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02/2015 journal articles

PREDICTORS OF DECREASED SKELETAL MUSCLE MASS IN COMMUNITY-DWELLING OLDER ADULTS

N. Shiraishi , Y. Suzuki, T. Hirose, S. Jeong, T. Shimada, K. Okada, M. Kuzuya

J Aging Res Clin Practice 2015;4(2):74-80

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Objective: To date, the actual prevalence of Skeletal muscle mass (SMM) loss by rigorous definition and its related factors have not been sufficiently surveyed in the community. We therefore examined the factors related to the reductions of skeletal muscle mass (SMM) in older adults. Design: Case-control study. Subjects: One hundred twenty four community-dwelling older adults aged ≥65 years participated. Measurements: Reductions of SMM were assessed by measuring difference between SMM at baseline and SMM 1 year later, by which participants were divided into three groups. Variables of the first tertile group, who had the greatest decrease in SMM, were compared with those of the second/third tertile groups. Variables included hight, weight, body mass index (BMI), maximal knee extension strength, grip strength, lower and upper muscle quality (UMQ), 5-m walking time (WT), timed up and go (TUG), food frequency questionnaire, mini nutritional assessment short form (MNA-SF), basic health checklist. A logistic regression analysis and classification and regression trees (CART) were used for multivariate analysis in order to extract variables that predicted reductions of SMM. Results: Significant differences were observed for age, SMM, UMQ, TUG, and WT between the first tertile and the second/third tertile groups, The CART analysis indicated that vitamin D intake UMQ and 5-m WT predicted significant decrease in SMM. Conclusion: The present study suggested a possibility that future reductions of SMM could be predicted by simple indices that may contribute to early detection of individuals at risk of developing sarcopenia in old age.

CITATION:
N. Shiraishi ; Y. Suzuki ; T. Hirose ; S. Jeong ; T. Shimada ; K. Okada ; M. Kuzuya (2015): Predictors of decreased skeletal muscle mass in community-dwelling older adults. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.52

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THE IMPACT OF FOOT AND NAIL CONDITION ON FALLING, IN THE CONTEXT OF THE ELDERLY IN ACUTE HOSPITAL SETTINGS

R. Rokkaku, S. Kaneko

J Aging Res Clin Practice 2015;4(2):81-84

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Abstract: This study investigates the relationship between in-patient foot and nail condition and their falling. The purpose is to determine if a nursing intervention can reduce the risk of falling in the acute hospital setting. We found that the group of those had fallen significantly suffered from abnormalities of their feet and/or nail. It became especially clear that falling was related to tinea, excessive keratin, and excessively long nails. Also, there were few nurses who were aware that foot and nail condition are a risk factor of falling. Relatedly, their concern for the condition of patients’ feet and nails was low. We recommend that nurses and patients improve the condition of feet and nails to reduce falling by the elderly in an acute hospital setting. In addition, we conclude that foot care enhances the lower extremities’ physiological functions.

CITATION:
R. Rokkaku ; S. Kaneko (2015): The impact of foot and nail condition on falling, in the context of the elderly in acute hospital settings. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.53

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DIETARY INADEQUACIES IN THE ELDERLY WITH ALZHEIMER’S DISEASE FOLLOWED AT THE REFERENCE HEALTH CENTER FOR ELDERLY CARE IN CURITIBA – BRAZIL

D. Rodrigues Lecheta , M.E. Madalozzo Schieferdecker, A.P. de Mello, I. Berkenbrock, J. Cardoso Neto, E.M.C. Pereira Maluf

