Socioeconomic Position and Malnutrition among Older Adults: Results from the FRADEA Study

Objectives

Low socioeconomic position (SEP) is related to many health-related conditions in older adults. However, there is a lack of knowledge on the association between SEP and malnutrition, a condition with serious consequences for older people in terms of quality of life and adverse health events. In the current study, we investigated socioeconomic inequalities in malnutrition and sub-domains of malnutrition in a sample of Spanish older adults.

Design

Cross-sectional population-based study.

Setting

Urban area of Albacete, Spain. Participants: 836 participants over age 70 from the first measurement wave (2007-2009) of the Frailty and Dependence in Albacete (FRADEA) study, a population-based cohort study.

Measurements

Educational level and occupational level were the indicators of SEP. Nutritional risk was measured with the Mini Nutrition Assessment® Short Form (MNA®-SF). Logistic regression analyses were performed.

Results

For both socioeconomic indicators there was a statistically significant association with nutritional risk (OR low education=1.99, 95% CI=1.18-3.35; OR low occupational level=1.71, 95% CI=1.08-2.72). However, these associations disappeared after adjusting for age and sex (OR low education=1.51, 95% CI=0.88-2.60; OR low occupational level=1.32, 95% CI=0.80-2.17). In adjusted models, statistically significant associations between SEP and sub-domains of the MNA®-SF were observed, but these associations were not consistent across socioeconomic indicators.

Conclusions

This study found that malnutrition is a condition that can appear in any older adult, regardless of their socioeconomic group. These findings suggest that interventions to prevent malnutrition in older adults can be targeted at a general older population, and do not have to be SEP specific.

     

Nutritional and Frailty State Transitions in the Singapore Longitudinal Aging Study

Background

Malnutrition is a major determinant of the physical frailty syndrome. Dynamic transitions in frailty states over time is well documented, but few studies have documented temporal changes in nutritional states and whether they influence frailty outcomes.

Design

Longitudinal cohort study.

Setting and Participants

Community-dwelling older Singaporeans aged ≥55y with a 5-year follow-up (n=1162) in the Singapore Longitudinal Ageing Study 2 (SLAS-2).

Measurements

The Mini Nutritional Assessment Short-Form (MNA-SF) was used to determine nutritional status, and the Fried’s criteria (shrinking, weakness, slowness, exhaustion and inactivity) was used to assess physical frailty phenotype at both baseline and follow-up. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were adjusted for multiple baseline co-variables.

Results

At baseline, being at risk of malnutrition/malnourished was associated with increased odds of prevalent prefrailty (OR=2.76, 95% CI=1.86-4.10) and frailty (OR=4.10, 95% CI=1.41-11.9). Baseline robust individuals who were persistently at risk of malnutrition/malnourished showed an increased odds of conversion to being pre-frail/ frail at follow-up (OR=3.45, 95% CI=1.00-11.9). Among baseline pre-frail/frail individuals, reversion to being robust were significantly less likely among those who were persistently at risk of malnutrition/malnourished (OR=0.26, 95% CI=0.10-0.67) and those whose baseline normal nutrition worsened at follow-up (OR=0.20, 95% CI=0.06-0.74).

Conclusion

Changes in nutritional states are associated with frailty state transitions, and monitoring changes in nutritional status is recommended for the prevention and severity reduction of frailty among older people in the community.

     

Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

Objectives

To examine the association between nutritional status and frailty in older adults.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited from 10 study sites in South Korea.

Participants

1473 volunteers aged 70–84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.

Measurements

Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried’s frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.

Results

Of the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.09–2.32) and frail (OR: 3.30, 95% CI: 1.96–5.54).

Conclusion

Poor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.

     

Dietary quality is associated with abdominal aortic calcification: A mean of 18-year longitudinal study in community-dwelling older adults

Objective

This study aimed to examine the association between baseline and changes in dietary quality assessed by the Alternative Healthy Eating Index-2010 (AHEI-2010) and abdominal aortic calcification (AAC) among community-dwelling older adults.

