Factors associated with the overlap of frailty and nutrition in institutionalized older adults: A multicenter study

ObjectivesThis multicenter cross-sectional study aimed to investigate the factors associated with the overlap of frailty and nutrition in older adults residing in nursing homes.MethodOlder adults (n = 344, mean age ± SD = 77.7 ± 9.1) were selected from 17 nursing homes, 10 in Piracicaba and seven in João Pessoa, Brazil. The modified Fried’s questionnaire and the Mini Nutrition Assessment Short-Form (MNA-SF) were used for screening frailty phenotypes and nutritional status, respectively. These variables overlapped into (1) frail and malnourished; (2) nonfrail and malnourished or frail and nourished; and (3) nonfrail and nourished. The independent variables were sex, age, mobility, number of medications, dependence for activities of daily living (ADL), maximal grip strength, muscle mass, body fat and body mass index (BMI). Spearman’s correlation and Poisson regression were used to analyze the data (α = 0.05).ResultsThe Spearman’s test demonstrated a moderate correlation (r²=-0.441) between frailty (mean ± SD = 2.8 ± 1.7) and nutritional status (mean ± SD = 10.5 ± 2.9). Regarding the overlap of frailty and nutrition, 139 participants (40.5 %) were frail and malnourished, 121 (35.3 %) were nonfrail and malnourished or frail and nourished, and 83 (24.2 %) were nonfrail and nourished. The Poisson regression showed association of the coexistence of frailty and malnutrition with age (PR = 1.009, 95 % CI = 1.003−1.016), number of medications (PR = 1.016, 95 % CI = 1.006−1.027), dependence for ADL (PR = 1.061, 95 % CI = 1.016−1.108), maximal grip strength (PR = 0.992, 95 % CI = 0.986−0.998) and BMI (PR = 0.997, 95 % CI = 0.996−0.998).ConclusionsThe findings showed that frailty and malnutrition were prevalent in institutionalized older adults and associated with advanced age, greater use of medicines, dependence for ADL, lower maximal grip strength and lower BMI.     

Health-related quality of life of institutionalized older adults: Influence of physical,nutritional and self-perceived health status

IntroductionInstitutionalized older adults have higher risks of diseases and worse health-related quality of life (HRQoL) than noninstitutionalized.ObjectiveTo evaluate the influence of physical state, nutritional status and self-perceived general health and oral health on the quality of life of institutionalized older adults in two Brazilian cities.MethodsA multicenter cross-sectional study was conducted in 17 homes for the aged of two Brazilian cities. Six trained researchers interviewed 344 older adults. The performance of activities of daily living (Katz scale) and frailty status (Fried scale) were applied to evaluate the physical state. The Mini Nutritional Assessment Short-Form (MNA-SF®) and the body composition were used to screening the nutritional status. A hand dynamometer was used to measure the dominant hand grip strength. The 12-Item Short Form Survey for self-perceived health (SF-12) was used to determine the HRQoL. A Likert scale was used to assess the general and oral health self-perception. Multiple Poisson regression model was applied to analyze the data (α = 0.05).ResultsThe mean (SD) score of the SF-12 was 60.89 (14.50) points. The factors associated with the highest SF-12 score were being able to walk, being nonfrail, being normal nourished, taking fewer medications, having greater dominant hand grip strength and higher self- perceived general health (p < 0.05).ConclusionBetter HRQoL in institutionalized older adults was associated with better physical state, nutritional status and self-perceived general health.     

Falls and self-assessment of eyesight among elderly people: A population-based study in a south Brazilian municipality

This paper seeks to verify the association between falls and self-assessment of visual acuity in elderly people by means of a cross-sectional population-based study involving 1593 elderly people (aged 60 or over) from the urban zone of the municipality of Bagé-RS. Poisson regression was used for association analysis. Fall prevalence in the last year was 28.0% (95%CI: 25.8; 30.2), with 45.0% of these having suffered two or more falls in the same period. Elderly people self-assessing their eyesight as bad/very poor (10.0%) or regular (33.3%) showed a linear increase in fall occurrence when compared to individuals who considered their eyesight to be good/excellent. Self-assessment of eyesight showed itself to be an important factor associated with the occurrence of falls. This results entails the need to make progress with tracing elderly people with eyesight difficulties and its possible impact on actions to prevent the occurrence of falls.     