J Aging Res Clin Practice 2015;4(2):85-91

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Background: Dietary changes are frequent in Alzheimer’s disease (AD). Objective: to assess the dietary intake of elderly with AD. Design: cross sectional study. Setting: AD patients followed at the Health Center of Elderly Care Ouvidor Pardinho, in Curitiba/Brazil, from November/2010 to July/2011. Participants: 96 individuals. Measurements: the scales used were the Mini Nutritional Assessment to determine the nutritional status and the Clinical Dementia Rating to set the stage of dementia. The average food intake of three days was analyzed for energy, carbohydrates, protein, fat, vitamin A, vitamin C, calcium, iron and liquids, and compared with the individualized nutritional recommendations. Results: 96 elderly patients were evaluated. The mean age was 78.0 ± 6.52 years, and most of them had mild AD (54.2%) and risk of malnutrition (55.2%). All of them were oral fed and 37.5% received modified consistency food. Regarding independence for feeding: 44.8% of the elderly needed assistance to serve food, 31.3% did not eat when the meal was not offered by the caregiver, and 31.3% ate less than usual. Regarding dietary adequacy: 41.7% had low-calorie diet, 46.9% low-protein diet, and most of the patients had insufficient intake of vitamins A and C, calcium and iron. Decreased appetite occurred in 31.3% of the elderly. Conclusion: the dietary intake of AD patients is inadequate when compared with nutritional recommendations. Caregivers should be informed about the need of specialized nutritional monitoring and feeding assistance for the demented patient since the early stage of the disease.

CITATION:
D. Rodrigues Lecheta ; M.E. Madalozzo Schieferdecker ; A.P. de Mello ; I. Berkenbrock ; J. Cardoso Neto ; E.M.C. Pereira Maluf (2015): Dietary inadequacies in the elderly with Alzheimer’s disease followed at the reference Health Center for elderly care in Curitiba – Brazil. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.54

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NUTRITIONAL FOLLOW-UP AFTER DISCHARGE OF MALNOURISHED GERIATRIC PATIENTS - DESIGN OF A RANDOMIZED CLINICAL STUDY

J. L. Pedersen, P.U. Pedersen, E.M. Damsgaard

J Aging Res Clin Practice 2015;4(2):92-101

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Objective: The purpose of the study is to investigate the effect of two nutritional follow-up intervention methods: home visit and telephone follow-up, on ADL, physical function, quality of life, readmission, and mortality, and compare the interventions with no followup. This article describes the considerations behind the study design. Design: The study is a randomized clinical study. The randomization allocated participants to one of three groups: ‘home visit’, ‘telephone consultation’, or ‘control’. Setting: Participants were recruited from two geriatric wards between May 2011 and October 2013. The follow-up period fell eight weeks after discharge from hospital. Participants: Inclusion: Malnourished or at risk of malnutrition, 75+ years and older, home-dwelling, and living alone. Exclusion: Terminal illness, cognitive impairment, and nursing home resident. Intervention: Nutritional counselling after hospital discharge, based on individual nutritional needs identified during admission, and tailored to the individual’s preferences and situation. The intervention was performed by a clinical dietician, and included the patient’s daily home carer. The intervention took place 1 week, 2 weeks, and 4 weeks after discharge, either as face-to-face counselling in the patients’ homes (home visit group), or via telephone (telephone consultation group). The control group received no followup after discharge. Measurements: Primary outcome is a change in ADL (Barthel-100), while secondary outcomes include other physical measurements (handgrip strength, 30-sec. chair stand test, CAS), quality of life and depression measurements (SF-36, Depression List, Geriatric Depression Score), and Avlund mobility-tiredness score. Other secondary outcome measures are readmission, and mortality rates at 30 and 90 days post-discharge. Conclusion: This randomized clinical trial will evaluate and compare two approaches to nutritional follow-up after discharge from hospital with no follow-up. It is expected that these interventions will prevent deterioration in physical function, which is significant in preventing further deterioration of physical, mental, and social functions, and reduce hospital readmissions and mortality.

