Effect of room temperature on tests for diagnosing vibration-induced white finger: finger rewarming times and finger systolic blood pressures

Purpose

This study investigates the effects of room temperature on two standard tests used to assist the diagnosis of vibration-induced white finger (VWF): finger rewarming times and finger systolic blood pressures.

Methods

Twelve healthy males and twelve healthy females participated in four sessions to obtain either finger skin temperatures (FSTs) during cooling and rewarming of the hand or finger systolic blood pressures (FSBPs) after local cooling of the fingers to 15 and 10 °C. The measures were obtained with the room temperature at either 20 or 28 °C.

Results

There were lower baseline finger skin temperatures, longer finger rewarming times, and lower finger systolic blood pressures with the room temperature at 20 than 28?°C. However, percentage reductions in FSBP at 15 and 10?°C relative to 30?°C (i.e. %FSBP) did not differ between the two room temperatures. Females had lower baseline FSTs, longer rewarming times, and lower FSBPs than males, but %FSBPs were similar in males and females.

Conclusions

Finger rewarming times after cold provocation are heavily influenced by room temperature and gender. For evaluating peripheral circulatory function using finger rewarming times, the room temperature must be strictly controlled, and a different diagnostic criterion is required for females. The calculation of percentage changes in finger systolic blood pressure at 15 and 10?°C relative to 30?°C reduces effects of both room temperature and gender, and the test may be used in conditions where the ±1?°C tolerance on room temperature required by the current standard cannot be achieved.

     

Multicenter study on finger systolic blood pressure test for diagnosis of vibration-induced white finger

Objective

A multicenter study (six Rosai hospitals around Japan) was performed to investigate the diagnostic value of changes in finger systolic blood pressure (FSBP) after segmental local cooling for vibration-induced white finger (VWF).

Methods

Subjects were 154 men without exposure to vibration and 135 men with occupational vibration exposure. They were classified into four groups: Group A, 154 unexposed control cases; Group B, 21 exposed cases without VWF; Group C, 31 cases with a history of VWF but without any signs of VWF within the last year; and Group D, 83 cases with active VWF within the last year. FSBP% measurements were taken at room temperatures of 23 ± 1 and 21 ± 1°C, using a strain-gauge Digimatic 2000 plethysmograph (Medimatic).

Results

At a room temperature of 23 ± 1°C, there was a significant difference between Groups A and D, and B and D. At a room temperature of 21 ± 1°C, there was a significant difference between Groups A and C, A and D, and B and D. The values in Group D were the lowest at both room temperatures. Assuming a cut-off value of 75% at 23 ± 1°C, the sensitivity and specificity were 65.2 and 87.5%, respectively. Assuming the same cut-off value at 21 ± 1°C, the sensitivity and specificity were 73.9 and 82.5%, respectively. These values were not too high. Most of the subjects with WVF in this study were retired and had not used vibratory tools for many years. The situation of the subjects may affect the results of the FSBP test. Our data did not confirm a difference in diagnostic accuracy between room temperatures of 23 ± 1 and 21 ± 1°C.

Conclusions

Our study showed that the sensitivity and specificity of the FSBP test with a cut-off value of 75% at 23 ± 1°C, were 65.2 and 87.5%, respectively, and at 21 ± 1°C, they were 73.9 and 82.5%, respectively.

     

Use of color charts for the diagnosis of finger whiteness in vibration-exposed workers

Objectives

To assess the usefulness of color charts for the diagnosis of finger whiteness in vibration-exposed workers.

Methods

A group of 146 forestry and stone workers exposed to hand-transmitted vibration (HTV) were examined twice over 1 year follow up period. The anamnestic diagnosis of finger whiteness was made on the basis of (a) a medical history alone, and (b) the administration color charts which showed changes in the skin color of fingers and hands. The cold response of digital arteries was assessed by measuring the change in finger systolic blood pressure (FSBP) after local cooling from 30 to 10°C (FSBP%_10°).