Low prevalence of atrial fibrillation in community-dwelling Chinese aged 55 years or older in Singapore: a population-based study

Background

The prevalence of atrial fibrillation (AF) in Asian populations appears to be lower than that in Western populations according to limited data. We conducted a community study to (a) estimate the prevalence of AF in Chinese adults aged 55 years or older in Singapore and (b) examine associated risk factors.

Methods

We conducted a whole-survey area population screening of 1839 Chinese residents aged 55 years or older in the southeast region of Singapore with a single electrocardiographic recording. We performed structured interviews and anthropometric as well as clinical measurements, including blood pressure.

Results

The estimated overall AF prevalence was 1.5% (95% confidence interval = 1.1-2.2); specifically, the prevalence was higher in men (2.6%) than in women (0.6%) and increased sharply to 5.8% only in individuals aged 80 years or older. This latter rate is lower than age-standardized rates in Western populations by approximately half and consistent with similarly low prevalence rates reported for Korea and China. Of the 26 cases of AF in this study, only 10 were known cases; 3 of the 10 patients were receiving anticoagulant therapy, whereas the rest were receiving antiplatelet therapy. Atrial fibrillation was significantly associated in multivariate analyses with male sex (odds ratio [OR] = 4.10), heart failure (OR = 3.11), and stroke (OR = 3.60).

Conclusions

These data add support to the view that the prevalence of AF in Asian populations is lower than that in Western populations. The observations from these contrasting populations warrant attention in future studies.     

A study of zinc status of elderly institutionalized patients

In a study of zinc status in the elderly, the mean serum and leucocyte zinc concentrations were found to be significantly lower in continuing-care patients compared with elderly people living in the community. The mean daily dietary intakes of zinc, protein and fibre did not differ between the two groups. Serum zinc levels were found to correlate with serum albumin levels. No significant relationship was found between the mean serum or leucocyte zinc concentrations of patients and either their mental status or the presence of skin pressure damage, leg ulcers or unhealed wounds.     

Meeting the oral health needs of institutionalized elderly

Numerous impairments cause suffering to the institutionalized elderly person. The medically compromised or severely demented patient, especially one with swallowing difficulties, presents a challenge to the dental practitioner. This paper summarizes typical geriatric dental problems that caregivers in a long-term care (LTC) facility should find recognizable. It also describes palliative and preventive treatment modalities that help improve the quality of life for such institutionalized patients.     

Family support, financial needs, and health care needs of rural elderly in China: A field study

This study examined family support, financial needs, and health care needs of 100 elderly persons in a rural county in China. Data revealed that immediate family members helped elderly persons with activities of daily living and instrumental activities of daily living, and that adult children also provided financial assistance to most of the elderly. However, only eight percent of the elderly persons reported that they had adequate financial resources. In the four villages surveyed, collective health care systems had collapsed in the early 1980's. Due to high costs of health care and the absence of government support, almost two thirds of the elderly persons had unmet needs for health care. In addition, elderly persons who reported poor health were more likely to have unmet financial and health care needs.     

Utilization of evidence-based therapies for heart failure in the institutionalized elderly

OBJECTIVES: Heart failure (HF) is a major source of morbidity and mortality in elderly populations. A significant proportion of the elderly with HF are living in long-term care facilities. Little is known about their management. The aim of this study was to evaluate the use of evidence-based therapies in institutionalized elderly patients with HF. DESIGN, SETTING AND PARTICIPANTS: Retrospective chart review conducted at 15 long-term care facilities in the Capital Health Region (Edmonton, Alberta). Residents > or =65 years of age with HF were identified using a pharmacy database. RESULTS: Overall prevalence of HF was 15% (313/2062 residents). Mean age was 87 years, median duration of residence was 1.8 years. Utilization of ACE-inhibitors, beta-blockers and spironolactone was 51%, 16% and 10%, respectively. Use of these medications was not significantly different between subgroups of those with and without contraindications to the therapies, different advance directive levels, gender or age. Sodium and fluid restricted diets were prescribed in only 11.0% and 3.8% of residents. Weight was not regularly monitored. Influenza and pneumococcal vaccination were administered to 60.4% and 81.2% of the residents. CONCLUSION: The use of evidence-based therapies in institutionalized elderly patients with HF is low, and unexplained by contraindications or advance directives. Efforts to increase the utilization of evidence-based therapies and improve monitoring are warranted.     

A prospective study of pressure sore risk among institutionalized elderly.

