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04/2016 journal articles

DIABETES STATUS IS ASSOCIATED WITH POOR COGNITIVE PERFORMACE IN SAUDI POPULATION AT HIGH METABOLIC RISK

T. Alaama, M. Basheikh, A. Khiyami, M. Mutwalli, S. Batawi, G. Watfa

J Aging Res Clin Practice 2016;5(4):170-174

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Objective: Previous studies have shown that Diabetes mellitus (DM) is associated with an increased risk of cognitive impairment, but little data is available on Arabic populations, inspite of their remarkably high prevalence of DM. In this study we attempt to study the effect of DM on cognitive performance in middle-aged and elderly patients. Design: Observational cross sectional study. Setting: Outpatient clinics in King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Participants: The study included 241 volunteers aged 59.6 ± 9.2 years; 171 outpatients with DM, matched with 70 controls without. Measurements: Volunteers underwent cognitive assessment using the Montreal Cognitive Assessment Test (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS). Results: RUDAS score was poorer in diabetics (25,25 ± 2,78 vs. 26,71 ± 2,57 in controls; p<0.0001) who are more likely to have cognitive impairment 16% , than those who are not diabetics 3%; p=0.004. This association was confirmed in multivariate analyses and shown to be independent of female gender and low education level, all of which were associated with worse RUDAS cognitive score.The results were not significant when the MoCA was used, as 85 % of the cases and 78 % of the controls had abnormal results;p=0.194.Among diabetics, there was no statistically significant effect found for glycemic control or DM duration on either one of the tests.The prevalence of obesity was similar in the two groups with 63% in diabetics and 62% in controls. Conclusion: In our population with an alarming prevalence of obesity, diabetes was associated with poorer cognitive performance independent of female gender or low education level, drawing attention to this under-recognized problem of cognitive impairment that could result in significant health and social problems, particularly in areas with high diabetes prevalence. RUDAS was found to be a very reasonable and convenient test to assess cognition in our sample characterized by a low educational level.

CITATION:
T. Alaama ; M. Basheikh ; A. Khiyami ; M. Mutwalli ; S. Batawi ; G. Watfa (2016): DIABETES STATUS IS ASSOCIATED WITH POOR COGNITIVE PERFORMACE IN SAUDI POPULATION AT HIGH METABOLIC RISK. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.120

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DIETETIC MANAGEMENT OF MALNUTRITION IN A HEALTHCARE SETTING: A SIX MONTH PRAGMATIC RANDOMISED CONTROLLED TRIAL WITH A 24 MONTH FOLLOW-UP

M. Milosavljevic, S. Bowden, A. Ferguson, L. Barone, S. Mason, L. Tapsell, G. Noble

J Aging Res Clin Practice 2016;5(4):175-180

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Background: This study explored approaches to long term dietetic management of disease related malnutrition, a growing problem across hospitals in the industrialised world. Objectives: The aim of this study was to compare the effectiveness of two current models of dietetic care for patients with Disease Related Malnutrition. Design: A six month pragmatic randomised controlled trial was conducted with a 24 month follow up. Setting: All patients referred to the dietitian from two general medical and two surgical wards at a major public regional referral centre who met the inclusion criteria were invited to participate. This included being identified on admission as “at risk” of malnutrition or malnourished. Participants: Dietitians attended to 1222 patients during the recruitment period. From 320 eligible participants, 241 (78%) were recruited; of these only 85 (27%) completed the study. Intervention: It compared extended community–based dietetic management with the more traditional short-term hospital care alone. Measurements: A series of variables were recorded at enrolment, six months and then a follow up at 24 months. These included: nutritional assessment, level of satisfaction with the dietetic service, bed day utilisation, readmission and mortality rates. Results: An intention to treat analysis showed both groups had a significant improvement in nutritional status at six months and this was maintained at 24 months. When patients received an extended community care dietetic service they were significantly more satisfied with the dietetic service than those who did not receive the service (P<0.001). Conclusion: The current standard dietetic care of patients admitted to our institution led to significant improvements in their nutritional status at six months and two years from initial contact. The patient’s level of satisfaction with the dietetic service was high when they were seen in the community.