Design

Population-based longitudinal study.

Setting

A subset of the Melbourne Collaborative Cohort Study (MCCS).

Participants

262 community-dwelling adults (60% female) aged 53 ± 5 years at baseline.

Measurements

Dietary intake was assessed using validated Food Frequency Questionnaires at baseline (1990-1994) and follow-up (2010-2011). AAC was evaluated by radiography and dual-energy x-ray absorptiometry (DXA) at follow-up.

Results

Higher baseline AHEI-2010 score was associated with lower AAC severity by radiography [OR (95% CI) for Tertile 3 VS Tertile 1: 0.53 (0.29-0.99)] after adjustment for gender, age, physical activity, smoking, BMI, systolic blood pressure, plasma total cholesterol, calcium and energy intake. The association between AHEI-2010 and AAC severity by DXA was also significant in the multivariate-adjusted model [OR (95% CI) for Tertile 3 VS Tertile 1: 0.38 (0.20-0.70)]. Changes in AHEI-2010 over 18 years were not associated with AAC severity.

Conclusion

Baseline but not the changes in AHEI-2010 was inversely associated with the risk of AAC severity suggesting that a high quality diet might help prevent or delay the progression of AAC in community-dwelling older adults and the benefits might be manifested over the long-term.

     

Mediterranean Diet and Musculoskeletal-Functional Outcomes in Community-Dwelling Older People: A Systematic Review and Meta-Analysis

Background

Population aging is increasing and this process together with its characteristics influence the prevalence and incidence of chronic conditions and musculoskeletal-functional outcomes such as frailty, functional disability and sarcopenia. Nutritional strategies focused on dietary patterns, such as a Mediterranean diet, can be protective from these outcomes.

Purpose

To investigate the association between adherence to a Mediterranean diet and frailty, functional disability and sarcopenia in community-dwelling older people.

Methods

We systematically reviewed electronic databases (MEDLINE, EMBASE, and others) and grey literature for articles investigating the relationship between adherence to a Mediterranean diet and frailty, functional disability and sarcopenia in community-dwelling people aged 60 and over. Study selection, quality of study assessment and data extraction were conducted independently by two authors. Random effects meta-analyses were performed, and pooled Odds Ratios (OR) were obtained.

Results

After the literature search, screening and eligibility investigation, we included 12studies, with a total of 20,518 subjects. A higher adherence to a Mediterranean diet was found to be inversely associated with frailty (OR 0.42, 95% CI: 0.28-0.65, I2=24.9%, p=0.262) and functional disability (OR 0.75, 95% CI: 0.61-0.93, I2=0.0%, p=0.78). Highly different study characteristics prevented us from performing a meta-analysis for sarcopenia. Cohort data indicated no association between adherence to a Mediterranean diet and sarcopenia; however, cross-sectional results showed a positive relationship.

Conclusion

A Mediterranean diet is protective of frailty and functional disability, but not of sarcopenia. More longitudinal studies are needed to understand the relationship between a Mediterranean diet and sarcopenia.

     

Dietary supplement use in older people attending memory clinics in Australia

Background

Dietary supplement use is common in older adults. There has been limited research in people attending memory clinics.

Objectives

To explore the use of dietary supplements in older people attending Australian memory clinics.

Design

Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study.

Participants

Community-dwelling older people who attended nine memory clinics and had a diagnosis of mild cognitive impairment (MCI) or dementia.

Measurements

Dietary supplement was defined as a product that contains one or more: vitamin, mineral, herb or other botanical, amino acid or other dietary substance. Non-prescribed supplement was defined as a supplement that is not usually prescribed by a medical practitioner. Polypharmacy was defined as use of five or more medications.

