01/2019 journal articles
ASSESSING THE IMPACT OF A NUTRITION-FOCUSED QUALITY IMPROVEMENT PROGRAM IN CARDIOPULMONARY PATIENTS
M.R. Costanzo, S. Kozmic, S. Sulo, F. Dabbous, B. Warren, J. Partridge, A. Brown, K. Sriram
J Aging Res Clin Practice 2019;8:63-69Show summaryHide summary
Background: Patients with cardiopulmonary diagnoses are at high risk for hospital readmissions and prolonged hospitalizations. Nutrition-focused quality improvement programs (QIPs) can improve the care of malnourished hospitalized patients. Objectives: Data collected previously was analyzed to evaluate the impact of a nutrition-focused QIP on health outcomes in patients with cardiopulmonary diseases. Design: The QIP consisted of malnutrition risk screening, prompt initiation of oral nutritional supplements (ONS), and nutrition education. Setting: A total of 4 hospitals implemented the QIP–2 teaching hospitals and 2 community hospitals. Participants: Eligible QIP participants were hospitalized patients with any diagnosis, 18 years of age or older, at risk for malnutrition at admission, and able to consume food and beverages orally. Measurements: Data collected from the QIP patients was compared to data from historical controls to assess differences in readmission rates and length of stay (LOS). Results: Patients were mainly older adults (66 ± 17.4 years) and non-obese (85%). Univariate analysis showed significant reductions in 30-day readmission rates for the QIP group when compared with the controls (13.9% for QIP vs. 26.4% for controls), with the QIP group experiencing a 55% reduction in the odds of being readmitted (OR = 0.45, p = 0.006). Similarly, a significant reduction in LOS was reported for the QIP group (5.4 ± 5.7 days for QIP vs. 6.8 ± 5.7 days for controls) corresponding to a relative risk reduction (RR) of 20% (RR = 0.80, p = 0.0085). Logistic regression adjusting for patient characteristics showed that the QIP patients were 33% less likely to be readmitted (p = 0.33), and had a 6% RR (RR = 0.94, p = 0.55) in LOS versus controls. Conclusions: Malnourished hospitalized cardiopulmonary patients participating in a nutrition-focused QIP experienced fewer readmissions and improved LOS compared to controls. These results underscore the importance of nutrition-focused interventions as a key part of treatment for cardiopulmonary patients.
M.R. Costanzo ; S. Kozmic ; S. Sulo ; F. Dabbous ; B. Warren ; J. Partridge ; A. Brown ; K. Sriram (2019): Assessing the Impact of a Nutrition-Focused Quality Improvement Program in Cardiopulmonary Patients. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.11
FACTORS ASSOCIATED WITH DIMINISHED COUGH INTENSITY IN COMMUNITY-DWELLING ELDERLY USING DAY CARE SERVICES: A PILOT STUDY
R. Mikiya, C. Momoki, D. Habu
J Aging Res Clin Practice 2019;8:57-62Show summaryHide summary
: Purpose: We investigated factors affecting diminished cough intensity in community-dwelling elderly using day care services. Participants and Methods: A total of 61 elderly males and females aged ≥65 years who were certified to receive long-term adult day care services were enrolled in this study. Assessments included: Cough intensity (assessed using cough peak flow measurements, as well as possible determinants of cough intensity, lifestyle, and demographic characteristics), nutritional status (using the Mini Nutritional Assessment-Short Form), dietary intake (using the Dietary Variety Score), routine activity (using the Japanese version of the International Physical Activity Questionnaire), care-related factors (including day care services utilization and an oral exercise regimen) as well as age, need for long-term care, gender, sarcopenia status, the Charlson Comorbidity Index, and body mass, limb skeletal mass, and respiratory indices. Results: A reduced cough peak flow (odds ratio 4.46, 95% confidence interval: 1.08–18.43) was associated with sarcopenia and was weakly (not significantly) associated with age, gender, and the Mini Nutritional Assessment-Short Form score. Conclusion: A reduced cough peak flow was independently associated with sarcopenia and associated with age, gender, and nutritional status.
