What do we know about... nutrition and older people?

Nutrition is important to the health and functioning of elderly people. This paper summarises the evidence that many old people suffer from undernutrition and outlines the insidious effects of this form of malnutrition. It discusses the physiological and practical difficulties elderly people face in achieving good nutrition, and the challenge this poses to health workers. Given the UK's ageing population, undernutrition in older people is a significant public health issue as well as one that should concern all health professionals involved in individual or group contacts with elderly clients.     

Organic foods: do they have a role?

Nutritional quality is defined as the value of the product for the consumer's physical health, growth, development, reproduction and psychological or emotional well-being. This extended definition of nutritional quality can be divided into two terms. One term is for the effects of food determined by its substance, i.e., the sum of all ingredients, beneficial and harmful compounds and their nutritional (or biological) aspects. As a function of inherent inconsistencies ranging from soil and climate differences to effects of cultivars, seasons and agricultural practices, differences in desirable ingredients are less pronounced compared with undesirable ingredients. Where differences are detected, the higher product quality is mostly found in organic produce. A potential advantage of organic agriculture in producing healthy foods is based on higher concentrations of beneficial secondary plant substances in organically grown crops compared to nonorganically grown crops. The second term of nutritional quality covers the feelings of well-being (or indisposition) that certain foods can induce in consumers. Organic agriculture has been confirmed as environmentally sound and more sustainable than mainstream agriculture. Related to this knowledge, the consumer's well-being is based on indulgence and the certainty that by purchasing, eating and enjoying organic food, one has contributed to a better future and an improved environment. These effects with their social implications along with improved animal welfare may, in the end, be more important than any measurable contribution of balanced Western diets to individual nutritional health.     

Household smoking bans: which households have them and do they work?

BACKGROUND: This study characterized Oregon households according to type and degree of restrictions on smoking and explored whether smoking restrictions are associated with decreased environmental tobacco smoke (ETS) exposure. METHODS: A population-based, random-digit-dialed cross-sectional telephone survey of 6,199 adult Oregonians was performed in 1997 to provide baseline data on tobacco use in Oregon. RESULTS: Seventy percent of Oregon households were composed of nonsmokers only, and 85% of those had a full ban on smoking inside the home. Of the households containing one or more smokers, 38% had a full household ban on smoking. Among respondents with a full ban in place, 99% of nonsmoker-only households reported that no one smoked in the home in the previous month, compared with 91% of households with at least one smoker. In both nonsmoker-only households and those with at least one smoker, full bans were strongly associated with awareness of the harm of ETS (OR = 12.8, 95% CI 7.3-22.3, and OR = 6.6, 95% CI 3.6-12.3, respectively). The presence of children in the household was also closely associated with full bans in the two types of households (OR = 4.6, 95% CI 2.8-7.6, and OR = 3.0, 95% CI 2.1-4.4, respectively). Nevertheless, 50% of households with children and a smoker present did not have a full ban in place. CONCLUSIONS: While the prevalence of household smoking restrictions is high in Oregon, there remains room for improvement, since 50% of households with a smoker and a child present do not have a full ban on indoor smoking. Public health messages that focus on household smoking restrictions may help protect nonsmokers from exposure to ETS.     

Telecare and older people: Who cares where?

'Telecare solutions' are seen as a potential means of addressing the future care needs of ageing societies in Western economies. The development of these remote care systems runs in parallel with policies aimed at 'ageing in place'; and is targeted at supporting the perceived care needs of frail older people within the home. Drawing on ethnographic and deliberative panel data from European Community funded research, we consider how these developments contribute to a reshaping of the place and experience of care for older people. We do so by addressing the ways in which remote care systems can, firstly, act to change the experience of home; and secondly, re-order the place of care-work and responsibilities to care as new actors become enrolled within the care network and existing care-givers take on differing roles and responsibilities. Finally, we consider how this paper contributes to conceptual debates around institution and extitution - that is, the de-territorialisation of the physical structure of the institution and its re-manifestation through new spaces and times that seek to end interior and exterior distinctions.     

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.     

Young people who attend specialist alcohol treatment: who are they and do they need special treatment?

OBJECTIVE: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). METHODS: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. RESULTS: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. CONCLUSIONS: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment.     