Results

Assuming the administration of color charts as the gold standard, the sensitivity and specificity of the medical history alone to diagnose finger whiteness was 88.2 and 93.8%, respectively, at the initial cross-sectional study and 94.4 and 97.7% at the end of the follow-up. Random-intercept linear regression analysis of follow up data showed that after adjustment for several covariates, FSBP%_10° was significantly associated with finger whiteness assessed by either medical history alone (P < 0.005) or the color charts (P < 0.001). However, a statistical measure of overall fit of regression models (Bayesian Information Criterion) suggested that the color chart method performed better than medical history alone for the prediction of the cold response of digital arteries.

Conclusion

The administration of color charts seems to reduce the proportion of false positive responses for finger whiteness in a population of vibration-exposed workers. The color chart method was a more significant predictor of digital arterial hyperresponsiveness to cold than medical history alone. These findings suggest that the use of color charts in clinical and epidemiological studies may be of help to assist in the diagnosis of finger whiteness in vibration-exposed workers.

     

Normal values for finger systolic blood pressures in males and females

Objective

To compare finger systolic blood pressures in males and females and in younger and older persons and provide normal values for all four fingers in younger and older males and females.

Methods

Eighty healthy subjects participated in the study: 20 males and 20 females aged 20–30 years, and 20 males and 20 females aged 55–65 years. Finger systolic blood pressures (FSBPs) were measured using strain-gauge plethysmography following local cooling at 30 and 10°C in accord with International Standard 14835-2. The FSBPs were measured simultaneously in the thumb and the four fingers of the dominant hand and the percentage changes in finger systolic blood pressures (%FSBPs) due to the cold provocation were calculated.

Results

The median finger systolic blood pressures increased with increasing age in both females and males, with the increase highly significant at 30°C but not at 10°C. The %FSBPs were not significantly affected by the age of males, but were significantly lower in older females than younger females. The FSBPs were lower in females than in males at 30°C but there was no significant difference between genders at 10°C. The %FSBPs were higher in younger females than younger males, but only significantly higher in the middle finger and there were no significant differences between the genders in the older age group. There were only minor differences between the four fingers in the FSBPs at 30 and 10°C. The %FSBPs across the four fingers were similar in the younger subjects and in the older females, but varied with finger in the older males.

Conclusion

Although there are some differences in the %FSBPs associated with age, gender, and finger, the differences may be sufficiently small to use a single value criterion when deciding on abnormalities in FSBP associated with cold provocation for persons aged 20–65 years.

     

Comparing SARC-F with SARC-CalF to Screen Sarcopenia in Community Living Older Adults

Objective

To compare the diagnostic value of the SARC-F combined with calf circumference (SARC-CalF) with the standard SARC-F to screen sarcopenia in community-dwelling older adults.

Design

Cross-sectional, diagnostic accuracy study.

Setting

Geriatric outpatient clinic of a university hospital.

Participants

Older adults >= 65 years.

Measurements

Muscle mass (bioimpedance analysis device), muscle strength (hand grip strength-Jamar hydraulic hand dynamometer), and physical performance (usual gait speed). Four currently used diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS), and Society on Sarcopenia Cachexia and Wasting Disorders (SCWD) criteria] were applied. SARC-CalF was performed by using two different calf circumference threshold: standard cut-off 31 cm (SARC-CalF-31) and national cut-off 33 cm (SARC-CalF-33). The sensitivity/specificity analyses of the SARC-CalF and SARC-F tools were run. We used the receiver operating characteristics curves and the area under the receiver operating characteristics curves (AUC) to compare the diagnostic accuracy to identify sarcopenia.

Results

We included 207 subjects; 67 male and 140 female with a mean age of 74.6±6.7 years. The prevalence of sarcopenia ranged from 1.9% to 9.2%. The sensitivity of SARC-F was between 25% (EWGSOP) and 50% (IWGS); specificity was about 82%. For SARC-CalF-31 and SARC-CalF-33 sensitivity was in general similar - between 25-50%-which pointed out that SARC-CalF was not superior to SARC-F for sensitivity in this sample. Corresponding specificities for SARCCalF-31 and SARC-CalF-33 were higher than SARC-F and were between 90-98%. Additionally, the AUC values, which indicates the diagnostic accuracy of a screening test, were in general higher for SARC-CalF-33 than the SARC-F and SARC-CalF-31.

