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01/2016 journal articles

A DESCRIPTIVE STUDY OF THE NUTRITION-RELATED CONCERNS OF CAREGIVERS OF PERSONS WITH DEMENTIA

J.G. Anderson, K.M. Rose, A.G. Taylor

J Aging Res Clin Practice 2016;5(1):1-6

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Objective: Family caregivers are the mainstay of caregiving support to persons with dementia, and often care for a family member with dementia for a decade or more prior to institutionalization or death. Malnutrition, including weight loss, is common among older adults with dementia, occurs throughout the disease process, and is associated with institutionalization and death. Nutrition education for caregivers is an important aspect of addressing the care needs of adults with dementia; however, nutrition education research in community-based persons and families experiencing dementia is minimal to non-existent. The need for tailored education resources ranks as highly important among caregivers; however, the nutrition concerns of caregivers in the home have not been identified. The purpose of the current study was to gather descriptive data about the nutrition-related concerns of family caregivers of persons with dementia. Design: A qualitative descriptive design using semi-structured interviews of caregivers of persons with dementia (n = 4) was used to collect the data. Thematic and content analysis was used. Results: Family caregivers experienced nutrition-related concerns and described a need for nutrition education to support the caregiving role. Four themes emerged: (1) meal preparation and food choices; (2) lack of appetite and eating behaviors; (3) making sense of existing nutrition information; (4) searching for reliable nutrition information. A discussion of each theme, including exemplars, is presented, along with suggestions provided by participants regarding how to address existing nutrition education resource needs.Conclusions: Issues surrounding care often are complex and require accurate and tailored information. Findings from the current study provide rich, valuable data regarding the needs of family caregivers with respect to nutrition concerns, allowing for the development, design, testing, and delivery of nutrition education resources and strategies.

CITATION:
J.G. Anderson ; K.M. Rose ; A.G. Taylor (2016): A Descriptive Study of the Nutrition-Related Concerns of Caregivers of Persons with Dementia . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.88

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IMPLEMENTATION OF NUTRITION SCREENING FOR OLDER ADULTS IN GENERAL PRACTICE: PATIENT PERSPECTIVES INDICATE ACCEPTABILITY

A.H. Hamirudin, K. Charlton, K. Walton, A. Bonney, G. Albert, A. Hodgkins, A. Ghosh, J. Potter, M. Milosavljevic, A. Dalley

J Aging Res Clin Practice 2016;5(1):7-13

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Background: Older patients’ views regarding undergoing nutrition screening within General Practice settings have not been evaluated to date. Objectives: To identify perceptions of older patients related to their experiences of having a nutrition screening process performed using the Mini Nutritional Assessment Short Form (MNA-SF®), accompanied by a clinical care pathway. Methods: Patients aged ≥75 years were invited to attend repeat screening between 6 months and one year following a first screening (n=143). Patients who were identified to be malnourished or at risk at baseline (n=44) were invited to participate in an individual interview to identify their perceptions of the MNA-SF® and the applicability of a nutrition resource kit that had been provided to them. Results: Nutritional status improved in the group identified to be malnourished/at risk at baseline (p= 0.01). Interviews indicated that the MNA-SF® process was well-received but that patients did not perceive themselves as being in need of nutrition support. Conclusion: This study demonstrates that introduction of routine nutrition screening of older patients attending General Practice can feasibly be implemented using the MNA-SF® and is acceptable to patients. It is recommended that this model of care be adopted in order to improve early identification of nutritional risk and facilitate referral to appropriate services.

CITATION:
A.H. Hamirudin ; K. Charlton ; K. Walton ; A. Bonney ; G. Albert ; A. Hodgkins ; A. Ghosh ; J. Potter ; M. Milosavljevic ; A. Dalley ; (2016): Implementation of nutrition screening for older adults in General Practice: Patient perspectives indicate acceptability. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.85

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BODY COMPOSITION AND POSTURAL INSTABILITY IN PEOPLE WITH IDIOPATHIC PARKINSON’S DISEASE

