Challenges in the Management of Geriatric Obesity in High Risk Populations

Alternative protein sources from selected legumes and mushrooms in the development of high-protein instant soup for the elderly

Elderly people are susceptible to malnutrition due to many factors. An essential public health priority is ensuring that seniors have appropriate nutrition to prevent and treat malnutrition and dehydration as well as fulfilling the nutrition necessity. This study was conducted to utilize selected legumes and mushrooms to develop a high-protein instant soup (HPIS) product that is nutritious and suitable for the consumption of the elderly. Black bean, along with oyster mushroom and split-gill mushrooms, exhibited considerable amounts of protein (19.13 ± 1.13, 2.77 ± 0.09, and 4.65 ± 0.61 g/100 g, respectively), calcium (2308.65 ± 113.07, 640.19 ± 0.80, and 743.89 ± 0.66, respectively), iron (40.84 ± 2.42, 7.31 ± 0.05, and 40.10 ± 2.15, respectively), and zinc (18.06 ± 1.07, 3.87 ± 0.03, and 26.23 ± 0.78, respectively) content, and were incorporated into the HPIS formula. Drum dryer rotation speed significantly affected the HPIS properties. The study on the effect of different rotation speeds (3, 5, 7, and 9 RPM) used during the drying process revealed the use of 7 RPM resulting in the soup product with considerable quality. The optimized HPIS formula, which was supplemented with minerals, was moderately liked (7.1-7.5) by the elderly consumer. The majority of the consumers accepted the product (97 %) and were interested in purchasing the product (91 %) if it was available on the market. Incorporating selected legumes and mushrooms resulted in a soup product containing nutrition conforming to the Thai recommended daily intake (RDI), possessing adequate physicochemical and sensory properties for the consumption of the elderly.

Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity

Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.

Characteristics of nursing homes with high percentages of falls and falls with injuries among residents with obesity

BACKGROUND

Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group.

AIM

We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity.

METHOD

We used resident assessment data and logistic regression analysis.

RESULTS

We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day.

CONCLUSION

Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity.

Obesity in Nursing Home Patients: Association with Common Care Problems

(1) Background: There is not much research about obesity in nursing homes although knowledge will help us to develop customized treatment plans and prevention strategies, which may help to decrease the burden for all persons involved. The objective of conducting this study was to describe the prevalence of obesity and the association between obesity and care problems in nursing home patients. (2) Methods: This study is a secondary data analysis of data collected in an annually performed cross-sectional study called "Nursing Quality Measurement 2.0". A standardized and tested questionnaire was used to collect data. (3) Results: In total, 1236 nursing home patients took part, and 16.7% of them were obese. The multivariate logistic regression analysis results show that urinary incontinence is significantly associated with the presence of obesity (OR 2.111). The other care problems of pressure injuries, fecal and double incontinence, physical restraints, falls, and pain were not associated with obesity. (4) Conclusions: The results indicate that, in the nursing home setting, healthcare staff should pay special attention to the patients' nutritional status and help patients to maintain a healthy weight and prevent a loss of muscle mass and function. Conducting more studies with larger sample sizes is recommended, as this will allow for differentiation among different obesity classes.

The efficacy of goal-directed recommendations in overcoming barriers to elective ventral hernia repair in older adults

BACKGROUND

Although ventral hernias are common in older adults and can impair quality of life, multiple barriers exist that preclude ventral hernia repair. The goal of this study was to determine if older adults with ventral hernias achieve surgeon-directed goals to progress to an elective ventral hernia repair.

METHODS

Patients ≥60 years evaluated for a ventral hernia in a specialty clinic from January 2018 to August 2021 were retrospectively reviewed. Nonoperative candidates with modifiable risk factors were included. Data collected included specific barriers to ventral hernia repair and recommendations to address these barriers for future ventral hernia repair eligibility. Patients lost to follow-up were contacted by phone.