Conclusions

We reported that addition of calf circumference item to SARC-F tool improved the specificity and diagnostic accuracy of SARC-F but it did not improve the sensitivity in a community-dwelling Turkish older adult population sample that had low prevalence of sarcopenia. The performance of SARC-CalF tool to screen sarcopenia is to be studied in different populations and living settings.

     

The impact of Fruit-Vegetable Diet on High Signal Resolution Pulse Wave (HSR-PW) Parameters

Objectives

The diet and lifestyle affect our life. Inadequate nutrition can cause various diseases including cardiovascular diseases. The aim of this study was to show the correlations between the fruit and vegetable diet and high signal resolution pulse wave parameters.

Design

This was an observational study.

Settings

The study was done during two-weeks rehabilitation treatment.

Participants

In this study 154 people using the fruit and vegetable diet have been examined.

Measurements

The participants were monitored using a new diagnostic method high signal resolution pulseoximetry (HSR-PW). They were examined two times: before starting the diet and after two weeks of using it. The high signal resolution pulse wave and its characteristic parameters have been compared.

Results

Analyzing the research results at the beginning and after two weeks of using this diet, the improvement of selected parameters has been noticed. With the improvement in the pulse wave was observed weight loss, improved blood counts (e.g. cholesterol, triglycerides) as well as decreased blood pressure particularly in people with treated hypertension.

Conclusions

The study shows that applied fruit and vegetable diet influenced favorably the people using it and contributed to the improvement of the HSR-PW parameters which are the source of information about the state of the cardiovascular system.

     

Tremor and hand-arm vibration syndrome (HAVS) in road maintenance workers

Objectives

The aim of this study was to evaluate postural and rest tremor among workers using vibrating hand tools, taking into account the possible effects of toxicants such as alcohol and tobacco. A further aim was to study workers diagnosed with hand-arm vibration syndrome (HAVS) at the time of examination.

Methods

This study comprises 103 road maintenance workers, 55 exposed to vibrating hand tools (age 41.0 years; range 21–62) and 48 referents (age 38.5 years; range 19–64). They were examined with the CATSYS Tremor Pen^®. Exposure to vibrating tools and serum biomarkers of alcohol and tobacco consumption were measured.

Results

Cumulative exposure to vibrating tools was associated with increased postural (p < 0.01) and rest tremor (p < 0.05) and with a higher Center Frequency of postural tremor (p < 0.01) among smokers and users of smokeless tobacco. Rest tremor Center Frequency was higher than postural tremor frequency (p < 0.001).

Conclusions

The main findings indicate an association between cumulative exposure to hand-held vibrating tools, tremor parameters and consumption of tobacco products. The hand position is important when testing for tremor. Rest tremor had a higher Center Frequency. Postural tremor was more strongly associated with exposure than rest tremor. The finding of increased tremor among the HAVS subjects indicated that tremor might be a part of the clinical picture of a HAVS diagnosis. As with all cross-sectional studies, inferences should be made with caution when drawing conclusions about associations between exposure and possible effects. Future research using longitudinal design is required to validate the findings of the present study.

     

How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

Background

Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice.In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable.

Methods

We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm.

Results

Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment.

Conclusions

We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.

     

Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: The Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus

Objective

To analyze the prevalence of sarcopenia in elderly care homes using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP) and to evaluate the applicability, sensitivity, and specificity of two simplified algorithms that do not include gait speed measurement.

Design

Cross-sectional study.

Setting

Long-term care homes.

Participants

249 residents (187 females and 62 males) with a mean age of 84.9 ± 6.7 years (range, 70–106 yrs).

Measurements

Cognitive impairment was evaluated with the Pfeiffer test, functional capacity with the Barthel index, walking ability by the Functional Ambulation Classification, muscle mass by bioelectrical impedance analysis, muscle strength by handgrip dynamometry and, gait speed over a distance of 4 m. Sarcopenia was assessed using the EWGSOP-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the EWGSOP algorithm using the MacNemar test and obtaining the sensitivity and specificity, kappa coefficient, and area under the receiver operating characteristic curve (AUC).

Results

Total or severe dependence was recorded in 67% of the 249 residents, severe or moderate cognitive impairment in 64%, inability to walk in 49%, and capacity to walk only with the aid of an ambulator or two people in 21%. The prevalence of sarcopenia was 63.0% by the EWGSOP algorithm, 62.9% by algorithm A and 63.2% by algorithm B (P = 1.000); 143 participants were diagnosed with sarcopenia by all three methods (P =1.000, K = 1.000).