A.S. Diab, L.A. Hale, M.A. Skinner, G. Hammond-Tooke, A.L. Ward, D.L. Waters

J Aging Res Clin Practice 2016;5(1):14-19

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Objectives: Idopathic Parkinson’s disease (PD) is the second most common neurodegenerative disorder. Our objective was to investigate the relationship between body composition and postural instability in people with PD, and age- and sex-matched controls. Design: Cross-sectional study among PD sufferers and age- and sex-matched controls. Setting: University of Otago’s Balance Clinic, School of Physiotherapy. Participants: Forty-seven people with PD and 58 age- and sex-matched controls. Measurements: Postural stability was assessed with the Sensory Organization Test, Motor Control Test, Timed Up and Go Test, and Step Test. Body composition was measured by dual energy x-ray absorptiometry (DXA). Movement Disorders Society-Unified Parkinson’s Disease Rating Scale was applied to assess PD severity. Results: Mean group differences between PD and controls for the equilibrium composite score, Timed Up and Go Tests, and Step Test were statistically significant (p<0.05); strategy and latency composite scores and body composition variables were not (p>0.05). Three PD participants were sarcopenic; 15 PD and 24 controls were obese. In PD participants, total body lean mass and age predicted latency composite scores. Disease, age, and leg fat mass predicted the Timed Up and Go Test results (p<0.05). Sex and disease predicted the equilibrium composite score (p<0.01). Conclusion: The prevalence of obesity was high and sarcopenia low in the PD group, which is a novel finding. Not surprisingly, participants with PD had reduced postural stability compared to controls. Disease status, age and sex were influential factors in the weak relationships found between postural stability and body composition. These findings may have clinical relevance for the treatment of the physical symptoms of those suffering from PD.

CITATION:
A.S. Diab ; L.A. Hale ; M.A. Skinner ; G. Hammond-Tooke ; A.L. Ward ; D.L. Waters (2016): Body composition and postural instability in people with idiopathic Parkinson’s disease. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.86

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A MINI NUTRITIONAL ASSESSMENT OF THE RISK OF MALNUTRITION IN ELDERLY UNDER THREE NUTRITION SUPPORT MODELS

E. Lindhorst, M. Ramel, P. Kelly, L. Jones

J Aging Res Clin Practice 2016;5(1):20-23

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Objective: The aim of this study was to determine which nutritional support setting fostered the best nutritional status in elderly patients using the Mini Nutritional Assessment survey. Design and Participants: The analytical sample included a total of 75 adults aged 60-89 years. Setting: There were three nutrition support settings: a nursing home, an assisted living facility, and independent living with congregate feeding. Measurements: The Mini Nutritional Assessment was used to examine nutritional status in patients living in one of the three nutritional support settings. Results: Individuals living independently individuals and attending congregate feedings resulted in the most people in the “normal nutritional status” category when compared with nursing home and assisted living residents. Conclusion: Individuals living independently in their homes who use congregate feeding have reduced risk of malnutrition.

CITATION:
E. Lindhorst ; M. Ramel ; P. Kelly ; L. Jones (2016): A MINI NUTRITIONAL ASSESSMENT OF THE RISK OF MALNUTRITION IN ELDERLY UNDER THREE NUTRITION SUPPORT MODELS. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.83

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A NEW PROPOSAL FOR THE CLINICAL-FUNCTIONAL CATEGORIZATION OF THE ELDERLY: VISUAL SCALE OF FRAILTY (VS-FRAILTY)

E. Nunes de Moraes, F.M. Lanna, R.R. Santos, M.A.C. Bicalho, C.J. Machado, D.E. Romero

J Aging Res Clin Practice 2016;5(1):24-30

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Ageing is closely associated with increasing frailty, and it continues to be defined in various different ways, complicating its practical application in the clinical context. Frailty is commonly used to predict the risk of functional decline, institutionalization or even death. Current models of frailty display significant limitations, because they are unable to encompass all the chronic conditions indicating adverse outcomes. In this article, we propose the Visual Scale of Frailty (VS-Frailty), based on the overall functionality and clinical complexity of elderly individuals. This scale emphasizes the importance of independence in basic, instrumental and advanced Activities of Daily Living (ADL), as well as taking into account the main causes of the functional decline of the elderly, such as sarcopenia syndrome, mild cognitive impairment and multiple comorbidities. The scale places the elderly into 10 categories ranging from completely independent to fully dependent. The scale provides the following advantages over other scales currently used: scope, ease of application, visual clarity, longitudinal monitoring, planning of health services, and the definition of therapeutic goals and prioritization of care. The use of VS-Frailty permits the individualization of the overall diagnosis, thus facilitating continuity of care in a systematized manner, ensuring comprehensive attention to the health of elderly individuals.

CITATION:
E. Nunes de Moraes ; F.M. Lanna ; R.R. Santos ; M.A.C. Bicalho ; C.J. Machado ; D.E. Romero (2016): A new proposal for the clinical-functional categorization of the elderly: Visual Scale of Frailty (VS-Frailty). The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.84

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HEALTH-RELATED QUALITY OF LIFE AND FUNCTIONAL HEALTH STATUS QUESTIONNAIRES IN OROPHARYNGEAL DYSPHAGIA

