very prevalent in both developed and developing countries despite ongoing awareness campaigns. The consequences of malnutrition are broad-ranging and ultimately impact on quality of life, increase length of stay in hospital and overall; increase the risk of unsuccessful outcomes of treatment. The management of malnutrition requires using appropriate screening tools to identify malnutrition and access to a registered dietician-who are the experts in nutrition-who will provide dietary advice to improve dietary intake through conventional dietary means and if unsuccessful through artificial supplementation. Failure to acknowledge the risks of malnutrition can seriously impact on morbidity and mortality rates.