CITATION:
M. Milosavljevic ; S. Bowden ; A. Ferguson ; L. Barone ; S. Mason ; L. Tapsell ; G. Noble (2016): Dietetic management of malnutrition in a healthcare setting: a six month pragmatic randomised controlled trial with a 24 month follow-up. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.119

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COMPARING OLDER ADULTS PRESENTING WITH DEHYDRATION AS A PRIMARY DIAGNOSIS VERSUS A SECONDARY DIAGNOSIS IN THE EMERGENCY DEPARTMENT

J.C. Mentes, H. Aronow

J Aging Res Clin Practice 2016;5(4):181-186

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Objectives: We compared clinical data of older adults, >65 years of age who presented to a large urban ED with a primary diagnosis of dehydration, ICD code 276.5 (PD) to those with dehydration as a secondary diagnosis (SD). Design: Comparative study using a large hospital emergency room administrative database (2008-2009). Setting: Large urban hospital. Participants: 231 participants mean age 81 years, 86 with PD were matched on age, gender and ethnicity to 145 with SD. Measurements: We collected data on chief complaints, laboratory tests, medical diagnoses, and medications as listed in the database. Results: Among major diagnoses, those with SD were more likely to have an infection. A logistic regression with SD as dependent variable and using variables significant at the univariate level revealed that infections (AOR= 6.7, 95% CI 2.92, 15.08) and difficulties with activities of daily living (AOR= 2.19, 95% CI 1.02-4.66) were more likely in those presenting with SD than with PD. Patients with SD were less likely to have a diabetes diagnosis (AOR=.32, 95% CI .14, .72), have diarrhea (AOR= .50, 95% CI .22, 1.19), and present with a dry mouth (AOR= .39, 95% CI, .19, .78). Those with SD were significant more likely to be repeat ED users, have longer hospital stays and have higher hospital costs than those with PD. Conclusions: Comorbid dehydration is often obscured by the seriousness of the presenting condition in the ED. This creates a missed opportunity to educate the patients and their families about the importance of maintaining adequate hydration, which may prevent rehospitalization.

CITATION:
J.C. Mentes ; H. Aronow (2016): Comparing older adults presenting with dehydration as a primary diagnosis versus a secondary diagnosis in the emergency department. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.118

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CARNITINE INSUFFICIENCY IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Y. Kinugasa, S. Sugihara, K. Yamada, M. Miyagi, K. Matsubara, M. Kato, K. Yamamoto

J Aging Res Clin Practice 2016;5(4):187-193

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Background: L-carnitine is an essential nutrient that plays a vital role in fatty acid energy metabolism of the heart and skeletal muscles. Primary or secondary carnitine insufficiency contributes to progressive left ventricular systolic dysfunction and physical frailty. However, the clinical features of patients with heart failure with preserved ejection fraction (HFpEF) and carnitine insufficiency remain unclear. Objectives: The present study aimed to evaluate the clinical characteristics and outcomes of these patients. Design: A prospective cohort study. Setting: Tottori University hospital. Participants: 117 patients who were hospitalized with HFpEF (ejection fraction ≥45%). Measurement: All measurements were obtained at hospital discharge. Carnitine insufficiency was defined as the lowest quantile of free carnitine level (<56.3 μmol/L) or the highest quantile of acylcarnitine to free carnitine ratio (≥0.35). Nutritional status and physical activity were assessed by the Geriatric Nutritional Risk Index (GNRI) and Barthel index (BI). Left ventricular diastolic function was assessed by echocardiography. The composite endpoints were hospitalization for heart failure and death from cardiac causes. Results: Patients with carnitine insufficiency (44.4%) had lower values of GNRI and BI, higher B-type natriuretic peptide levels, and lower early diastolic mitral annular velocity in the subgroups with sinus rhythm compared with those with preserved carnitine (all p<0.05). During a mean follow-up of 472±249 days, composite endpoints occurred in 26.5% of patients. Multivariate Cox hazard analysis showed that carnitine insufficiency was an independent predictor of cardiac events (p<0.05). Conclusions: Carnitine insufficiency is associated with adverse outcomes in patients with HFpEF.