R. Mikiya ; C. Momoki ; D. Habu (2019): Factors associated with diminished cough intensity in community-dwelling elderly using day care services: A pilot study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.10
EFFECTS OF VITAMIN D SUPPLEMENTATION ON WELL-BEING, POSTURAL CONTROL, MUSCLE STRENGTH, BONE AND CALCITROPIC HORMONES – A RANDOMIZED DOUBLEBLIND PLACEBO CONTROLLED TRIAL
S.A. Eriksen, J. Starup-Linde, R.P. Hirata, K.K. Petersen, T. Graven-Nielsen, P. Vestergaard
J Aging Res Clin Practice 2019;8:49-56Show summaryHide summary
Background: Antidepressants may increase the risk of fractures through negative effects on the musculoskeletal system that could be hindered by vitamin D supplements. Objectives: To study the pleiotropic effects of daily vitamin D supplementation in depressed patients treated with citalopram (patients) and healthy controls. Design: Randomised double blind placebo controlled trial. Setting: A study of Danish women in the age 50 to 90 years. Participants: A total of 21 patients and 50 controls. Intervention: Participants received daily vitamin D supplementation (50 micrograms) or placebo in one year. Measurements: Bone Densitometry by dual-energy x-ray absorptiometry. Serum 25-hydroxyvitamin D, intact-Parathyroid Hormone, type 1 procollagen N terminal peptide, tartrate resistant acid phosphatase type 5b. Pain sensitivity measures based on pain detection thresholds by cuff algometry, temporal summation of pain, conditioned pain modulation, and cutaneous pain sensitivity by pinprick test. Degree of depression by the Major Depression Inventory. Physical performance was assessed by Timed up and go, isomeric handgrip exercise, and postural control by force plate. Results: Serum 25(OH)D levels increased in the vitamin D treated patients compared with controls at the 12 months visit (P<0.05). Conversely, intact- Parathyroid Hormone decreased among the patients and controls receiving vitamin D compared with placebo (P<0.05). Vitamin D improved Major Depression Inventory scores in patients and controls compared with placebo (P<0.05). In patients receiving vitamin D, handgrip strength improved (P<0.05). Conclusions: Vitamin D may improve depressive symptoms, and improve handgrip strength among patients compared to controls.
S.A. Eriksen ; J. Starup-Linde ; R.P. Hirata ; K.K. Petersen ; T. Graven-Nielsen ; P. Vestergaard (2019): Effects of vitamin D supplementation on well-being, postural control, muscle strength, bone and calcitropic hormones – a randomized double-blind placebo controlled trial. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.9
ORAL N-ACETYLCYSTEINE LOWERS PLASMA HOMOCYSTEINE IN ADULTS ON A BACKGROUND OF ANABOLIC RESISTANCE TRAINING
W. Hildebrandt, H. Krakowski-Roosen, H. Renk, A. Künkele, R. Sauer, D. Tichy, L. Edler, R. Kinscherf
J Aging Res Clin Practice 2019;8:44-48Show summaryHide summary
Lowering high plasma levels of homocysteine (tHcy) by folate/vitamin-B-supplementation only unsufficiently protects against cardiovascular diseases and dementia. To enhance therapeutic options, we evaluated whether the significant tHcy-lowering effect of oral N-acetylcysteine (NAC) in sedentary adults (-11.71% ) is still detectable on a background of anabolic resistance training (RT) which moderately decreases tHcy itself. Reanalysing a previous randomized controlled double-blinded clinical trial, we compared the effect of oral NAC (8 weeks 1.8 g/d, n=9) to that of placebo (n=8) on postabsorptive tHcy in healthy middle-aged subjects (tHcy 11.82±0.69 µM) undergoing 8 weeks of supervised progressive RT. NAC (+RT) led to a significantly greater reduction of tHcy (-13.97±5.81%) than placebo (+RT) (-3.85±4.81%) as confirmed by ANOVA (P<0.05) adjusting for methionine plasma levels and gain in strength. This add-on effect of NAC (~-10%) suggests that combining cysteine supplementation with RT may offer a novel (additional) option to lower tHcy in an aging population.