Conclusion

Further studies that include residents with functional and/or cognitive impairment are required to validate these results, comparing the diagnostic performance of the EGWSOP algorithm with that of the simplified algorithms validated in the present report.

     

Age and IQ Explained Working Memory Performance in a RCT with Fatty Fish in a Group of Forensic Inpatients

Objectives

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.

Design

A randomized controlled trial.

Setting

A forensic facility.

Participants

Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.

Intervention

Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.

Measurement

Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.

Results

Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.

Conclusion

Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

     

Single-arm resistance training study to determine the relationship between training outcomes and muscle growth factor mRNAs in older adults consuming numerous medications and supplements

Objectives

Determine if the muscle mRNA levels of three growth factors (insulin-like growth factor-1 [IGF1], ciliary neurotropic factor [CNTF], and vascular endothelial growth factor-D [VEGFD]) are correlated with muscle size and strength gains from resistance exercise while piloting a training program in older adults taking medications and supplements for age-associated problems.

Design

Single-arm prospective study.

Setting

US Veterans Affairs hospital.

Participants

Older (70±6 yrs) male Veterans (N=14) of US military service.

Intervention

Thirty-five sessions of high-intensity (80% one-rep max) resistance training including leg press, knee curl, and knee extension to target the thigh muscles.

Measurements

Vastus lateralis biopsies were collected and body composition (DEXA) was determined pre- and post-training. Simple Pearson correlations were used to compare training outcomes to growth factor mRNA levels and other independent variables such as medication and supplement use.

Results

Average strength increase for the group was ≥ 25% for each exercise. Subjects averaged taking numerous medications (N=5±3) and supplements (N=2±2). Of the growth factors, a significant correlation (R>0.7, P≤0.003) was only found between pre-training VEGFD and gains in lean thigh mass and extension strength. Mass and strength gains were also correlated with use of α-1 antagonists (R=0.55, P=0.04) and pre-training lean mass (R=0.56, P=0.04), respectively.

Conclusions

Muscle VEGFD, muscle mass, and use of α-1 antagonists may be predisposing factors that influence the response to training in this population of older adults but additional investigation is required to determine if these relationships are due to muscle angiogenesis and blood supply.

     

Influence of thoracic aortic inflammation and calcifications on arterial stiffness and cardiac function in older subjects

Background

Vascular aging is accompanied by gradual remodeling affecting both arterial and cardiac structure and mechanical properties. Hypertension is suggested to exert pro-inflammatory actions enhancing arterial stiffness.

Objectives

To determine the influence of thoracic aortic inflammation and calcifications on arterial stiffness and cardiac function in hypertensive and normotensive older subjects.

Design

A prospective study.

Setting

An acute geriatrics ward of the University Hospital of Nancy in France.

Subjects

Thirty individuals ≥ 65 years were examined, including 15 hypertensive subjects and 15 controls well-matched for age and sex.

Measurements

Applanation tonometry was used to measure aortic pulse wave velocity (AoPWV) and carotid/brachial pulse pressure amplification (PPA). Left ventricular parameters were measured with magnetic resonance imaging. Local thoracic aortic inflammation and calcification were measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Biomarkers of low-grade inflammation were also quantified.

Results

AoPWV was higher in elderly hypertensive subjects comparatively to normotensive controls (15.5±5.3 vs. 11.9±2.5, p=0.046), and hypertensives had a higher calcification volume. In the overall population, calcifications of the thoracic descending aorta and inflammation of the ascending aorta accounted for respectively 18.1% (p=0.01) and 9.6% (p=0.07) of AoPWV variation. Individuals with high levels of calcifications and/or inflammation had higher AoPWV (p=0.003). Inflammation had a negative effect on PPA explaining 13.8% of its variation (p<0.05).

Conclusions

This study highlights the importance of local ascending aortic inflammation as a potential major actor in the determination of PPA while calcifications and hypertension are more linked to AoPWV. Assessment of PPA in the very elderly could provide complementary information to improve diagnostic and therapeutic strategies targeting ascending aortic inflammation.