CITATION:
Y. Kinugasa ; S. Sugihara ; K. Yamada ; M. Miyagi ; K. Matsubara ; M. Kato ; K. Yamamoto (2016): Carnitine Insufficiency is Associated with Adverse Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.116

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ATROPHIC GASTRITIS (AG) AND ITS CLINICAL SEQUELS AMONG ELDERLY PEOPLE IN FINLAND AND ESTONIA. A COMPARATIVE STUDY USING GASTROPANEL AND B12- VITAMIN TESTING OF THE RESIDENTS IN ASSISTED-HOUSING FACILITIES

R. Aine, E. Kahar, K. Aitokari, J. Salminen, C. Eklund, L. Paloheimo, A. Peetsalu, K. Syrjänen

J Aging Res Clin Practice 2016;5(4):194-202

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Objective: Atrophic gastritis (AG) is associated with severe clinical sequels, including malabsorption of vitamin-B12, calcium, iron, magnesium, and zinc, with potential to develop irreversible neurological complications (e.g. dementia). To assess the prevalence of AG and its clinical sequels by serum biomarker testing and B12-vitamin measurement in elderly people in Estonia and Finland. Methods: In total, 209 residents of assisted-housing facilities (mean age 82 years) were screened by GastroPanel (Biohit Oyj, Finland) and active B12-vitamin test, the results linked with their medical history. Results: Study subjects in Tampere (n=106) and Tartu (n=103) differed in many characteristics of their medical history, including previously diagnosed B12-vitamin deficiency (p=0.006). Data requested for GastroPanel testing disclosed significantly less use of PPI medication and B12-vitamin supplementation in Tartu (p=0.0001). GastroPanel diagnostic profile (5 categories) was significantly different (p=0.0001), most markedly the HP-prevalence (all cases) (52.4%% vs 24.5%). AG in Finland (12.3%) and Estonia (15.6%) was not different (p=0.494), but manifest B12-vitamin deficiency was more common in Tartu (23.3% vs. 3.8%)(p=0.0001). Of all known complications of AG, only i) the diagnosed vitamin B12 deficiency (OR=3.5), and ii) diagnosed pernicious anaemia (OR=9.4) were significantly associated with AG. Conclusions: In Estonia, the majority (92%) of B12-vitamin deficient cases remained undiagnosed as compared to Finland (23.5%). To prevent irreversible complications, early diagnosis and adequate supplementation of vitamin B12 deficiency is essential. This is best done by detecting the subjects at risk (AG patients) by targeted GastroPanel screening, even years before the development of protean clinical manifestations.

CITATION:
R. Aine ; E. Kahar ; K. Aitokari ; J. Salminen ; C. Eklund ; L. Paloheimo ; A. Peetsalu ; K. Syrjänen (2016): Atrophic gastritis (AG) and its clinical sequels among elderly people in Finland and Estonia. A comparative study using GastroPanel and B12-vitamin testing of the residents in assisted-housing facilities. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.115

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DIETARY HABITS AND FUNCTIONAL LIMITATION OF OLDER BRAZILIAN ADULTS: EVIDENCE FROM THE BRAZILIAN NATIONAL HEALTH SURVEY (2013)