Results

964 patients, mean age 77.6 years, were included. Dietary supplements were used by 550 (57.1%) patients; 353 (36.6%) used two or more. Non-prescribed supplements were used by 364 (36.8%) patients. Supplement use was associated with older age (OR: 1.12, 95% CI: 1.03-1.21), lower education level (OR: 1.53, 95% CI: 1.01-2.32) and a diagnosis of MCI rather than dementia (OR: 1.52, 95% CI: 1.05-2.21). Potential drug-supplement interactions were identified in 107 (11.1%) patients. Supplement users had increased prevalence of polypharmacy compared to non-users (80.5% vs. 48.1%, p<0.001).

Conclusions

Dietary supplements, including non-prescribed supplements, were commonly used by people attending memory clinics. Supplement use increased the prevalence of polypharmacy and resulted in potential supplement-drug interactions. Further research is required to assess the clinical outcomes of supplement use.

     

Swallowing function and nutritional status in Japanese elderly people receiving home-care services: A 1-year longitudinal study

Objectives

Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care.

Design

Prospective observational cohort study with 1-year follow-up.

Setting

Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012.

Participants

One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving homecare services because of physical disabilities, without malnutrition.

Measurements

Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model.

Results

Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65–16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition.

Conclusion

Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.

     

Subjective Well-Being Is Associated with Food Behavior and Demographic Factors in Chronically Ill Older Japanese People Living Alone

Objectives

This study aimed to examine the relationships among subjective well-being, food and health behaviors, socioeconomic factors, and geography in chronically ill older Japanese adults living alone.

Design

The design was a cross-sectional, multilevel survey. A questionnaire was distributed by post and self-completed by participants.

Setting

The sample was drawn from seven towns and cities across Japan.

Participants

A geographic information system was used to select a representative sample of older people living alone based on their proximity to a supermarket. Study recruitment was conducted with municipal assistance.

Measurements

To assess subjective well-being and food and health behaviors of respondents with disease, a logistic regression analysis was performed using stepwise variable analyses, adjusted for respondent age, socioeconomic status, and proximity to a supermarket. The dependent variable was good or poor subjective well-being.

Results

In total, 2,165 older people (744 men, 1,421 women) completed the questionnaire (63.5% response rate). Data from 737 men and 1,414 women were used in this study. Among people with a chronic disease, individuals with good subjective well-being had significantly higher rates than those with poor subjective well-being for satisfaction with meal quality and chewing ability, food diversity, food intake frequency, perception of shopping ease, having someone to help with food shopping, eating home-produced vegetables, preparing breakfast themselves, eating with other people, and high alcohol consumption. A stepwise logistic analysis showed that the factors strongly related to poor subjective well-being were shopping difficulty (men: odds ratio [OR] = 3.19, 95% confidence interval [CI], 1.94–5.23; P < 0.0001; women: OR = 2.20, 95% CI, 1.54–3.14; P < 0.0001), not having someone to help with food shopping (women: OR = 1.41, 95% CI, 1.01–1.97; P = 0.043), not preparing breakfast (women: OR = 2.36, 95% CI, 1.40–3.98; P = 0.001), and eating together less often (women: OR = 1.99, 95% CI, 1.32–3.00; P = 0.002).

Conclusion

Subjective well-being of people with chronic diseases is associated with food intake and food behavior. The factors that affect poor subjective well-being in chronically ill older Japanese people living alone include food accessibility and social communication.

     

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up of the International Mobility in Aging Study

Background

Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population.

Objectives

To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression.

Design and Setting

Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study.

Participants

1104 out of 2002 older adults aged 64–74 years old free of mobility disability at baseline (2012) and then reassessed in 2016.

Measurements

Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity.

Results

1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality.

Conclusion

Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

     

Association Between Insulin-Like Growth Factor-1 and Frailty Among Older Adults

Objectives

Frailty is a course experienced in advanced aging. Identification of a biological factor associated with frailty is required. Although serum insulin-like growth factor-1 (IGF-1) is a potential factor related with frailty, consensus has not been reached regarding this relationship. This study aimed to investigate the association between IGF-1 and frailty in older adults.