CITATION:
J. L. Pedersen ; P.U. Pedersen ; E.M. Damsgaard (2015): Nutritional follow-up after discharge of malnourished geriatric patients - design of a randomized clinical study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.55

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IMPACT ON DIET QUALITY AND RESILIENCE IN URBAN COMMUNITY DWELLING OBESE WOMEN WITH A NUTRITION AND PHYSICAL ACTIVITY INTERVENTION

A. Taetzsch, D. Quintanilla, S. Maris, J. Letendre, L. Mahler, F. Xu, M.J. Delmonico, I.E. Lofgren

J Aging Res Clin Practice 2015;4(2):102-108

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Objective: To examine the effect of a Tai Chi, resistance training, and behaviorally-based diet education intervention on dietary quality as well as resilience and physical resilience in obese older women. Design: Community health outreach with a quasi-experimental design. Setting: An urban senior center in Rhode Island. Participants: Thirty-three women, 85% were minorities, with mean age of 65±8.2 years and BMI of 37.3±4.6 kg/m2, were enrolled in the study at baseline however only 17 women in the intervention (EXD) group and 9 women in the wait-list control (CON) group completed the study. Measurement: Dietary quality and nutrition risk were measured using the Dietary Screening Tool (DST), resilience was measured by the Resilience Scale, and physical resilience was examined using the Physical Resilience Scale. Intervention: Participants in the EXD group engaged in 12 weeks of Tai Chi, resistance training, and behaviorally-based diet education. The diet education was based off of the modified Dietary Approaches to Stop Hypertension (DASH) diet and led by a Registered Dietitian. Results: There was no change in dietary quality by group or time. However the EXD group had significantly higher dietary quality compared to the control group (p=0.025) at post intervention, although there was no difference in nutrition risk category. There was no change seen in overall resilience, however the EXD group improved physical resilience (p=0.048). Conclusion: A community health outreach that involved Tai Chi, resistance training, and behaviorally-based diet education may promote higher dietary quality as well as improve physical resilience in obese older women.

CITATION:
A. Taetzsch ; D. Quintanilla ; S. Maris ; J. Letendre ; L. Mahler ; F. Xu ; M.J. Delmonico ; I.E. Lofgren (2015): Impact on Diet Quality and Resilience in Urban Community Dwelling Obese Women with a Nutrition and Physical Activity Intervention. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.56

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EFFECTS OF INGESTING MILK FERMENTED BY LACTOCOCCUS LACTIS H61 ON SKIN PROPERTIES AND HEALTH BIOMARKERS IN MIDDLE-AGED WOMEN: A RANDOMIZED, DOUBLE-BLIND STUDY

H. Kimoto-Nira, N. Moriya, K. Sasaki, C. Suzuki

J Aging Res Clin Practice 2015;4(2):109-115

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Objective: Previously, we showed that ingestion of fermented milk made by only Lactococcus lactis strain H61 (H61-fermented milk) improves various skin properties in young Japanese women (age, around 20 y). Because the condition of human skin varies with age, we investigated the effects of H61-fermented milk on skin properties of middle-aged women. Design and setting: A randomized, double-blind trial in a clinical research setting. Participants: Healthy, middle-aged, female volunteers (n = 23; age: 36–62 y). Intervention: H61-fermented milk (1010 CFU) or conventional yogurt (1010CFU of both Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus; a reference food) was given daily for 4 weeks. Measurements: Before and at the end of the 4-week treatment, we measured skin hydration (inner forearms and cheek) and sebum content (cheek only). In addition, salivary samples were collected for analysis of immune, stress, and inflammation biomarkers. Self-questionnaires (regarding skin and general health conditions) were done at week 4. Results: By mechanical analysis, the interventions did not alter the skin properties of either group. At week 4, self-questionnaire skin scores for elasticity and texture were significantly higher; scores for darkness tended to be improved in the H61-fermented milk group than the conventional yogurt group. In the general health condition section, diarrhea was significantly more prevalent in the H61-fermented milk than in the conventional yogurt group. The intervention did not alter immunoglobulin A, cortisol, α-amylase, and C-reactive protein levels in saliva. Conclusions: According to self-questionnaires, H61-fermented milk provides beneficial effects on some skin properties of middle-aged women. This intervention would be useful for increasing the quality of life in an aging population after characterizing the beneficial effect by mechanical analysis in future study.