W. Hildebrandt ; H. Krakowski-Roosen ; H. Renk ; A. Künkele ; R. Sauer ; D. Tichy ; L. Edler ; R. Kinscherf (2019): Oral N-acetylcysteine lowers plasma homocysteine in adults on a background of anabolic resistance training. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.8
PREVALENCE AND PROGNOSTIC VALUE OF GERIATRIC SYNDROMES IN ELDERLY PATIENTS IN INTERMEDIATE GERIATRIC REHABILITATION UNITS
M. Serra-Prat, E. Martínez-Suárez, R. Cristofol Allue, S. Santaeugènia, M. Roqué, A. Salvà, the XARESS group
J Aging Res Clin Practice 2019;8:39-43Show summaryHide summary
Background: The prevalence and prognostic value of geriatric syndromes in geriatric rehabilitation units is poorly understood. Objective: To determine the prevalence of geriatric syndromes in intermediate geriatric rehabilitation units and evaluate associations with outcomes and death during admission. Methods: Observational, longitudinal study of patients admitted to 10 intermediate geriatric rehabilitation units in 2015. Admission-to-discharge data were collected retrospectively from a shared minimum data set (CMBD-RSS). The geriatric syndromes considered were dementia, depression, immobility, urinary incontinence, faecal incontinence, instability, insomnia, acute confusional state, terminal illness and pressure ulcers. The main outcome measures were functional status on admission (assessed using the Resource Utilization Group Activities of Daily Living Scale), functional improvement between admission and discharge, length of stay and death during admission. Results: We analysed 5619 patients (mean age 80.2 years; 57.1% women). The mean number of syndromes was 2.3. The most prevalent syndromes were urinary incontinence (62%), dementia (35%), faecal incontinence (35%) and immobility (26%). The presence of each geriatric syndrome increased the risk of functional impairment at discharge (except in the case of insomnia) and of death during admission (except in the case of instability syndrome). Conclusions: Geriatric syndromes are very prevalent in intermediate geriatric rehabilitation units and indicate a lower probability of functional recovery and a greater probability of death during admission.
M. Serra-Prat ; E. Martínez-Suárez ; R. Cristofol Allue ; S.Santaeugènia ; M. Roqué ; A. Salvà ; the XARESS group (2019): Prevalence and prognostic value of geriatric syndromes in elderly patients in intermediate geriatric rehabilitation units . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.7
PREVALENCE AND CHARACTERISTICS ASSOCIATED WITH ALCOHOL USE AND ALCOHOL RELATED PROBLEMS IN COMMUNITY DWELLING OLDER ADULTS
Y. van Gils, E. Franck, S.J.P. van Alphen, E. Dierckx
J Aging Res Clin Practice 2019;8:28-38Show summaryHide summary
Objective: This study examine the prevalence, characteristics and associated factors of alcohol use and alcohol related problems among Belgian community dwelling older adults. Design: Retrospective cross-sectional study by extensive examination survey. Setting: The participants were questioned in their homes or in community centres. Participants: Overall, 1,366 adults ≥65 years participated in this study. Method: Information about self-reported alcohol use during the past year, Health Related Quality of Life (HRQL) and alcohol related problems was gathered with respectively the AUDIT, SF36 and MAST-G. Results: Of the total sample, 84.4% reported alcohol consumption. Using the NIAAA guidelines, the overall prevalence for at risk drinking was 26.6% and for binge drinking 14.8%, both risky alcohol patterns. Logistic regression analyses were performed on the drinking sample to determine the predictors associated with at risk drinking, binge drinking and hazardous drinking. Being male, a smoker of former smoker and living alone were associated with at risk drinking. Being male, being aged 65-74 years, being a smoker, reporting polypharmacy, MCS and having recent loss experience were associated with binge drinking. More than 25% of respondents were classified as hazardous drinking (score ≥5 on MAST-G). Associated factors with hazardous drinking were being male, having a family history of alcohol problems, PCS and MCS. Conclusions: The prevalence rates for at risk alcohol patterns and alcohol related problems were higher than in previous studies. As older adults are more vulnerable to the adverse consequences of alcohol use, awareness about alcohol use should be raised among older adults, as well as amongst health care givers and researchers.