P. Orlandoni, N. Jukic Peladic

J Aging Res Clin Practice 2016;5(1):31-37

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Background: Oropharyngeal dysphagia negatively affects the quality of life of patients. It may lead to malnutrition, dehydration, aspiration pneumonia and death, especially in older people. Dysphagia and its level of severity have to be assessed accurately and in a timely fashion, because only early intervention can prevent the onset of complications. There are numerous self-administered questionnaires to monitor both the severity of dysphagia and the effectiveness of therapeutic approaches. The objective of this article is to conduct a literature review and to illustrate the characteristics of various self-assessment questionnaires for oropharyngeal dysphagia. Methods: A search of observational studies of adult populations with dysphagia, published from 1990 to June 2014, was performed in the electronic database Pubmed. Results: A total of 23 self-assessment questionnaires, on Health-related Quality of Life and Functional Health status, were identified. Fourteen questionnaires were excluded from the analysis for the following reasons: the questionnaire was written in a language other than English or Italian (n=3); the questionnaire was specific for caregivers (n=1); the questionnaires were not specific for oropharyngeal dysphagia (n=10). Nine questionnaires, validated in adult populations, were examined. Only two self-assessment questionnaires on quality of life - DHI (Dysphagia Handicap Index) and SWAL-QOL (Swallowing Quality Of Life) - were correctly validated; other questionnaires had methodological errors. Conclusions: A specific self-assessment questionnaire for older adults was not found. Almost all of the currently available questionnaires need to be improved methodologically. Furthermore, new questionnaires specifically for older people should be developed.

CITATION:
P. Orlandoni ; N. Jukic Peladic (2016): Health-related Quality of Life and Functional Health status questionnaires in Oropharyngeal Dysphagia. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.87

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LOW RATES OF VITAMIN D SCREENING: CONCERN FOR AGING WITH POOR SKELETAL HEALTH IN THE OLDER MINORITIES

N.J. Rianon, K.P. Murphy, C.B. Dyer, B.J. Selwyn

J Aging Res Clin Practice 2016;5(1):38-42

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Background: Regardless of discussion about vitamin D deficiency in minority population, there is a scarcity of information on vitamin D screening practice in older minority patients by their PCPs. Screening for risk factors does improve diagnosis and treatment of compromised skeletal health. Objective: To compare vitamin D screening rates between older patients from Caucasian and other non-Caucasian backgrounds including Blacks and Hispanics who were being treated by their PCPs for osteopenia, osteoporosis or related fractures. Design: Retrospective cross-sectional analysis. Setting: Electronic medical chart review from two urban primary care clinics (family medicine and geriatrics, Houston, TX) between January 2010 and December 2011. Participants: 133 patients 50 years or older who visited primary care clinics for osteopenia, osteoporosis or related fractures. Measurements: an order for 25-hydroxy vitamin D a year before or after an osteoporosis related visit. Results: Regardless of the clinic type, higher percentages of minority patients were not screened for vitamin D. While patients with older age from both groups were more likely to be screened, no single patient characteristic remained significant after adding clinic type to the logistic models. Conclusions: Lower rates of vitamin D screening put older minority patients at higher risk of aging with worsening skeletal health. Perspective and knowledge about vitamin D screening by PCP is recommended for future research to improve vitamin D screening and treatment in minority elderly.

CITATION:
N.J. Rianon ; K.P. Murphy ; C.B. Dyer ; B.J. Selwyn (2016): Low rates of vitamin D screening: concern for aging with poor skeletal health in the older minorities. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.81

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AGE-RELATED DIFFERENCES IN CO-MORBIDITY NUMBER, FUNDUS ATHEROSCLEROSIS LEVEL AND THE SERUM VALUES OF GSH-PX, HS-CRP AND HDL-C IN ELDERLY CHINESE PATIENTS

Q. Ruan, Z. Yu, C. Ma, Z. Bao, J. Li, J. Chen, L. Fu

J Aging Res Clin Practice 2016;5(1):43-49

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Background: The ApoE genotype, atherosclerosis, status of inflammation, oxidative stress and co-morbidity may be detrimental to the elderly. Objectives: To identify biomarkers of aging. Setting: All subjects were Chinese elderly in Shanghai. Subjects: 549 outpatients (489 male, 60 female), divided into ≤74 year-old, 75-84 year-old and the oldest old (≥85 year-old ) groups. Methods: A univariate analysis was used to investigate 5 age-related categorical variables and 26 continuous variables. The related variables were used to find the independent biomarkers of aging by Multivariate logistic regression analyses. Results: The serum values of Glutathione peroxidase, HDL-C and C reactive protein, the number of co-morbidities and fundus atherosclerosis level were the main independent age-associated factors that influenced aging. Compared with ≥85 year-old individuals, ≤74 year-old individuals had fewer co-morbidities [OR, 0.757 (95% CI, 0.636, 0.902)], lower grades of fundus atherosclerosis [Grade 0: OR, 26.059 (95% CI, 4.705, 144.324)] and [Grade I: OR, 8.539 (95% CI, 3.555, 20.513)] and lower serum levels of HDL-C [OR, 0.127 (95% CI, 0.037, 0.433)]. However, 75-84 year-old patients had significantly lower plasma levels of GSH-px [OR, 0.986, (95% CI, 0.972, 1.00)], HDL-C [OR, 0.158 (95% CI, 0.054, 0.457)] and HsCRP [Grade I: OR, 8.516 (95% CI,1.630, 44.484)], [Grade II: OR,7.699 (95% CI,1.544, 38.388)] and [Grade III: OR,7.251 (95% CI,1.346, 39.070)]. Conclusion: The oldest old patients had significantly high anti-oxidant capability and serum HDL-C level. However, these patients also had a significantly high systemic inflammation, number of co-morbidities and grades of fundus atherosclerosis.