CITATION:
H. Kimoto-Nira ; N. Moriya ; K. Sasaki ; C. Suzuki (2015): EFFECTS OF INGESTING MILK FERMENTED BY LACTOCOCCUS LACTIS H61 ON SKIN PROPERTIES AND HEALTH BIOMARKERS IN MIDDLE-AGED WOMEN: A RANDOMIZED, DOUBLE-BLIND STUDY. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.57

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PHYSICAL ACTIVITY IN HOSPITALIZED OLD MEDICAL PATIENTS; HOW ACTIVE ARE THEY, AND WHAT

M. Holst, P.L. Hansen, L.A. Pedersen, S. Paulsen, C.D. Valentinsen, M. Kohler

J Aging Res Clin Practice 2015;4(2):116-123

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Objective: To examine how physically active Danish old medical patients are during hospitalization and to achieve knowledge of motivation and barriers to physical activity. Background: Functional decline in frail old patients during hospitalization is an important clinical problem with potential long-lasting undesirable outcomes and complications. Design: A mixed methods study including qualitative and quantitative methods. Methods: Patients >60 years of age were recruited at two medical departments during one week. Three SenseWear armband monitors were used for quantitative monitoring of physical activity. Semi Structured interviews were used for qualitative data. Results: The study comprised 13 patients, five female and eight male, mean age 73 (SD 9); BMI 19.4-32.1, mean 25.2 (SD 3.7). Only 11 patients completed 24-hours of SenseWear armband monitoring. Half of the participants walked less than 50 steps a day. The majority were bedridden 9 to 15 hours a day. Five of 11 patients had very low activity score. Four patients were moderately active for 19-38 minutes. Five patients sleep less than 6,3 hours, mean 9 (SD 3.3). Lying down was recorded for a mean of 11 hours (SD 4). Factors motivating to physical activity were: Praise and recognition from the staff, experienced boredom, continued ability to perform Activities of Daily Living. Barriers: Symptoms of illness, fear of falling, lack of meaningful activities, inadequate facilities and staff’s lack of focus. Organisational routines such as waiting for physical examinations and rounds, were barriers for patients to get out of bed. Conclusion: Old medical patients were very inactive during hospitalization. Motivation for physical activity was continued ADL abilities, boredom and staff interest, however often hindered by organizational barriers, lack of meaningful activities and focus from staff.

CITATION:
M. Holst ; P.L. Hansen ; L.A. Pedersen ; S. Paulsen ; C.D. Valentinsen ; M. Kohler ; (2015): PHYSICAL ACTIVITY IN HOSPITALIZED OLD MEDICAL PATIENTS; HOW ACTIVE ARE THEY, AND WHAT. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.58

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ALZHEIMER’S COGNITIVE IMPAIRMENT CAN BE CURED BY DECREASING BLOOD HOMOCYSTEIC ACID