Y. van Gils ; E. Franck ; S.J.P. van Alphen ; E. Dierckx (2019): Prevalence and characteristics associated with alcohol use and alcohol related problems in community dwelling older adults. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.6
AMYLOIDß, APP, AND DISCOVERIES IN THE TREATMENT OF ALZHEIMER’S DISEASE
G. Webb, T.A. Clemons
J Aging Res Clin Practice 2019;8:27Show summaryHide summary
G. Webb ; T.A. Clemons (2019): Amyloidβ, APP, and Discoveries in the Treatment of Alzheimer’s Disease. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.5
PREVALENCE OF UNDER NUTRITION AND ASSOCIATED FACTORS AMONG PEOPLE OF OLD AGE IN DEBRE MARKOS TOWN, NORTHWEST ETHIOPIA, 2015
Z.K. Adhana, G.H. Tessema, G.A. Getie
J Aging Res Clin Practice 2019;8:20-26Show summaryHide summary
Background: Malnutrition is defined as a disproportion of nutrients caused by either an excess intake of nutrients or a nutritional deficit. One of the most common nutritional problems in older people (aged 60 years and over) is under nutrition. Worldwide studies revealed that the prevalence of under nutrition in people of old age is high. Objective: To assess the prevalence of under nutrition and its associated factors among old people in Debre Markos town, Northwest Ethiopia, 2015. Methods and materials: A cross sectional study design was conducted among 423 study subjects of old age in Debre Markos town from August 4 to August 30, 2015. Primary data was collected using a pre tested Mini Nutritional Assessment Short-Form (MNA-SF) screening tool and structured questionnaires by trained data collectors. The data that was collected was entered and cleaned using EpiData version 3.1 statistical software then exported to the SPSS version 20 statistical package for further data analysis. Descriptive statistics of frequency, tables and graphs were used and summary measures were calculated to determine the prevalence of under nutrition. The data was also used to describe the distribution of the independent variables among study subjects. Bivariate and multivariate logistic regression models were utilized to calculate crude and adjusted odds ratios in order to identify factors associated with under nutrition of study participants at 0.05 level of significance. Result: The prevalence of under nutrition among study participants was found to be 22.7% (95%CI 18.7-26.7). A number of independent variables have a significant association with under nutrition, including gender (females (AOR 7.95 95% CI (2.86, 22.08)), age (Oldest Old and Middle Old, (AOR=3.45 95%CI (1.44, 8.26) and (AOR=5.25, 95%CI (2.48, 11.13) respectively), marital status (widowed elderly individuals (ARO 3.29 95 % CI (1.54, 7.06)), individuals with eating difficulty (AOR 10.73 95 % CI (4.49, 25.63), individuals with vision problems (AOR 5.67 95 % CI (2.80, 11.48) and meal frequency (ARO 6.71 95 % CI (3.31, 13.63). Conclusion and recommendation: Prevalence of under nutrition among study participants was 22.7%. Gender, age, marital status, eating difficulty, visual problems and meal frequency were found to be independent determinant factors of under nutrition among study subjects. The government, family members and other stakeholders should give more attention to older individuals especially older females.
Z.K. Adhana ; G.H. Tessema ; G.A. Geti (2019): Prevalence of under nutrition and Associated Factors among People of Old Age in Debre Markos Town, Northwest Ethiopia, 2015. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.4
EVALUATION OF INPATIENTS NUTRITIONAL STATUS AND PROGNOSTIC INVOLVEMENT
J. Ares Blanco, L. Moreno Díaz, E. Fernández-Fernández, A.J. López-Alba
J Aging Res Clin Practice 2019;8:15-19Show summaryHide summary
Background: There is an association between malnutrition and mortality. However, it is unclear if this association is truly independent of confounding factors. Objectives: The objective of this study is to evaluate nutritional status, defined according to the three categories defined in the Nutritional Screening Tool “Mini Nutritional Assessment”, and to investigate its prognostic involvement. Design, Setting and Participants: Single cohort retrospective observational study in hospitalized patients between December 2013 and January 2014, who were placed under observation until September 2015 (21 months) (n=144). Nutritional status was determined by MNA short form at the beginning of the study, as well as clinical and epidemiological data. Results: Based on categories defined by MNA SF, 59 (40.97%) were well nourished, 55 (38.19%) were at risk of malnutrition, and 30 (20.83%) patients showed malnutrition. 45 patients died during follow up (31.25%). Of them, 40% (18) were malnourished, 38% (17), at risk of malnutrition, and 22% (9), well nourished. After adjusting for confounding factors, hazard ratio (95% CI) for all-cause mortality was significantly greater in the malnourished group (3.44 (1,27-9,31: p 0,015)), comparing to the reference group (well-nourished patients). Conclusions: Nutritional status defined according to the 3 categories defined in MNA short form predicts the probability of mid-term death in hospitalized patients, after adjusting for confounding factors as age and comorbidities. These data show the importance of knowing nutritional status during hospitalization for avoiding potential complications and helping the patient to overcome them.