Design

Cross-sectional study.

Setting

Cohort study that was part of the “National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes.”

Participants

The study participants were 4133 older adults (mean age, 71.8 ± 5.4 years).

Measurements

We assessed serum IGF-1 levels and frailty status and collected demographic variables, including cognitive function, as covariates.

Results

Frailty and pre-frailty were present in 274 subjects (7%) and 1930 subjects (47%), respectively. Subjects were divided into four groups based on quartiles of IGF-1 levels. Multinomial logistic analysis showed that the lowest group had significant odds of pre-frailty (crude model: odds ratio [OR] 1.58, 95% confidence interval [CI] 1.30–1.90, p <.001; adjusted model: OR 1.38, 95% CI 1.13–1.68, p =.002) and frailty (crude model: OR 3.42, 95% CI 2.38-4.92, p <.001; adjusted model: OR 1.54, 95% CI 1.02–2.32, p =.039), compared with the highest group.

Conclusion

Lower serum IGF-1 levels were independently related with frailty in older adults.

     

Screening for malnutrition in community dwelling older Japanese: Preliminary development and evaluation of the Japanese Nutritional Risk Screening Tool (NRST)

Background

Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations.

Objective

This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II.

Participants

The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people.

Measurements

Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People.

Results

The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST).

Conclusions

These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.

     

Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia and Function in Aging Rehabilitation (SAFARI) Multi-Centric Study

Background

Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation.

Objective

The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults.

Design

Multi-centric cohort study.

Participanst and Settings

Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016.

Measurements

The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission.

Results

We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an orthopedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG.

Conclusions

Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.

     

Use of ACE-inhibitors and Quality of Life in an Older Population

Background

Improved ability to treat chronic diseases have increased the interest in measuring health-related quality of life (HRQoL) in older adults. Hypertension and heart failure have been associated with decreased HRQoL.

Hypothesis

The aim of this study was to assess the association between health-related quality of life and use of angiotensin converting enzyme inhibitors in unselected community-dwelling elderly.

Methods

We analyzed data of all 387 subjects aged 75+ living in a rural Italian town, without exclusion criteria. HRQoL was assessed using the Health Utility Index Mark 3, which allows formal cost-effectiveness calculations. The association of the HRQoL score with use of ACE-I was analyzed by multivariable linear and logistic regression.

Results

The median HUI3 score was 0.31, and 186 participants (48%) reported a score above the median value. Use of ACE-I was reported by 34 (9%) participants, and confirmed by general practitioners. Use of these agents was associated with significantly better HRQoL (B=.16, 95% CI=.02 -.30; P=.025). Also, use of ACE-I was associated with increased probability of better HRQoL in logistic regression (OR=2.83; 95% CI=1.03 - 7.78; P=.044) after adjusting. No associations were found between the HRQoL score and use of calcium antagonists or beta-blockers.

Conclusions

Use of ACE-I, but not of other antihypertensives, is associated with better HRQoL among community-dwelling older adults. ACE-inhibitors might therefore present with the best cost-effectiveness ratio for the treatment of older populations.

     

Older adults with fear of falling show deficits in motor imagery of gait

Objective

Understanding of the underlying mechanisms of Fear of Falling (FoF) could help to expand potential treatments. Given the nature of motor performance, the decline in the planning stage of motor execution may be associated with an expression of FoF. The aim of this study was to assess the planning/prediction accuracy in motor execution in people with FoF using gait-related motor imagery (MI).

Design

Cross-sectional case/control study.

Setting

Three health centers in Japan.

Participants

Two hundred and eighty-three community-dwelling older adults were recruited and stratified by presence of FoF as FoF group (n=178) or non-FoF group (n=107).