CITATION:
Q. Ruan ; Z. Yu ; C. Ma ; Z. Bao ; J. Li ; J. Chen ; L. Fu (2016): Age-related differences in co-morbidity number, fundus atherosclerosis level and the SERUM values of GSH-px, Hs-CRP and HDL-C in elderly Chinese patients. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.89

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AGING AND THERAPEUTIC DELAY IN COLORECTAL CANCER: A FRENCH POPULATION-BASED STUDY

C. Montuclard, V. Jooste, V. Quipourt, S. Marilier, J. Faivre, C. Lepage, A.M. Bouvier

J Aging Res Clin Practice 2016;5(1):50-57

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Background/Objectives: Data on the time between colorectal cancer diagnosis and treatment in real-life practice for elderly patients are scarce. We measured times from diagnosis to first-course therapy in elderly patients with colon and rectal cancers. Design: The study was carried out on the population-based Burgundy Digestive Cancer Registry (France). Setting: Therapeutic delays were described by medians and interquartile ranges and compared by the Kruskal-Wallis rank test. Factors associated with changes in therapeutic delay were identified using a multivariate Cox model. Participants: The analysis was carried out on 2,884 patients aged 60 years and over with colorectal adenocarcinoma diagnosed between 2005 and 2011. Measurements and Results: The median therapeutic delay for colon cancer was 25 days in patients aged 60 to 69 years and 24 days for those aged 70-79 years. The delay fell significantly to 19 days in patients aged 80 and over (p<0.001). The median therapeutic delay for rectal cancer did not vary according to age group (respectively 39, 38 and 33 days). For colon cancer, a Charlson comorbidity score=0, in all age groups, and private care for patients under 80 years, significantly shortened the therapeutic delay. It was significantly longer during the period [2008-2011] only in patients under 80 (HR: 0.89 [0.81 - 0.99] p=0.037). For rectal cancer, only advanced stage (HR advanced vs II: 1.39 [1.04-1.86], p=0.025) shortened the therapeutic delay in patients under 80, while private care shortened therapeutic delay only in patients over 80 (HR private vs public: 1.66 [1.00-2.74], p=0.049). Conclusion: This study highlights that differences in therapeutic delay for the elderly increased over time for colon and rectal cancer. The therapeutic delay did not differ much between the 60-69 and the 70-79 years age groups, whereas it was shorter for patients aged 80 and over.

CITATION:
C. Montuclard ; V. Jooste ; V. Quipourt ; S. Marilier ; J. Faivre ; C. Lepage ; A.M. Bouvier (2016): AGING AND THERAPEUTIC DELAY IN COLORECTAL CANCER: A FRENCH POPULATION-BASED STUDY. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.90

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CAUSE-SPECIFIC MORTALITY OF OLDER ADULTS WITH AND WITHOUT DEPRESSIVE SYMPTOMS

P.D. St. John, S.L. Tyas

J Aging Res Clin Practice 2016;5(1):58-60

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Objective: To determine which causes of death are most closely associated with depressive symptoms. Methods: 1751 community-living older adults were assessed in 1991 and followed five years later. Depressive symptoms were assessed with the Center for Epidemiologic Studies – Depression (CES-D) scale. Death certificates were reviewed independently by two reviewers. Multinomial logistic regression models were adjusted for age and gender, and constructed with specific causes of death as the outcome compared to the reference category of being alive at time 2. Results: Death certificates were available for 253 (59%) of the 429 deceased participants. Those with depressive symptoms were more likely to die from cardiovascular diseases, stroke, respiratory diseases and non-specific syndromes, but not from infections or neoplasms. There were few deaths due to neurologic, renal, and gastrointestinal diseases. Conclusions: Depressive symptoms may be associated with death due to cardiovascular disease, stroke and respiratory disease.

CITATION:
P.D. St. John ; S.L. Tyas (2016): Cause-Specific Mortality of Older Adults with and without Depressive Symptoms. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.82

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