     

Clinical Practice Variation Needs to be Considered in Cost-Effectiveness Analyses: A Case Study of Patients with a Recent Transient Ischemic Attack or Minor Ischemic Stroke

Background and Objective

The cost-effectiveness of clinical interventions is often assessed using current care as the comparator, with national guidelines as a proxy. However, this comparison is inadequate when clinical practice differs from guidelines, or when clinical practice differs between hospitals. We examined the degree of variation in the way patients with a recent transient ischemic attack (TIA) or minor ischemic stroke are assessed and used the results to illustrate the importance of investigating possible clinical practice variation, and the need to perform hospital-level cost-effectiveness analyses (CEAs) when variation exists.

Methods

Semi-structured interviews were conducted with 16 vascular neurologists in hospitals throughout the Netherlands. Questions were asked about the use of initial and confirmatory diagnostic imaging tests to assess carotid stenosis in patients with a recent TIA or minor ischemic stroke, criteria to perform confirmatory tests, and criteria for treatment. We also performed hospital-level CEAs to illustrate the consequences of the observed diagnostic strategies in which the diagnostic test costs, sensitivity and specified were varied according to the local hospital conditions.

Results

56 % (9/16) of the emergency units and 63 % (10/16) of the outpatient clinics use the initial and confirmatory diagnostic tests to assess carotid stenosis in accordance with the national guidelines. Of the hospitals studied, only one uses the recommended criteria for use of a confirmatory test, 38 % (6/16) follow the guidelines for treatment. The most cost-effective diagnostic test strategy differs between hospitals.

Conclusions

If important practice variation exists, hospital-level CEAs should be performed. These CEAs should include an assessment of the feasibility and costs of switching to a different strategy.

     

Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly

Objective

To increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d).

Design

Intervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention.

Setting

Two care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center.

Participants

22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years).

Intervention

We used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes.

Measurements

Dietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests.

Results

Protein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g).

Conclusion

Including familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.

     

Validity of knee-estimated height to assess standing height in older adults: A secondary longitudinal analysis of the Mexican health and aging study

Objective

The main objective was to test the validity of height estimated by knee height in Mexican older adults, as a surrogate for standing height.

Design

Cohort study.

Setting

Data were drawn from the first and third waves of the Mexican Health and Aging Study.

Participants

Included participants were community-dwelling 50-year or older adults with measured height at baseline and in follow-up. Subjects with a lower limb fracture in the follow-up were excluded.

Measurements

Main measurements were baseline standing height and 11-year follow-up and knee-estimated height in follow-up. Population specific equations were used to estimate standing height from knee height. Comparisons between baseline standing height and knee-derived height were done with simple correlations, limits of agreement (Bland-Altman plot) and Deming regressions.

Results

A total of 136 50-year or older adults were followed-up for eleven years, with a mean age of 60. There was a positive correlation between knee-estimated height and baseline standing height of 0.895 (p<0.001) for men and of 0.845 (p<0.001) for women. Limits of agreement for men were from -6.95cm to 7.09cm and for women from -6.58cm to 8.44cm.

Conclusion

According to our results, knee-estimated height could be used interchangeably with standing height in Mexican older adults, and these results might apply also to other populations.

     

Early nutritional follow-up after discharge prevents deterioration of ADL functions in malnourished,independent, geriatric patients who live alone–A randomized clinical trial

Objectives

To compare the effects of two nutritional follow-up interventions with regard to preventing short-term deterioration in ADL, and to compare their effects on physical function, emotional health, and health-related quality of life.

Design

Randomized clinical trial with two intervention groups and one control group, and a follow-up period of eight weeks.

Setting

Intervention in the participants’ homes after discharge from hospital.

Participants

Inclusion: Malnourished geriatric patients and patients at risk of malnutrition (MNA<24), aged 75 years and older, living at home and alone.

Exclusion

Nursing home residents and patients with terminal illnesses or cognitive impairment.

Randomization

At discharge, the patients were assigned to one of three groups: ‘home visit’, ‘telephone consultation’, or ‘control’ group.

Intervention

Individually tailored nutritional counselling of the patient and the patient’s daily home carer by a clinical dietician one, two, and four weeks after discharge from hospital. The counselling was either in-person at the patients’ homes, or by telephone. The control group received no follow-up after discharge.