Measurements

Participants were tested for both imagery and execution tasks of a Timed Up and Go (TUG) test. The participants were first asked to imagine the trial (iTUG) and estimate the time it would take, and then perform the actual trial (aTUG). The difference between iTUG and aTUG (Δ TUG) was calculated.

Results

The FoF group was significantly slower in aTUG, but iTUG duration was almost identical between the two groups, resulting in significant overestimation in the FoF group. The adjusted logistic regression analysis showed that increased Δ TUG (i.e., tendency to overestimate) was significantly associated with FoF (OR = 1.05; 95% CI = 1.02–1.10). Low frequency of going outdoors was also associated with FoF (OR 2.95; 95% CI: 1.16–7.44).

Conclusions

Older adults with FoF overestimate their TUG performance, reflecting impairment in motor planning. Overestimation of physical capabilities can be an additional explanation of the high risk of falls in this population.

     

Muscle,Health and Costs: A Glance at their Relationship

Objective

To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs.

Design

Cross-sectional Maastricht Sarcopenia Study (MaSS).

Setting

Community-dwelling, assisted-living, residential living facility.

Participants

227 adults aged 65 and older.

Measurements

Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months.

Results

Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs).

Conclusion

Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.

     

Effects of Low-Dose Dairy Protein Plus Micronutrient Supplementation during Resistance Exercise on Muscle Mass and Physical Performance in Older Adults: A Randomized,Controlled Trial

Objectives

To investigate whether supplementation with low-dose dairy protein plus micronutrients augments the effects of resistance exercise (RE) on muscle mass and physical performance compared with RE alone among older adults.

Design

Randomized controlled trial.

Setting

Tokyo, Japan.

Participants

Eighty-two community-dwelling older adults (mean age, 73.5 years) were randomly allocated to an RE plus dairy protein and micronutrient supplementation group or an RE only group (n = 41 each).

Intervention

The RE plus supplementation group participants ingested supplements with dairy protein (10.5 g/day) and micronutrients (8.0 mg zinc, 12 μg vitamin B12, 200 μg folic acid, 200 IU vitamin D, and others/day). Both groups performed the same twice-weekly RE program for 12 weeks.

Measurements

Whole-body, appendicular, and leg lean soft-tissue mass (WBLM, ALM, and LLM, respectively) with dual-energy X-ray absorptiometry, physical performance, biochemical characteristics, nutritional intake, and physical activity were measured before and after the intervention. Data were analyzed by using linear mixed-effects models.

Results

The groups exhibited similar significant improvements in maximum gait speed, Timed Up-and-Go, and 5-repetition and 30-s chair stand tests. As compared with RE only, RE plus supplementation significantly increased WBLM (0.63 kg, 95% confidence interval [CI]: 0.31-0.95), ALM (0.37 kg, 95% CI: 0.16-0.58), LLM (0.27 kg, 95% CI: 0.10-0.46), and serum concentrations of 25-hydroxyvitamin D (4.7 ng/mL, 95% CI: 1.6-7.9), vitamin B12 (72.4 pg/mL, 95% CI: 12.9-131.9), and folic acid (12.9 ng/mL, 95% CI: 10.3-15.5) (all P < 0.05 for group-by-time interactions). Changes over time in physical activity and nutritional intake excluding the supplemented nutrients were similar between groups.

Conclusion

Low-dose dairy protein plus micronutrient supplementation during RE significantly increased muscle mass in older adults but did not further improve physical performance.

     

Selenium Concentrations and Mortality Among Community-Dwelling Older Adults: Results from ilSIRENTE Study

Background

Selenium has a wide range of pleiotropic effects, influencing redox homeostasis, thyroid hormone metabolism, and protecting from oxidative stress and inflammation. Serum selenium levels are reduced in the older population.

Objectives

to investigate the association of serum selenium levels with all-cause mortality in a sample of community-dwelling older adults.