OBJECTIVE: To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly. DESIGN: Cohort study. SETTING: 250-bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days. PATIENTS: Two hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay greater than 10 days, at risk for pressure sore development (Braden Scale score less than or equal to 17) but free of existing pressure sores were studied for 12 weeks or until discharge. MEASURES: Skin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks. MAIN OUTCOME MEASURES: Presence/absence and stage of pressure sores. MAIN RESULTS: Stage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P less than 0.001) and had lower systolic and diastolic blood pressure (P less than 0.001) and higher body temperature (P less than 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age. CONCLUSIONS: Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.     

氟卡胺对老年人左心室舒张功能的影响

采用双盲、交叉（安慰剂）对照，应用多普勒超垢心动图观察氟卡胺对２０例阵发性房性心律失常但无明显器质性心脏病的老年人左室舒张功能的影响，结果发现，与安慰剂比较，氟卡胺能显著降低左心室舒张期顺应性。     

Patient transitions relevant to individuals requiring ongoing ventilatory assistance: A Delphi study

BACKGROUND:

Various terms, including ‘prolonged mechanical ventilation’ (PMV) and ‘long-term mechanical ventilation’ (LTMV), are used interchangeably to distinguish patient cohorts requiring ventilation, making comparisons and timing of clinical decision making problematic.

OBJECTIVE:

To develop expert, consensus-based criteria associated with care transitions to distinguish cohorts of ventilated patients.

METHODS:

A four-round (R), web-based Delphi study with consensus defined as >70% was performed. In R1, participants listed, using free text, criteria perceived to should and should not define seven transitions. Transitions comprised: T1 – acute ventilation to PMV; T2 – PMV to LTMV; T3 – PMV or LTMV to acute ventilation (reverse transition); T4 – institutional to community care; T5 – no ventilation to requiring LTMV; T6 – pediatric to adult LTMV; and T7 – active treatment to end-of-life care. Subsequent Rs sought consensus.

RESULTS:

Experts from intensive care (n=14), long-term care (n=14) and home ventilation (n=10), representing a variety of professional groups and geographical areas, completed all Rs. Consensus was reached on 14 of 20 statements defining T1 and 21 of 25 for T2. ‘Physiological stability’ had the highest consensus (97% and 100%, respectively). ‘Duration of ventilation’ did not achieve consensus. Consensus was achieved on 13 of 18 statements for T3 and 23 of 25 statements for T4. T4 statements reaching 100% consensus included: ‘informed choice’, ‘patient stability’, ‘informal caregiver support’, ‘caregiver knowledge’, ‘environment modification’, ‘supportive network’ and ‘access to interprofessional care’. Consensus was achieved for 15 of 17 T5, 16 of 20 T6 and 21 of 24 T7 items.

CONCLUSION:

Criteria to consider during key care transitions for ventilator-assisted individuals were identified. Such information will assist in furthering the consistency of clinical care plans, research trials and health care resource allocation.     

Information needs and sources of family caregivers of home elderly patients

Meeting the information needs of family caregivers in a timely and appropriate way is a key concern of home care. The present study aimed to explore the following two areas: (a) the priority information needs and sources of family caregivers of home elderly patients and (b) the differences in information needs according to severity of dementia. The subjects were 475 family caregivers of home elderly patients residing in Nagoya city. Data was collected through questionnaires. Severity of dementia was evaluated according to the criteria of the public long-term care insurance policy (levels 0-5). The top 3 items they perceived as of most concern were dementia, first aid, and available public long-term care insurance services. A few respondents felt the need for information on public long-term care insurance services. Nearly half of the caregivers were interested in food and nutrition. The respondents were more likely to receive information from their care managers or physicians than any other source. Caregivers of elderly dependents with severe dementia reported a greater need for information on the spread of dementia, dementia-specific care, or the negative effects of dementia on family and neighborhood. Our results provide useful information on how family caregivers should be educated.     

