Depressive symptoms in institutionalized older adults

OBJECTIVE

To estimate the prevalence of depressive symptoms among institutionalized elderly individuals and to analyze factors associated with this condition.

METHODS

This was a cross-sectional study involving 462 individuals aged 60 or older, residents in long stay institutions in four Brazilian municipalities. The dependent variable was assessed using the 15-item Geriatric Depression Scale. Poisson’s regression was used to evaluate associations with co-variables. We investigated which variables were most relevant in terms of presence of depressive symptoms within the studied context through factor analysis.

RESULTS

Prevalence of depressive symptoms was 48.7%. The variables associated with depressive symptoms were: regular/bad/very bad self-rated health; comorbidities; hospitalizations; and lack of friends in the institution. Five components accounted for 49.2% of total variance of the sample: functioning, social support, sensory deficiency, institutionalization and health conditions. In the factor analysis, functionality and social support were the components which explained a large part of observed variance.

CONCLUSIONS

A high prevalence of depressive symptoms, with significant variation in distribution, was observed. Such results emphasize the importance of health conditions and functioning for institutionalized older individuals developing depression. They also point to the importance of providing opportunities for interaction among institutionalized individuals.     

Malnutrition and falls risk in community-dwelling older adults

Background and Aims

Falls and fall-related injuries result in reduced functioning, loss of independence, premature nursing home admissions and mortality. Malnutrition is associated with falls in the acute setting, but little is known about malnutrition and falls risk in the community. The aim of this study was to assess the association between malnutrition risk, falls risk and falls over a one-year period in community-dwelling older adults.

Methods

Two hundred and fifty four subjects >65 years of age were recruited to participate in a study in order to identify risk factors for falls. Malnutrition risk was determined using the Mini Nutritional Assessment-Short Form.

Results

28.6% had experienced a fall and according to the Mini Nutritional Assessment-Short Form 3.9% (n=10) of subjects were at risk of malnutrition. There were no associations between malnutrition risk, the risk of falls, nor actual falls in healthy older adults in the community setting.

Conclusions

There was a low prevalence of malnutrition risk in this sample of community-dwelling older adults and no association between nutritional risk and falls. Screening as part of a falls prevention program should focus on the risk of developing malnutrition as this is associated with falls.     

Nutritional intake in both free-living and institutionalized older adults with xerostomia

A common problem in the institutionalized as well as the free-living elderly is inadequate nutrition. This problem will continue in significance as the population continues to age. Previous studies have indicated a variety of nutritional deficiencies in the diets of older adults. Chronic degenerative diseases and usage of multiple pharmacologic agents are also prevalent in the geriatric population and confound this complex problem. A common observation among the many contributing factors to the problem of relative or absolute malnutrition in seniors is that many individuals exhibit the sign/symptom of xerostomia (dry mouth). Recent studies indicate that nearly one in five older adults exhibit xerostomia. Xerostomia increases the difficulty of these older adults in obtaining the proper nutrition. Problems in lubricating, masticating, tolerating, tasting and swallowing food contribute significantly to the complex physiological and psychological manifestations of aging. To this date the literature fails to demonstrate an association between xerostomia and malnutrition in the elderly.     

Change and predictors of quality of life in institutionalized older adults with dementia

Purpose

This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period.

Methods

Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer’s disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline.

Results

The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures.

Conclusions

A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults’ QoL.     

Granzyme B: a marker of risk for influenza in institutionalized older adults

Risk for influenza increases with age while cellular immune responses decline. This was a prospective study to determine the relationship between cytokine and granzyme B levels in peripheral blood mononuclear cells stimulated with live influenza virus, and subsequent influenza illness. Granzyme B levels were lower in the group who later developed symptomatic laboratory-confirmed influenza (n=10) compared to the group who did not (n=90) (ANOVA, P=0.024). In contrast, none of the cytokine levels were related to the development of influenza. Thus, granzyme B is a potential marker of influenza risk in older adults.     

A cross-national comparison of institutionalized tube-fed older persons: the influence of contrasting healthcare systems

OBJECTIVE: Different health care settings may influence the type of patients selected for long-term tube-feeding. Clinical characteristics of older, tube-fed institutionalized subjects living in Ontario, Canada were compared with those in the United States (US). DESIGN: A cross-sectional cohort study Setting: Nursing homes in the states of Mississippi, Texas, and Vermont (US) and chronic care facilities in Ontario. PARTICIPANTS: Tube-fed residents older than age 65 living in facilities in the US between January 1, 1996, and March 31, 1997 (n = 859), and in institutions in Ontario between January 1, 1996, and December 31, 1997 (n = 913). MEASUREMENTS: Data were obtained from Minimum Dataset assessments at both sites. Demographic and clinical characteristics were compared between tube-fed subjects living in the US and those in Canadian facilities. RESULTS: In a logistic regression model, the following characteristics were significantly more likely to be found among tube-fed subjects in the US than in those in Ontario: greater impairment of cognitive performance, cardiopulmonary disease, a diagnosis of dementia, female, and age greater than 80 years. Characteristics that were significantly less likely to be present among the US tube-fed subjects included: recurrent lung aspirations, a chewing or swallowing problem, do not resuscitate status, restraint use, weight loss, and stroke. CONCLUSIONS: Clinical characteristics differ between older, institutionalized tube-fed subjects in Ontario and in US nursing homes. In order to put these differences into context, consideration must be given to how the contrasting healthcare systems in these two countries may drive decision-making for long-term tube-feeding.