What do we know about older former carers? Key issues and themes

Despite a significant growth in the number older former family carers, they remain largely invisible in carer‐related research and literature. To begin to address this deficit, a four‐stage literature review was conducted to identify existing knowledge about older former carers. Narrative synthesis of the findings yielded five themes – the concept of ‘older former carer’, the legacies of caring, influences on the legacies of caring, conceptualising post‐caring and support services for older former carers. Critical analysis of these findings suggests that existing evidence has a number of strengths. It highlights the terminological and conceptual confusion in the field, identifies the profound financial and health‐related legacies older former carers’ experience, the factors which shape these legacies and some of the complexities of bereavement older former carers face. The support needs of older former carers are also illuminated. However, the field is characterised by key weaknesses. The evidence base is fragmented and uneven. In part this reflects lack of definitional consensus and in part the fact that there is much more evidence about some sub‐groups, such as carers of relatives admitted to a care home, than others. Methodology‐related weaknesses include small sample sizes and a focus on a single, often condition‐specific, group of older former carers. An overarching criticism relates to the narrow conceptual/theoretical purview. As post‐caring tends to be viewed as one of the final temporal ‘stages’ of the carer's ‘care‐giving career’, a bifurcatory model of carer/former carer is created, i.e. that a carer actively provides care and a former carer is no longer caring. This constructs being a former carer – namely formerality – as a single fixed state failing to capture its dynamic and shifting nature and constrains the potential of research to generate new knowledge and extend understanding.     

Monitoring local safety-net providers: do they have adequate capacity?

The safety-net providers that serve the nation's thirty-nine million uninsured residents are vulnerable organizations even in good economic times, yet efforts to monitor their capacity have been limited at best. This study of the safety-net in five cities found that capacity was strained for specialty services and that access to pharmaceuticals was difficult, while primary care capacity was more often adequate to serve those who presented themselves for care. Also, free clinics grew during the 1990s, while many other safety-net providers focused on improving their efficiency and collecting more fees from patients.     

Alcohol and health: do we know enough?

This North East of England survey aimed to evaluate the level of knowledge about alcohol of groups, which included doctors, nurses and the police, who have a role to play in promoting health education. A comparison was made with sectors of the general public, known to be at risk from alcohol-related diseases, particularly young people and those in middle management in industry and commerce. The survey found that a proportion of doctors are unaware of the safe limits of alcohol consumption, and more than a third of the nurses were unaware that these limits were lower for women. Although campaigns did not appear to be reaching middle aged, and other at-risk groups 16-18-year-olds were well informed.     

Thin adolescents: Who are they? What do they do? Socio-demographic and use-of-time characteristics

ObjectivesExamine: (1) the anthropometric, socio-demographic and use-of-time characteristics of thin adolescents, and (2) compare these characteristics to other weight status categories.MethodsData were from the 2007 National Children's Nutrition and Physical Activity Survey which collected data on a random sample of 2200 9 to 16 year old Australians from February to August 2007. Seven socio-demographic variables, anthropometric data (height and weight were measured) and nine use-of-time variables were used, and compared across the weight status categories. Physical activity was measured using pedometers and the Multimedia Activity Recall for Children and Adults.Results5.3% of adolescents were classified as thin, a percentage which did not significantly vary by age, sex, indigenous status, household income, education level or family structure. Relative to other adolescents, thin adolescents were shorter and lighter. Thin adolescents were less active than their normal weight peers, but walked further and accumulated significantly less screen and TV time than obese adolescents.ConclusionThin adolescents were found in similar proportions across all socio-demographic bands. Thin adolescents recorded similar physical activity levels to their normal weight peers, but were more active than obese adolescents. The findings from the study support in part the theory of thinness related developmental delay.     

Nutritional requirements of surgical and critically-ill patients: do we really know what they need?

Malnutrition remains a problem in surgical and critically-ill patients. In surgical patients the incidence of malnutrition ranges from 9 to 44%. Despite this variability there is a consensus that malnutrition worsens during hospital stay. In the intensive care unit (ICU), 43% of the patients are malnourished. Although poor nutrition during hospitalisation may be attributable to many factors, not least inadequacies in hospital catering services, there must also be the question of whether those patients who receive nutritional support are being fed appropriately. Indirect calorimetry is the 'gold standard' for determining an individual's energy requirements, but limited time and financial resources preclude the use of this method in everyday clinical practice. Studies in surgical and ICU patient populations have been reviewed to determine the 'optimal' energy and protein requirements of these patients. There are only a small number of studies that have attempted to measure energy requirements in the various surgical patient groups. Uncomplicated surgery has been associated with energy requirements of 1.0-1.15 x BMR whilst complicated surgery requires 1.25-1.4 x BMR in order to meet the patient's needs. Identifying the optimal requirements of ICU patients is far more difficult because of the heterogeneous nature of this population. In general, 5.6 kJ (25 kcal)/kg per d is an acceptable and achievable target intake, but patients with sepsis or trauma may require almost twice as much energy during the acute phase of their illness. The implications of failing to meet and exceeding the requirements of critically-ill patients are also reviewed.