J. Ares Blanco ; L. Moreno Díaz ; E. Fernández-Fernández ; A.J. López-Alba (2019): EVALUATION OF INPATIENTS' NUTRITIONAL STATUS. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.3
NUTRITIONAL ADEQUACY AND ORAL NUTRITIONAL SUPPLEMENTATION IN OLDER COMMUNITY-DWELLING ADULTS
L. McKeever, I.C. Farrar, S. Sulo, J. Partridge, P. Sheean, M. Fitzgibbon
J Aging Res Clin Practice 2019;8:7-14Show summaryHide summary
Background: Older adults (65 years and older) comprise a high-risk group that are susceptible to the development of malnutrition. Dietary intake and diet quality represent key modifiable risk factors to help prevent and to treat declines in nutrition status, with oral nutritional supplements (ONS) often being a cost-effective therapy for many to increase protein and caloric intake. The DETERMINE Checklist offers a series of questions capable of mapping the initial landscape of contextual factors that influence the dietary patterns of the at-risk populations. Objectives: To examine independent predictors of inadequate dietary intake and poor diet quality amongst a multi-ethnic sample of urban community-dwelling older adults in an effort to identify target groups of participants that could benefit most from an ONS intervention. Design: Cross-sectional. Participants: Chicago, Illinois, United States urban residents greater than 55 years of age who self-reported to be non-Hispanic White, non-Hispanic Black, or Hispanic. Methods: Telephone surveys were conducted to obtain basic demographic information. The DETERMINE Checklist was administered to (1) characterize participants’ nutritional risk, and (2) identify participants with inadequate intake and/or poor diet quality. Predictors of inadequate intake, defined as any participant who reported either to eat less than two meals per day and/or poor diet quality, defined as any participant who reported to eat few fruits, vegetables or dairy were used to identify groups of participants who could benefit most from ONS consumption. Mantel-Hanzel chi square, Breslow-day tests, and logistic regressions were conducted. Results: 1001 ethnically diverse participants were interviewed (37% non-Hispanic White, 37% non-Hispanic Black, and 26% Hispanic). Respondents were predominantly female (69%) with a mean age of 66.9 (± 6.4) years. The majority were found to be at either moderate or high nutrition risk (78.7%). Domains of the DETERMINE Checklist that predicted either inadequate dietary intake or poor diet quality included social isolation, lower levels of educational attainment, food insecurity, limitations in activities of daily living (ADL), polypharmacy, or three or more alcoholic drinks per day. Of the participants who met the criteria as those who would benefit from ONS, less than 50% had reported consuming ONS in the past six months. Conclusion: Older community-dwelling adults living in an urban setting, especially those with social isolation, lower levels of education, food insecurity, limitations with ADLs, polypharmacy, and those reporting heavy alcohol intake represent a population who could benefit from consuming ONS. Efforts should be made towards further understanding these contextual factors and providing nutrition education along with an ONS intervention that could be beneficial to supplement dietary inadequacies in this population.
L. McKeever ; I.C. Farrar ; S. Sulo ; J. Partridge ; P. Sheean ; M. Fitzgibbon (2019): Nutritional Adequacy and Oral Nutritional Supplementation in Older Community-Dwelling Adults. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.2
EFFECT OF ß-HYDROXY-ß-METHYLBUTYRATE (HMB) ON MUSCLE STRENGTH IN OLDER ADULTS WITH LOW PHYSICAL FUNCTION
K. Kinoshita, S. Satake, Y. Matsui, S. Kawashima, H. Arai
J Aging Res Clin Practice 2019;8:1-6Show summaryHide summary
Objectives: To evaluate the effects of β-hydroxy-β-methylbutyrate (HMB) on muscle strength, physical performance, and muscle mass without additional exercise training in older adults with low physical function. Design: Randomized, controlled trial (Open-label study). Setting: Outpatients. Participants: 34 senior outpatients with low physical function who do not exercise regularly. Intervention: 2.4 g of HMB (3.0 g of calcium β-hydroxy-β-methylbutyrate [CaHMB]) per day was given for 60 days, and subjects in the control group were asked to engage in daily activities as normal. Measurements: Weakness or low function was defined by the Asian Working Group for Sarcopenia criteria, then the participants were assigned to the HMB group or the control group. All participants underwent several evaluations such as grip strength, the timed up and go test, the 5-times chair stand test (5CS), and skeletal muscle mass index by the bioimpedance method at baseline and at the end of intervention or control period. Results: An intragroup comparison of pre- to post-treatment values showed significant improvement in grip strength and the 5CS in the HMB group (grip strength: HMB, 16.6±6.1 kg to 18.2±6.4 kg, P=.001; control, 16.5±4.3 kg to 16.7±4.7 kg, P=.729; 5CS: HMB, 11.0 [8.8-13.0] s to 10.1 [8.5-12.6] s, P=.011; control, 11.1 [8.6-13.8] s to 10.0 [8.8-11.3] s, P=.246). Two-way repeated measures analysis of variance (ANOVA) used to compare the HMB and control groups showed a significant improvement in grip strength in the HMB group compared with the control group (P=.029). Conclusion: A supplementation of HMB without additional exercise may improve muscle strength in older patients with low muscle strength.
K. Kinoshita ; S. Satake ; Y. Matsui ; S. Kawashima ; H. Arai (2019): Effect of β-Hydroxy-β-methylbutyrate (HMB) on muscle strength in older adults with low physical function . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2019.1