RESULTS

In total, 559 patients were evaluated, with 182 (32.6%) deemed nonoperative candidates with modifiable risk factors (median age 68 years, body mass index 38.2). Surgeon-directed recommendations included weight loss (53.8%), comorbidity management by a medical specialist (44.0%), and smoking cessation (19.2%). Ultimately, 45/182 patients (24.7%) met preoperative goals and progressed to elective ventral hernia repair. Alternatively, 5 patients (2.7%) required urgent/emergency surgical intervention. Importantly, 106/182 patients (58.2%) did not return to clinic after initial consultation. Of those contacted (n = 62), 35.5% reported failure to achieve optimization goals. Initial body mass index ≥40 and surgeon-recommended weight loss were associated with lack of patient follow-up (P = .01, P = .02) and progression to elective ventral hernia repair (P = .009, P = .005).

CONCLUSION

Nearly one-third of older adults evaluated for ventral hernias were nonoperative candidates, most often due to obesity, and over half of these patients were lost to follow-up. An increase in structured support is needed for patients to achieve surgeon-specified preoperative goals.

Effectiveness of a Two-Year Multicomponent Intervention for the Treatment of Overweight and Obesity in Older People

This study aimed to assess the effectiveness of a two-year intervention based on the Mediterranean diet for the treatment of overweight and obesity in a sample of 51 older people from the Mediterranean city of Alicante (Spain). We also examined the effects of the intervention on psychological well-being. The participants were randomly assigned to the experimental and control groups. The experimental group received group nutritional education sessions, an individualized dietary-nutritional treatment based on a Mediterranean diet, and a physical activity program; the control group received Mediterranean nutritional education in a written format. The experimental group showed a greater loss in weight (p = 0.017) and percentage of fat mass (p = 0.049), and a greater reduction in body mass index (BMI) (p = 0.014) and waist circumference (p = 0.010). Both groups improved their depression scores using the PHQ-9; however, no significant improvement was seen in adherence to the Mediterranean diet (PREDIMED) and anxiety level (GAD-7). These results suggest that a two-year intervention based on the Mediterranean diet allows an older population with overweight or obesity to achieve greater weight loss and a greater decrease in BMI, waist circumference, and fat mass percentage. In relation to psychological well-being, depression levels improved at the end of said intervention.

Clustering of Physical Activity and Sedentary Behavior Associated With Body Composition in Brazilian Older Adults

This study described the clustering patterns of moderate to vigorous physical activity and sedentary time (ST) according to handgrip strength and investigated the association between identified clusters of fat and lean mass in older adults from southern Brazil. Objective measures were used for moderate to vigorous physical activity, ST, and body composition outcomes. Two-step cluster and linear regression analyses were conducted according to handgrip strength. Three clusters were identified: all-day sitters, sitters, and active sitters. The prevalence of clusters in the low-strength group was 58.2%, 22.8%, and 19.0%, respectively, while the prevalence of clusters in the high-strength group was 42.1%, 34.8%, and 23.1%, respectively. All-day sitters had 2.6% more fat mass than active sitters with low strength. High levels of ST characterized all cluster profiles; low strength, lack of moderate to vigorous physical activity, and high ST levels among older adults may indicate a subpopulation at a greater risk of overweight and obesity-related diseases.

Proposed cut-off points for anthropometric and bioelectrical measures based on overweight and obesity criteria in Spanish institutionalised elderly people