T. Hasegawa, T. Uchida, A. Chanoki

J Aging Res Clin Practice 2015;4(2):124-128

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Recent big two clinical trials of amyloid beta treatment for Alzheimer’s disease are all failed to recover the cognitive impairment, it has forced us to reconsider the central hypothesis of amyloid pathogen for Alzheimer’s disease. We recently published that human Alzheimer’s patients showed the strong relationship between Mini Mental State Examination (MMSE) scores and blood homocysteic acid (HA) level. However this relationship did not show the pathogenic action of HA. So we investigated the pathogenic effect of blood HA on MMSE score, that is, how does blood HA level change affect MMSE score? 6 AD patients (all female: age 77, 82, 86,87, 91, 91) were given green tea powder 1g at every meal for 2 months. Their blood HA level and MMSE score were measured before and after taking green tea powder. The relationship between blood HA level change and MMSE score change was investigated. The strong statistically significant negative relationship between blood HA level change and MMSE score change: r=-0.96, p=0.00018, n=6. From our observation, it shows that blood HA level change induced MMSE score change, that is, Alzheimer’s cognitive ability was controlled by blood HA level. Now we can present that some healthy food, that is named HBF, can recovered 100% Alzheimer’s cognitive impairment by the decreasing the homocysteic acid in a peripheral blood. We made the open-trial of HBF on the Alzheimer’s and lewy bodies dementia’s cognitive recovery. Two male lewy bodies dementia patients, 11 female Alzheimer’s patients were enrolled. All patients were at end stage. They ingested HBF supplement 1.5g at every meals for 1-2 months. Their MMSE scores were measured before and after their HBF ingestion. Their blood homocysteic acid levels were measured by ELISA method before and after their ingestions. Results were extremely amaging. 100% of all patients showed their cognitive recovery. Their blood homocysteic acid decreased their level by HBF. Now we have made a relative large open trial of AD patients. 91 patients were enrolled. Their cognitive recovery were measured by NM scale (New Clinical Scale for Rating of Mental States). All patients who took HBF showed the recovery of their behaviors. From this open-trial of HBF, many facts can be confirmed. (1) Alzheimer’s cognitive impairment can be recovered at even end stage. (2) Alzheimer’s disease is induced by homocysteic acid.

CITATION:
T. Hasegawa ; T. Uchida ; A. Chanoki (2015): Alzheimer’s cognitive impairment can be cured by decreasing blood homocysteic acid. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.59

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ASSESSING PREDICTIVE ABILITY OF A PREOPERATIVE SCREEN TO IDENTIFY OLDER ADULTS AT RISK FOR DELIRIUM FOLLOWING ELECTIVE ORTHOPEDIC SURGERY

A. Vanderbilt, W.K. Barsoum, A. Kumar, L. Capone, C.R. Szubski, B.J. Messinger-Rapport

J Aging Res Clin Practice 2015;4(2):129-132

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Objective: Post-surgical nursing interventions can reduce but not eliminate the risk of delirium. A preoperative screen for delirium risk which discriminates between those persons at lower versus higher risk of delirium may help future research efforts develop a subject pool for intensive interventions to reduce delirium incidence. The aim of this study is to assess the ability of a previously developed and tested delirium screening tool, the Cleveland Clinic Confusion Score (CCCS), to predict delirium in a select population. Design: Prospective, observational study. Setting/Participants: Convenience sample of 111 adults aged 50 years or older presenting to a preoperative orthopedic clinic. Intervention: We integrated the CCCS into the preoperative evaluation for elective hip and knee surgery. Postoperatively, clinical care nurses screened patients for delirium twice daily using the Nursing Delirium Screening Scale (Nu-DESC). Research nurses gathered additional data regarding postoperative confusion from the chart and family after discharge. Measurements: Primary outcome was the predictive value of the CCCS for delirium. Results: Of the 111 subjects, a positive preoperative CCCS screen was recorded in 31 individuals (27.9%) and postoperative delirium was identified in 12 individuals (10.8%). CCCS assessment in this population had a positive predictive value of 29% and a negative predictive value of 96%. Conclusion: When a delirium screening tool is incorporated into the preoperative process and coupled with a nursing tool for delirium detection, clinicians can identify a subset of older elective orthopedic surgery patients unlikely to develop postoperative delirium. Preoperative delirium screening may help clinicians focus perioperative interventions on higher risk individuals to further reduce delirium risk beyond current, postoperative nursing interventions.

CITATION:
A. Vanderbilt ; W.K. Barsoum ; A. Kumar ; L. Capone ; C.R. Szubski ; B.J. Messinger-Rapport (2015): Assessing Predictive Ability of a Preoperative Screen to Identify Older Adults at Risk for Delirium Following Elective Orthopedic Surgery. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.60

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