E. Alves Valle, J. Vaz de Melo Mambrini, S. Viana Peixoto, D. Carvalho Malta, C. de Oliveira, M.F. Lima-Costa

J Aging Res Clin Practice 2016;5(4):203-208

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Objective: To compare the consumption of selected healthy and unhealthy food groups among elderly Brazilians with daily living activity limitations relative to those with no limitations. Design: Cross-sectional analyses of a nationally representative survey. Setting: The Brazilian National Health Survey, conducted in 2013. Subjects: 11,177 Brazilians aged 60 and over. Results: The prevalence of daily living limitations was 29% (95% CI 27.6,30.5). The consumption of daily meat, beans on a regular basis, and recommended fruit and vegetables intake were 67.1% (95% CI 66.5,68.7), 71.3% (95% CI 69.9,72.8) and 37.3% (95% CI 35.6,39.9), respectively. Compared to those without functional limitation, the consumption of these three food groups was significantly lower among those older adults with functional limitation (Prevalence Ratio = 0.89, 95% CI 0.80,0.98; 0.90, 95% CI 0.82,0.99 and PR 0.86, 95% CI, 0.76,0.96, respectively), independently of age, sex, marital status, living arrangements and education. Level of education showed a strong positive association with fruit and vegetable consumption, and a negative association with bean consumption, a staple diet in Brazil. Conclusions: Our findings highlight the need for public health policies to increase consumption healthy food consumption among those older adults with functional limitations, especially fruit and vegetable intake among those who have low education levels.

CITATION:
E. Alves Valle ; J. Vaz de Melo Mambrini ; S. Viana Peixoto ; D. Carvalho Malta ; C. de Oliveira ; M.F. Lima-Costa (2016): Dietary habits and functional limitation of older Brazilian adults: evidence from the Brazilian National Health Survey (2013). The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.114

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PLASMA LEVELS OF INTERLEUKIN-6 AND SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR ARE ASSOCIATED WITH MUSCLE PERFORMANCE IN PRE-FRAIL COMMUNITY-DWELLING OLDER WOMEN?

L. Paccini Lustosa, L. Souza Máximo Pereira, P. Parreira Batista, D.A. Gomes Pereira, J.M. Domingues Dias, A. Netto Parentoni

J Aging Res Clin Practice 2016;5(4):209-213

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Aim: Increased plasma levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α have been associated with frailty syndrome and reduced muscle strength in older. Sarcopenia influenced loss of mobility and functional independence, and contributed to frailty syndrome. Furthermore, sarcopenia mainly entails a decrease in type II muscle fibers, with consequent loss of muscle power; this could occur as a result of a lack of physical activity. Objective: To examine the correlation of muscular performance and the plasma levels of IL-6 and soluble TNF receptor (sTNFr) in pre-frail community-dwelling women. Methods: The study included 32 pre-frail women (≥ 65ys). The measurements were plasma concentrations of IL-6 and sTNFr1 (ELISA); muscle strength (isokinetics Biodex System). The muscle resistance program constituted 75% of maximum load (3 times/week, 10 weeks). Statistical analysis were made through Pearson and Spearman correlation (α = 5%). Results: There was a significant inverse correlation between sTNFr1 and muscle strength, pre- (r = −0.36, P = .04) and post-training (r = −0.37, P = .04) and, a significant positive correlation between IL-6 and muscle strength (r = 0.45, P = .01). Conclusion: The correlations found between the inflammatory mediators and the measures of muscular performance evaluated before and after training suggest that, as the muscles increase their ability to generate power, sTNFr concentrations decrease, and the levels of IL-6 increase. Muscle resistance exercises should be encouraged in pre-frail older women to induce the release of cytokines.

CITATION:
L. Paccini Lustosa ; L. Souza Máximo Pereira ; P. Parreira Batista ; D.A. Gomes Pereira ; J.M. Domingues Dias ; A. Netto Parentoni (2016): Plasma Levels of Interleukin-6 and Soluble Tumor Necrosis Factor Receptor Are Associated with Muscle Performance in Pre-Frail Community-Dwelling Older Women?. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.113

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EXPLORING CENTENARIANS’ PERCEPTION OF NUTRITION

E.C. Holston, B. Callen

J Aging Res Clin Practice 2016;5(4):214-216

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Background/Objective: Centenarians’ dietary habits have been associated with healthy aging, although it is centenarians’ perceptions about their diet that influence what they eat and in what amounts. However, there is little research on centenarians’ viewpoints about their past and current eating patterns and their impact on centenarians’ current nutritional status. Thus, this study explored the perceptions about lifetime dietary habits of community-dwelling Appalachian centenarians. Design: A qualitative descriptive design. Setting: Home or the facility where participants lived. Participants: A convenience sample of community-dwelling centenarians. Measurements: Face-to-face interviews were used. Transcripts were analyzed with the Nuendorf’s method of content analysis. Results: Emerging themes were source of food, food preferences, food consumption, balanced diet, food preparation & storage, responsibility for nutrition of family, and longevity. Conclusion: Centenarians’ perceptions about their dietary behaviors need to be considered when adjusting their diets and eating patterns for clinical purposes.