The increasing prevalence of obesity among the institutionalised elderly population and its severe consequences on health requires an early and accurate diagnosis that can be easily achieved in any clinical setting. This study aimed to determine new cut-off values for anthropometric and bioelectrical impedance measures that are superior to body mass index criteria for overweight and obesity status in a sample of Spanish institutionalised elderly population. A total of 211 institutionalised older adults (132 women, aged 84.3±7.3 years; 79 men, aged 81.5±7.3 years) were enrolled in the current cross-sectional study. Anthropometric and bioelectrical impedance measures included the body mass index, waist circumference, gluteal circumference, waist-hip ratio, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio. In women, the waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat index presented strongly significant specificity and sensitivity (area under the curve [AUC], p<0.0001) and elevated discriminative values (receiver operating characteristic [ROC] curves: 0.827 to 0.867) for overweight and obesity status. In men, the waist-hip ratio, waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio were strongly significant AUC (p<0.0001), with moderate-to-high values (ROC curves: 0.757-0.871). In conclusion, our findings suggest that gluteal circumference, waist circumference, and sagittal-abdominal diameter in women and trunk fat, visceral-fat ratio, and waist circumference in men may represent more suitable cut-off values superior to body mass index criteria for overweight and obesity in the Spanish institutionalised elderly population.

A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea

This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.

[Current ESPEN Guideline Clinical Nutrition and Hydration in Geriatrics]

Malnutrition, dehydration and obesity are relevant health problems with far-reaching consequences for older people. Routine screening for malnutrition and dehydration should be carried out in order to identify vulnerable and affected persons at an early stage and to be able to take timely countermeasures. In many cases, adequate nutrition and hydration can be supported by simple nursing measures and optimisation of the food and drink supply. Nutritional advice, sip feed, enteral and parenteral nutrition are further effective measures for the prevention and therapy of malnutrition. An ingestion deficiency dehydration should be diagnosed on the basis of serum osmolality and requires a rapid compensation of the deficit by hypotonic fluids - depending on the severity, in the form of drinks, subcutaneously or intravenously. Weight loss in old age should only be considered in cases of obesity with associated health problems and should be achieved by moderate energy reduction in combination with physical exercise.

Dietary weight-loss interventions for the management of obesity in older adults

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) < 35 kg/m²), other recent research indicates that voluntary weight loss can positively affect diverse health outcomes in older individuals with overweight and obesity (BMI > 27 kg/m²), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m²) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

Safety and effectiveness of laparoscopic Y-en-Roux gastric bypass surgery in obese elderly patients

Purpose

To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique.

Methods

Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant.

Results

Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown.

Conclusions

Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.

[Problems of optimal nutrition of elderly and senile patients with comorbidities against obesity]

AIM

To analyze the effectiveness of the main and low - calorie standard diets in elderly and senile patients with comorbidities against obesity.

MATERIALS AND METHODS

Retrospective analysis of the inpatient data. Patients received the main or low - calorie standard diet at the Nutrition clinic. The analysis included clinical, laboratory, body composition (bioimpedance) parameters and the results of indirect calorimetry. The primary endpoint was anthropometric and body composition data. Statistical analysis was performed using Statistica 10.0 for Windows 6.1 (StatSoft Inc., USA).

RESULTS AND DISCUSSION

46 patients were included in the analysis. The average age was 65 years (95% CI 63.63-66.37 years). All patients had abdominal obesity. 44 patients (97.78%) had hypertension, 32 (71.11%) - osteoarthrosis, 28 (60.87%) - dyslipidemia, 16 (35.56%) - diabetes mellitus; and сoronary artery disease was detected in 9 patients (20%). Diet therapy caused a statistically significant decrease in body weight, waist and hip circumferences, fat mass, lean mass, total body fluid and muscle mass (in particular, 25.35% weight loss was due to muscle mass loss), as well as the improvement of lipid profile.

CONCLUSION

Dietary interventions, such as main and low - calorie standard diets, routinely used for inpatient settings allow us to reduce body weight and improve anthropometric parameters in elderly and senile obese patients with comorbidities, which is accompanied by positive changes in lipid and carbohydrate metabolism even in a short - term follow - up. However, the protein content for standard diets is insufficient for this target group and leads to the loss of both fat and muscle mass.

Obesity in the geriatric population - a global health perspective

The obesity crisis has been a major concern for public health organizations worldwide, and affects the geriatric population in parallel to that of the general population. Though geriatric obesity has been recognized in developed countries, such trends have also extended into developing countries due to disproportionate consumption of energy-dense low-cost food and increasingly sedentary lifestyles. The consequences of geriatric obesity include impaired physical function, decreased quality of life, institutionalization and death. The aim is to describe the obesity epidemic in both developed and developing countries, as well as highlight current surveillance efforts to monitor geriatric obesity on a global scale such as the Study on Global Ageing and Adult Health (SAGE study), which evaluates epidemiology trends in six different countries (China, Ghana, India, Mexico, Russia and South Africa). The impact of obesity on health, disease and systems worldwide will be described, as well as projections of future trends of this disease.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services. POSITION STATEMENT: It is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly - a preliminary study

Purpose

Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.

Patients and methods

A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.

Results

The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model.

Conclusion

For detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.

ESPEN guideline on clinical nutrition and hydration in geriatrics

BACKGROUND

Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats.

AIM

To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.

METHODS

This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.

RESULTS

We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.

CONCLUSION

A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Effect of the asthma-chronic obstructive pulmonary disease syndrome on the stroke, Parkinson's disease, and dementia: a national cohort study

Background

To evaluate the association of asthma–chronic obstructive pulmonary disease syndrome (ACOS) with neurodegenerative diseases (stroke, Parkinson's disease and dementia) and the role of the steroids in the neurodegenerative diseases among the ACOS cohort.

Materials and Methods

Comparison of the ACOS cohort (N = 10,260) with the non-ACOS cohort (n = 20,513) based on the patients aged ≧40 years in the National Health Insurance Research Database from January 1, 2000 to December 31, 2010. These patients follow up to diagnosis of neurodegenerative diseases or the December 31, 2011; using multivariable Cox proportional hazards models.

Results

After adjustment for potential confounders, the [adjusted hazard ratio (aHR), 95% confidence interval (CI)] in the ACOS cohort were [1.39, 1.28–1.50] [1.56, 1.34–1.81] and [1.43, 1.29–1.59] for stroke, Parkinson's disease, dementia; respectively. The [aHR, 95% CI] for ACOS cohort with (inhaler corticosteroids ≧0.13 gram/ oral steroids ≧0.08gram) were with less risk (all aHR<1, p values <0.05) for these 3 neurodegenerative diseases except Parkinson's disease with inhaler corticosteroids >0.43 gram. The risk of stroke and dementia were the lower in patients with < 250 μg/d of a fluticasone equivalent inhaler corticosteroids (aHR = 0.53, 95% CI = 0.35–0.79; aHR = 0.53, 95% CI = 0.31–0.90, respectively).

Conclusions

The ACOS cohort had a higher risk of the neurodegenerative diseases. The lower dose of the inhaler corticosteroids with cumulative dose ≧0.13 gram have the less risk of stroke and dementia.

Health Indicators of US Older Adults Who Received or Did Not Receive Meals Funded by the Older Americans Act

BACKGROUND

The Older Americans Act (OAA) requires that nutrition programs provide meals and related nutrition services that promote health and help manage chronic diseases. The purpose of this study was to compare health status, food security, functional limitations, and chronic diseases of older adults who received or did not receive OAA meals using data from a representative sample of US adults.

METHODS

Data were from the National Health and Nutrition Surveys 2011-2014 for 2,392 older adults ≥ 65 years of age, including 187 Mexican Americans, 212 other Hispanics, 521 non-Hispanic Blacks, 219 non-Hispanic Asians, and 1253 non-Hispanic Whites.

RESULTS

Those receiving OAA meals had higher percent of food insecurity and functional disabilities. Adjusting for potential confounders, adults who received OAA meals had higher odds of emphysema (OR = 2.02; 1.05, 3.89) and lower odds of good-to-excellent health (OR = 0.52; 0.36, 0.77). Women and minorities had poorer health status compared to non-Hispanic Whites.

CONCLUSION

A higher proportion of older adults who received nutritional services reported poorer health as compared to older adults who do not participate in these services. Future studies should assess nutritional adequacy for older adults who participate in nutritional programs comparing sex and race/ethnicity.