Measurements

Primary outcome: Change in ADL (Barthel-100 score) at discharge and eight weeks later.

Secondary outcomes

Change in physical performance (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 (Mob-T).

Results

Two-hundred and eight participants were randomized, 73 to home visits and 68 to telephone consultations. The control group comprised 67 patients. The mean age of the participants was 86.1 years. At eight weeks after discharge, 157 completed the follow-up (home visit 52, telephone consultation 51, and control group 54). The mean age of these patients was 85.8 years. More patients in the home visit group improved or maintained their ADL (96%), compared to the telephone (75%) and control groups (72%), p<0.01. No difference was detected among the groups with regard to physical measurements, health-related quality of life, and emotional health.

Conclusion

Early nutritional follow-up after discharge, performed as home visits, prevents deterioration of ADL in malnourished, independent, geriatric patients who live alone and thereby preserves their independence.

     

Frailty in relation to the risk of Alzheimer’s disease,dementia, and death in older Chinese adults: A seven-year prospective study

Objectives

To explore the relationship of general health decline assessed by frailty and risk of dementia and Alzheimer’s disease (AD).

Design

A seven-year prospective cohort study.

Setting

Secondary analysis of data from the Beijing Longitudinal Study on Aging.

Participants

Urban and rural communitydwelling people aged 60 and older at baseline.

Measurements

Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 40 health deficits at baseline. Dementia was diagnosed by DSM-IIIR. AD and vascular dementia (VaD) were diagnosed by NINCDS-ADRDA and NINDS-AIREN. The relationships between frailty and the risk of dementia, AD and death were evaluated through multivariable models.

Results

Of 2788 participants at baseline (1997), 171 (11.1%) reported a history of dementia. In seven years, 351 people developed dementia (13%: 223 AD and 128 other types of dementia) and 813 died (29%). After adjustment for age, sex, education, and baseline cognition, baseline frailty status significantly associated with Alzheimer’s disease and dementia and death. For each deficit accumulated, the odds ratio of death increased by 5.7%, and the odds ratio of dementia increased by 2.9% (p < 0.001).

Conclusion

Frailty was associated with Alzheimer’s disease and dementia over a seven years period. Frailty index might facilitate the identification of older adults at high risk of dementia for the application of the most effective, targeted prevention strategies.

     

Soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not improve muscle functional property restoration

Objectives

Effect of 3 different dairy protein sources on the recovery of muscle function after limb immobilization in old rats.

Design

Longitudinal animal study.

Setting

Institut National de la Recherche Agronomique (INRA). The study took part in a laboratory setting.

Intervention

Old rats were subjected to unilateral hindlimb immobilization for 8 days and then allowed to recover with 3 different dietary proteins: casein, soluble milk proteins or whey proteins for 49 days.

Measurements

Body weight, muscle mass, muscle fibre size, isometric, isokinetic torque, muscle fatigability and muscle oxidative status were measured before and at the end of the immobilization period and during the recovery period i.e 7, 21, 35 and 49 days post immobilization.

Results

In contrast to the casein diet, soluble milk proteins and whey proteins were efficient to favor muscle mass recovery after cast immobilization during aging. By contrast, none of the 3 diary proteins was able to improve muscle strength, power and fatigability showing a discrepancy between the recovery of muscle mass and function. However, the soluble milk proteins allowed a better oxidative capacity in skeletal muscle during the rehabilitation period.

Conclusion

Whey proteins and soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not allow muscle functional property restoration.

     

Altered Eating Attitudes in Nursing Home Residents and Its Relationship with their Cognitive and Nutritional Status

Background

although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects.

Objectives

the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state.

Design and Setting

a observational experimental study was carried out at several nursing homes of Murcia, Spain.

Subjects

139 nursing home residents.

Methods

EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford’s scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated.

Results

33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment.

Conclusions

our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.

     

Association of grip strength,upper arm circumference,and waist circumference with dementia in older adults of the wise study: A cross-sectional analysis

Objective

We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults.

Design

Cross-sectional epidemiological study.

Setting

Residential homes, day care centres, nursing homes and institutions.

Participants

2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013.

Measurements

Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria.

Results

Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia.

Conclusions

Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.