Design and Setting

Data are from the ‘Invecchiamento e Longevità nel Sirente’ (Aging and Longevity in the Sirente geographic area, ilSIRENTE) study, a prospective cohort study that collected information on individuals aged 80 years and older living in an Italian mountain community (n=347). The main outcome was risk of death after ten years of follow-up.

Participants and measurements

Participants were classified according to the median value of selenium (105.3 μg/L) in two groups: high selenium and low selenium.

Results

A total of 248 deaths occurred during a 10-year follow-up. In the unadjusted model, low levels of selenium was associated with increased mortality (HR, 0.66; 95% CI 0.51-0.85). After adjusting for potential confounders the relationship remained significant (HR, 0.71; 95% CI 0.54-0.92).

Conclusions

Low serum levels of selenium are associated with reduced survival in elderly, independently of age and other clinical and functional variables.

     

Variation in somatic symptoms by patient health questionnaire-9 depression scores in a representative Japanese sample

Background

This study aims to evaluate variation in somatic symptoms by age using patient health questionnaire-9 (PHQ) depression scores, which may be helpful in identifying depression.

Methods

The study evaluated a nationally representative cross-sectional sample of community-dwelling adults in Japan in 2013. We utilized the PHQ to identify risk for depression, with PHQ?≥?10 defining at least moderate depression. Bivariate and factor analyses were used to capture underlying patterns in self-reported symptoms over a 30?day period; aged-stratified multivariate logistic regression was performed to further explore associations between age, symptoms, and depression.

Results

Of 3753 respondents, 296 (8, 95% CI 7.0–8.8) reported a PHQ?≥?10; 42% of these were male and mean age was 51.7?years old (SD?=?18.6). Multivariate analysis showed that presence of fatigue and malaise (OR?=?1.7, 95% CI 1.3–2.4) was significantly associated with PHQ?≥?10. After stratification by age, PHQ?≥?10 was associated with gastrointestinal complaints among 18–39?year olds (OR?=?1.7, 95% CI 1.0–2.9); fatigue and malaise (OR?=?1.8, 95% CI 1.1–3.1) among 40–64?year olds; and fatigue and malaise (OR?=?1.8, 95% CI 1.1–3.0) as well as extremity pain (OR?=?1.7, 95% CI 1.0–2.8) in over 65?year olds.

Conclusion

Age-related somatic symptom correlates of PHQ?≥?10 differ across the lifespan. Predominantly gastrointestinal symptoms in younger patients, and generalized fatigue, malaise, and musculoskeletal pain in older groups were observed. In order for screening physicians to proactively identify depression, awareness of age-related somatic symptoms is warranted.

     

Effectiveness of food-based fortification in older people a systematic review and meta-analysis

Background

Early intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more attractive alternative to improve meals, than conventional oral nutritional supplements.

Aims

To determine the effectiveness of food-based fortification to prevent risk of malnutrition in elderly patients in community or institutionalized elderly patients.

Methods

A systematic review was conducted of randomized controlled trials, quasi-experimental, and interrupted time series including a longitudinal analysis.

Participants

Elderly patients who are institutionalized, hospitalized or community-dwelling, with a minimum average age of 65 years. All type of patient groups, with the exception of people in critical care, or those who were recovering from cancer treatment, were included.

Intervention

Studies had to compare food-based fortification against alternatives. Studies that used oral nutritional supplementation such as commercial sip feeds, vitamin or mineral supplements were excluded. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out.

Results

From 1011 studies obtained, 7 were included for the systematic review, with 588 participants. It was possible to perform meta-analysis of four studies that provided results on caloric and protein intake. Food-based fortification yielded positive results in the total amount of ingested calories and protein. Nevertheless, due to the small number of participants and the poor quality of some studies, further high quality studies are required to provide reliable evidence.

Implications for practice

Despite the limited evidence, due to their simplicity, low cost, and positive results in protein and calories intake, simple dietary interventions based on the food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition.