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04/2015 journal articles

WHAT ARE THE GAP BETWEEN GERIATRICIANS AND ONCOLOGIST? A SURVEY OF DOCTOR AWARENESS OF MEDICAL CARE AMONG ELDERLY PATIENTS WITH CANCER IN SOUTHWEST CHINA

L.-X. Wang, Z.M. Meng, S.S. Nie, B. Xiang, J. Li, Q.Q. Sun, H. Qin, Y.L. Gong, C.C. Pan, C.Yi, Y.X. Yang, S. Wang

J Aging Res Clin Practice 2015;4(4):190-196

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Objectives: Old patients with cancer are a great challenge to physicians. This study investigated the similarities and differences in the respective opinions of geriatricians and oncologists with regard to clinical practice among elderly patients with cancer in south west China. Design, Setting, Participants and Measurements: Doctors from five local public hospitals of Sichuan were surveyed with a questionnaire via face-to-face interview. The ratio of geriatricians to oncologists’ was1:1. The questionnaire addressed respondents’ demographic characteristics and was composed of 11 multiple-choice questions and a clinical scenario. Results: The respondents included 64 oncologists and geriatricians, respectively. More than forty percent participants believed that current treatments were under-treatment. «Opinion of family members» was the top one reason for under-treatment in both groups, more oncologist choice «comorbidity» as cause of insufficient treatment than geriatricians (p=0.001). Age (57.03%) was the fifth effect factor impacting on treatment decision except for physical function (81.25%), comorbidity (71.09%) and cancer itself. Physical function, comorbidity and age between 65-84, geriatrician and oncologist did have different attitude. Conclusions: The attitude to physical function and comorbidity were the main difference between geriatrician and oncologist for their clinical decisions. A workshop should be set up to optimize the treatment proceedings.

CITATION:
L.-X. Wang ; Z.M. Meng ; S.S. Nie ; B. Xiang ; J. Li ; Q.Q. Sun ; H. Qin ; Y.L. Gong ; C.C. Pan ; C.Yi ; Y.X. Yang ; S. Wang (2015): What are the Gap between Geriatricians and Oncologist? A survey of Doctor Awareness of medical care among elderly patients with cancer in Southwest China. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.71

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MALNOURISHED OLDER ADULTS ADMITTED TO REHABILITATION IN RURAL NEW SOUTH WALES REMAIN MALNOURISHED THROUGHOUT REHABILITATION AND ONCE DISCHARGED BACK TO THE COMMUNITY: A PROSPECTIVE COHORT STUDY

S. Marshall, A. Young, J. Bauer, E. Isenring

J Aging Res Clin Practice 2015;4(4):197-204

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Objectives: Understanding the nutritional journey that older adults make from rehabilitation to home will help to target nutrition screening and intervention programs. This study aimed to determine the nutritional status, physical function and health-related quality of life amongst malnourished older adults admitted to two rural rehabilitation units and 12 weeks post-discharge to the community. Design: Observational prospective cohort study, conducted August 2013 to February 2014. Setting: Rehabilitation units in rural New South Wales, Australia. Participants: Thirty community-dwelling, malnourished older adult inpatients (mean age 79.5±7.1 years, 57% female). Intervention: Observation of usual care: basic nutrition services typical to rural rehabilitation units. Measurements: Outcome assessments were measured at rehabilitation admission, discharge and 12 weeks post-discharge, with nutrition status via the Scored Patient-Generated Subjective Global Assessment as the primary outcome measure. Secondary outcome measures included physical function (Modified Barthel Index) and health-related quality of life (Assessment of Quality of Life-6D). Results: At admission, half of the rehabilitation patients were moderately malnourished and half were severely malnourished, with the cohort becoming and remaining moderately malnourished on discharge and 12 weeks post-discharge. Only four patients (24%) were well-nourished 12 weeks post-discharge. Following discharge, there was a trend showing decline in physical function. No improvement was found in health-related quality of life following discharge. Conclusion: Malnourished older adults admitted to rural rehabilitation units with basic nutrition care are likely to be discharged with moderate malnutrition, and remain moderately malnourished in the community for at least 12 weeks. Physical function and health-related quality of life remain poor in this population. Collaboration between health services and within the multidisciplinary team is essential to identify and treat malnourished older adults, and novel approaches for inpatient and post-discharge nutrition support is needed.

CITATION:
S. Marshall ; A. Young ; J. Bauer ; E. Isenring (2015): Malnourished older adults admitted to rehabilitation in rural New South Wales remain malnourished throughout rehabilitation and once discharged back to the community: a prospective cohort study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.72

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DIFFERENCES BETWEEN CANADIAN AND MEDITERRANEAN DIETS: AN ASSESSMENT OF MACRONUTRIENTS IN THE DIETS OF CANADIAN OLDER ADULTS USING DATA FROM THE CANADIAN COMMUNITY HEALTH SURVEY 2.2

I. Culum, J.B. Orange, D. Forbes, M. Borrie

J Aging Res Clin Practice 2015;4(4):205-213

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Introduction: The World Health Organization (WHO) recommends a diet that limits saturated fat consumption and encourages unsaturated fat consumption. A diet that is compatible with the WHO recommendations and of considerable interest to researchers interested in dementia is the Mediterranean diet (MeDi). What is known empirically at present about the MeDi and dementia is that t may have roles to play in reducing the risk factors as well as the overall risk for developing dementia. Objectives: In this cross-sectional study, we examined the macronutrient composition of the average Canadian diet (CanDi) in order to see how it may differ from the average Mediterranean diet (MeDi). Additionally, we compared how the CanDi differs between groups based on gender, age, geographical location and classification (i.e. urban vs. rural), and dementia risk. Design: The Canadian Community Health Survey (CCHS) 2.2 data were used to estimate the macronutrient composition of the CanDi for older adults (age 50+) (N = 10,503 [4,955 male, 5,548 female], mean age = 64[10.30]). Results: The average daily macronutrient intake in a CanDi was found to be 227.7 g of carbohydrates, 78.5 g of proteins, 67.8 g of fats (21.8 g of saturated fats, 27.1 g of monounsaturated fats, and 12.4 g of polyunsaturated fats), as well as 8.3 g of alcohol and have an average energy value of 1856.9 Kcal. The energy breakdown by macronutrient in a CanDi is estimated as follows: 49.2% from carbohydrates, 16.9% from proteins, and 31.1% from fats (10% saturated, 12.3% monounsaturated, and 5.7% polyunsaturated fats). On average, the respondents did not meet the daily energy requirements for their respective age group as outlined in Canada’s Food Guide. Conclusion: The macronutrient composition of the CanDi differs not only from the MeDi, but also from previous Western diet generalizations. Of particular interest is the finding that respondents identified as being “at-risk” for developing dementia consumed significantly less of each macronutrient and less food overall than those who were identified as otherwise healthy.

CITATION:
I. Culum ; J.B. Orange ; D. Forbes ; M. Borrie (2015): Differences between Canadian and Mediterranean diets: An assessment of macronutrients in the diets of Canadian older adults using data from the Canadian Community Health Survey 2.2. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.73

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NUTRITIONAL RISK IN HOSPITALIZED OLDER ADULTS WITH NEOPLASMS

V. Braga, J.L. Braga de Aquino, V.A. Leandro-Merhi

J Aging Res Clin Practice 2015;4(4):214-217

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Objective: To investigate nutritional risk in hospitalized older adults with neoplasms. Methods: This cross-sectional study collected the following data from 142 older patients: gender, age, length of hospital stay (LHS), death outcome, and nutritional status indicators, such as body mass index (BMI), nutritional risk screening (NRS), subjective global assessment (SGA), and energy intake. The statistical analyses included the tests chi-square, Fisher’s exact, and Mann-Whitney’s at a significance level of 5%. Results: According to the NRS, 42.25% of the patients were at nutritional risk, and according to the SGA, 40.14% of the patients were malnourished. A total of 6.34% of the patients died. Death outcome was significantly associated with gender (p=0.0408); SGA (p=0.0301); NRS (p=0.0360); and LHS (p=0.0043). Nutritional risk (NRS) was significantly associated with SGA and BMI (p<0.0001), and LHS (p=0.0199). Conclusion: Death outcome was more common in malnourished patients, patients at nutritional risk, and patients with longer LHS. Nutritional risk was associated with malnutrition (SGA), BMI, and longer LHS. Hence, early nutritional care should be provided routinely in the hospital care of hospitalized older patients.

CITATION:
V. Braga ; J.L. Braga de Aquino ; V.A. Leandro-Merhi (2015): NUTRITIONAL RISK IN HOSPITALIZED OLDER ADULTS WITH NEOPLASMS . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.74

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COMPARISON OF ITALIAN AND NORWEGIAN POSTACUTE CARE SETTINGS FOR OLDER PATIENTS IN NEED OF FURTHER TREATMENT AND REHABILITATION AFTER HOSPITALIZATION

J.F. Abrahamsen, R. Rozzini, S. Boffelli, A. Cassinadri, A.H. Ranhoff, M. Trabucchi

J Aging Res Clin Practice 2015;4(4):218-225

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Background/Objectives: Little is known regarding the influence of sociodemographic and clinical factors, on the short term outcomes of different postacute care (PAC) models in different countries. Design and setting: Prospective cohort study of a 19- bed Italian hospital subacute care (SAC) unit and a 19-bed Norwegian nursing home (NH) intermediate care (IC) unit, both based on Comprehensive Geriatric Assessment and similar multidisciplinary staffing. Participants: A total of 664 Italian and 961 Norwegian community-dwelling patients ≥70 years of age, in need of postacute geriatric based treatment, rehabilitation and care. The patients were admitted from acute medical, surgical and orthopaedic hospital units. Measurements: Demographic data, clinical information, comprehensive geriatric assessment (CGA), discharge destination and length of stay were recorded in an Italian and a Norwegian database and compared. Results: The Italian patients receiving hospital SAC, were more seriously affected by the acute disease and trauma, median Barthel index (BI) at admission/discharge was 40/60, compared to 75/85 in the Norwegian patients, and fewer of them were able to return to own home as compared to the Norwegian patients ( 64% vs. 82%). Although the Italian patients had a lower BI at discharge, fewer of them were transferred to nursing homes (9%), as compared to the Norwegian patients (14%), while more of them were discharged to further rehabilitation, acute hospitalization, hospice or died (27%), as compared to the Norwegian patients (4%). Of the patients discharged to own home, only 8% of the Italian compared to 71% of the Norwegian patients received nurse assisted home care. Admission BI and improvement in BI, were highly significant predictors for the ability to return home in multivariate logistic regression analysis both in the Italian and the Norwegian patients. Conclusions: Both clinical and sociodemographic factors influenced the clinical outcome of older patients receiving PAC in Italy and Norway. Such differences should be taken into account when results from different PAC models in different countries are compared. Both the Italian hospital SAC model and the Norwegian NH IC model are feasible and good alternatives, but more firm inclusion criteria may further optimize the selection of patients suitable for different PAC options.

CITATION:
J.F. Abrahamsen ; R. Rozzini ; S. Boffelli ; A. Cassinadri ; A.H. Ranhoff ; M. Trabucchi (2015): Comparison of Italian and Norwegian postacute care settings for older patients in need of further treatment and rehabilitation after hospitalization. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.75

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BONE MINERAL DENSITY IN MASTER CYCLISTS: A 2-YEAR FOLLOW-UP STUDY

T. Abe, J.P. Loenneke, V.K. Nahar, M.A. Ford, M.A. Bass, S.G. Owens, M. Loftin

J Aging Res Clin Practice 2015;4(4):226-229

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Before and after a follow-up period of two-years, six male master cyclists (mean age was 59 years at the start of the study, cycle training; 5-6 hrs/wk) had dual-energy X-ray absorptiometry measured body composition (i.e., areal bone mineral density [aBMD] and appendicular lean soft tissue mass [aLM]) taken. aBMD at the femoral neck and lumber spine were similar between the two measurements, but aLM (p=0.056) tended to be higher at the 2-year follow-up. There were no significant (p>0.05) associations between changes in aLM and aBMD at femoral neck or lumber spine. Male master cyclists who exercise with a mild training volume (5-6 hrs/wk) maintained aBMD at the lumber spine and femoral neck. Furthermore, aLM tended to increase over the 2-year period. Further research is necessary to determine the training volume threshold needed to maintain aBMD in master cyclists.

CITATION:
T. Abe ; J.P. Loenneke ; V.K. Nahar ; M.A. Ford ; M.A. Bass ; S.G. Owens ; M. Loftin (2015): Bone mineral density in master cyclists: a 2-year follow-up study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.76

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HIGH PREVALENCE OF NUTRITION RISK AMONG COMMUNITY LIVING OLDER PEOPLE IN WOERDEN, THE NETHERLANDS

T.A. Haakma, C.A. Wham

J Aging Res Clin Practice 2015;4(4):230-234

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Abstract: Background: Undernutrition is a common problem in Dutch older people and may cause increased length of hospitalisation, early institutionalization and decreased quality of life. Nutrition risk precedes undernutrition and can be identified by timely nutritional screening. Design: This cross-sectional study aimed to examine the prevalence of nutrition risk among older people living in the community of Woerden. Measurements: Nutrition risk was assessed using a validated questionnaire: Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (‘SCREEN II’). Participants: The sample (n=335, mean age 80, age range 75-85) were 32% men, 40% received home care and 46% lived alone. Results: Nutrition risk was present in two thirds (67%) of the respondents (38% ‘at high risk’, 29% ‘at risk’). The most common SCREENII items that led to nutrition risk were a low intake of meat and alternatives (65%), milk products (59%), fruit and vegetables (59%) and eating alone (56%). Those who received home care were 1.8 times more likely to be at nutrition risk than people without home care (p=0.03) and those living alone were 3.3 times more likely to be at nutrition risk than those living with others (p<0.001). Conclusions: Intervention strategies are needed to encourage Dutch older people to take opportunities to eat meals with others and to improve their intake of major food group items. Training of home care staff to identify nutrition problems should be prioritised.

CITATION:
T.A. Haakma ; C.A. Wham (2015): High prevalence of nutrition risk among community living older people in Woerden, The Netherlands. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.77

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EVALUATION OF THE RELATIVE VALIDITY OF FOOD RECORD CHARTS (FRCS) USED WITHIN THE HOSPITAL SETTING TO ESTIMATE ENERGY AND PROTEIN INTAKES

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Abstract: Objective: To determine the relative validity of two semi-quantitative food record charts (FRCs) to estimate patients’ energy and protein intakes. Design, setting & participants: A pilot service evaluation of twenty seven patients in adult acute care wards in an NHS hospital, Scotland UK. Measurements: Weighed plate-wastage was undertaken to measure dietary intakes of patients being monitored using FRCs on two adult acute wards. Both FRCs listed food items typically served at each meal along-with an indication of portion size on a Likert scale. All items consumed over 12 hours (three meals and two snacks) were weighed prior to provision and all left-over items were weighed once eating had terminated to determine amounts consumed. Estimated energy and protein intakes from both methods were determined and compared using 95% limits of agreement. Results: FRCs on both wards underestimated energy and protein intakes (mean bias (95% CI): Ward A, n=12; -219 (-1170, 732) kcal; -five (-50, 40) gram and Ward B, n=15; -437 (-1403, 529) kcal, -18 (-57, 21) gram). All 12 FRCs on ward A and 13 out of 15 records on ward B were incomplete due to omissions of whole meals or omissions of particular foods and drinks throughout the day. Details of ‘portion eaten’ were frequently omitted from the completed FRCs on both wards. Discrepancies existed between food items documented on FRCs to those observed and weighed. Conclusions: Further development of FRCs and training of staff is needed to ensure appropriate completion and thus accurate estimation of patients’ intakes to better inform nutritional care.

CITATION:
L. Bartkowiak ; J. Jones ; E. Bannerman (2015): Evaluation of the relative validity of food record charts (FRCs) used within the hospital setting to estimate energy and protein intakes. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.78

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CITICOLINE EFFICIENCY ON COGNITIVE FUNCTION: A SYSTEMATIC REVIEW

N. Cano-Cuenca, J. Solís-García del Pozo, J. Jordán

J Aging Res Clin Practice 2015;4(4):235-246

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Background: Citicoline is considered an ingredient in particular foods in the USA and is available in pharmaceutical form in Europe and Japan. It has been postulated to render positive effects on the nervous system, either by increasing levels of neurotransmitters, or by affording neuroprotection. Methods: Several clinical trials have shown the efficacy and safety of this biomolecule in several neurodegenerative diseases and in acute ischemic stroke. Here, we have performed a systematic review to validate the effect of citicoline on MMSE, memory, attention, and basic activity of daily living. In electronic database searches, we found 14 randomized clinical trials reporting citicoline effects on cognitive function. Findings: A positive effect of citicoline on MMSE in acute ischemic stroke was found, which was not evidenced for Alzheimer disease or vascular dementia. On activities of daily living, citicoline failed to exert beneficial effects in patients with acute ischemic stroke or progressive cognitive impairment. Conclusions: Given the present data there is no evidence that supports advising patients with cognitive alterations to take chronic citicoline supplements.

CITATION:
N. Cano-Cuenca ; J. Solís-García del Pozo ; J. Jordán (2015): Citicoline efficiency on cognitive function: A systematic review. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.79

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ALZHEIMER’S DISEASE IS, AT LEAST IN PART, A COPPER-2 TOXICITY DISEASE

G.J. Brewer

J Aging Res Clin Practice 2015;4(4):247-252

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Developed countries have a raging epidemic of Alzheimers disease, with prevalence around 20% by age 70. Good evidence indicates this epidemic is new, with an Alzheimer’s-like dementia being rare prior to 1900. Prevalence of Alzheimer’s in undeveloped countries is still quite low, around 1%. These sets of facts strongly indicate that environmental change is causing the epidemic in developed countries. It is hypothesized here, with very good evidence, that the new environment change in developed countries is ingestion of inorganic copper, copper-2, from drinking water and supplement pills. There is good evidence that copper toxicity plays a major role in the pathogenesis of Alzheimer’s, with the size of the free copper pool intimately tied to cognition and cognition loss. Studies in AD animal models show that tiny amounts of inorganic copper in drinking water greatly enhance Alzheimers-type pathology and memory loss. Studies in humans show that those ingesting supplement pills containing copper, if they also eat a high fat diet, suffer rapid loss of cognition. Drinking water copper, and pill copper are both divalent copper, or copper-2. A recent study shows that food copper is primarily copper-1. There is an intestinal transport system specific for copper-1, and this copper goes to the liver, and is put into safe channels. Because mammals, including humans, ingested only copper-1, their systems evolved to safely handle copper-1. With development came copper plumbing and supplement pill ingestion, and copper-2 is now ingested. Some of it bypasses the liver, ends up in the blood free copper pool, and is toxic to cognition.

CITATION:
G.J. Brewer (2015): Alzheimer’s Disease is, at Least in Part, a Copper-2 Toxicity Disease. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2015.80

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