CITATION:
E.C. Holston ; B. Callen (2016): Exploring Centenarians’ Perception of Nutrition. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.111

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ACCURACY OF 24-HR FOOD-REGISTRY METHOD IN ELDERLY SUBJECTS: ROLE OF A SURROGATE RESPONDENT

J. Pardío, P. Arroyo, A. Loría, S. Torres-Castro, M. Agudelo-Botero, B.L. Jiménez Herrera, A.T. Serrano Miranda

J Aging Res Clin Practice 2016;5(4):217-219

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Importance: There are problems in the dietary assessment of elders due to the aging process. Objective: To assess the comparativity of dietary diversity reported by an elder with that reported independently by his/her Caregiver. Design: Comparison of foods consumed by elder in the previous 24-h reported by elder and caregiver. Outcome variable: % of foods reported and unreported by either. Setting: A Housing Development Unit, and a Geriatric Rehabilitation Clinic. Participants: 26 elders of 65-94 years of age, plus 26 caregivers. Results: The %foods unreported was more than double in elders than in caregiver (37% vs 17%). Regression models using sociodemographic variables of elders and caregivers as predictor variables showed only one significant variable [Caregiver cooked for the elder] associated with %unreported by caregiver and with %reported by either. No association with age, sex, being next-of-kin, schooling, cognitive level or setting was observed. Conclusion: The use of surrogates in dietary evaluation of elders should be carried out using the person in charge of preparing foods for the elder.

CITATION:
J. Pardío ; P. Arroyo ; A. Loría ; S. Torres-Castro ; M. Agudelo-Botero ; B.L. Jiménez Herrera ; A.T. Serrano Miranda (2016): Accuracy of 24-Hr food-registry method in elderly subjects: role of a surrogate respondent. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.112

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GENDER DIFFERENCES IN PRACTICE, KNOWLEDGE AND ATTITUDES REGARDING FOOD HABITS AND MEAL PATTERNS AMONG COMMUNITY DWELLING OLDER ADULTS

J. Johannesson, E. Rothenberg, S. Dahlin Ivanoff, F. Slinde

J Aging Res Clin Practice 2016;5(4):220-228

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Objective: To study gender differences in older adults according to practice, knowledge and attitudes regarding food habits and meal patterns. Design: Cross-sectional study. Setting: Two urban districts of Gothenburg, Sweden. Participants: A total of 297 individuals were included, 102 men and 195 women. They were 80 years or older and living in ordinary housing without being dependent upon the municipal home help services or help from another person in Activities of Daily Life, and cognitively intact, defined as having a score of 25 or higher in the Mini Mental State Examination. Measurements: Telephone interviews regarding food habits and meal patterns were conducted. Results: Almost all participants (99%) ate their main meal at home and men preferred company at meals more often (p<0.001). Women had the sole responsibility to shop for food more often (p<0.000), and generally regarded cooking as a routine or something they just had to do. Among men, few (13%) took a great interest in cooking and 36 % of the men stated that cooking was something they were not capable of performing (p<0.000). Men had company at meals every day more often (71% vs 40%). Respondents stated that loneliness took away the enjoyment of cooking and changed their habits when becoming a widow or widower. Conclusion: Women take greater responsibility for the household than men, regardless of marital status. A large proportion of the men thought cooking was something they were not able to do. The findings in this study may indicate a possible gender difference in the need for societal support.

CITATION:
J. Johannesson ; E. Rothenberg ; S. Dahlin Ivanoff ; F. Slinde (2016): Gender differences in practice, knowledge and attitudes regarding food habits and meal patterns among community dwelling older adults. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.117

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