护理干预对脑卒中吞咽障碍患者家庭康复的影响

目的探讨家庭康复护理对脑卒中吞咽障碍患者吞咽功能恢复的影响。方法将30例脑卒中吞咽障碍患者随机分为干预组16例和对照组14例。用才藤7级分类法作为评价标准,对干预组患者进行以吞咽功能训练为主的家庭康复护理。对照组采用神经科常规护理治疗。结果两组患者4周康复护理训练后评分间差异有统计学意义（P〈0．01）。干预组治疗后评分较治疗前明显改善,并且与对照组比较有明显差异（P〈0．01）。干预组和对照组显效率和有效率分别为50％、100％和0、64．3％。结论对脑卒中吞咽障碍患者进行以吞咽功能训练为主的家庭康复护理干预。能显著改善患者的吞咽功能。     

Family presence during resuscitation: A Canadian Critical Care Society position paper

BACKGROUND:Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. The exclusion of family members from the resuscitation area should, therefore, be reassessed.OBJECTIVE:The present Canadian Critical Care Society position paper is designed to help clinicians and institutions decide whether to incorporate FPDR as part of their routine clinical practice, and to offer strategies to implement FPDR successfully.METHODS:The authors conducted a literature search of the perspectives of health care providers, patients and families on the topic of FPDR, and considered the relevant ethical values of beneficence, nonmaleficence, autonomy and justice in light of the clinical evidence for FPDR. They reviewed randomized controlled trials and observational studies of FPDR to determine strategies that have been used to screen family members, select appropriate chaperones and educate staff.RESULTS:FPDR is an ethically sound practice in Canada, and may be considered for the families of adult and pediatric patients in the hospital setting. Hospitals that choose to implement FPDR should develop transparent policies regarding which family members are to be offered the opportunity to be present during the resuscitation. Experienced chaperones should accompany and support family members in the resuscitation area. Intensive educational interventions and increasing experience with FPDR are associated with increased support for the practice from health care providers.CONCLUSIONS:FPDR should be considered to be an important component of patient and family-centred care.     

Falls in the elderly of the Family Health Program

This study aims to determine the factors that may be related to falls in the elderly assisted by the Family Health Program (FHP). Elderly individuals aged 60 years or over, who were assisted by the FHP primary care system (n = 2209), responded to a sociodemographic and health questionnaire. Mental health was evaluated using the Geriatric Depression Scale (GDS) and quality of life was assessed by the Medical Outcome Study Short-Form Health Survey (SF-36). In order to verify which independent variables affected the occurrence of falls, logistic regression analysis was performed. 27.1% of the sample reported one fall during the previous year, and 8.7% were recurrent fallers over the same period. The factors considered in the final model for falls were: age over 80 years-old, female gender, the presence of more than eight associated diseases, need for hospitalization during the previous year and appointments outside the FHP routine, hearing complaints, GDS score over 11 points, and emotional problems SF-36 score between 25 and 74 points. The factors included in the final model for falls can be easily identified and properly overcome by FHP strategy. Patient falling history investigation should thus form part of the FHP team routine. This concern should be reinforced when it comes to women aged 80 years and over.     

Family caregiving of the elderly in Botswana: Boundaries of culturally acceptable options and resources

Care of the elderly in Botswana is solely afamily responsibility. In the absence of formalprograms for the elderly it is important tounderstand the cultural beliefs that guidedecision making regarding acceptance of elderlycare. The purpose of this study was to explorethe experiences of family caregivers to olderpersons in Botswana. Using grounded theorymethodology, 24 caregivers who were caring foran older person were interviewed. The findingsindicate that the perceptions that guided thecaregivers' decision making process ofacceptance or non-acceptance of assistance fromboth family members and the government fellinto three inter-related but distinctcategories: Stigma, Appropriate-inappropriateforms of care; and Sense of Place. It isrecommended that cultural sensitivity should beconsidered in designing models of support forfamilies who are looking after their olderrelatives. Finally, a clear understanding ofthe perceptions of family members' needs mustbe emphasized as these differ from healthworkers' perceptions of family needs.     

Changes in hypnotic usage in residential homes for the elderly: a longitudinal study

The use of hypnotic drugs in 25 local authority homes for the elderly was recorded on a 1-day point prevalence study following a 6-mth monitoring programme involving all new admissions. From a total population of 1114 residents 390 (35%) were taking hypnotics on the night of the survey, showing a slight increase from similar surveys carried out in 1980 and 1981. The proportion of residents receiving hypnotics within each home varied from 0.0 to 61.8%. Correlation with levels of usage in the previous surveys was low, suggesting that pattern of hypnotic usage may change considerably over time within individual homes. Of the 156 residents who were admitted as permanent residents during the 6-mth period preceding the survey, 56 (35.9%) had been taking hypnotics on admission. Both the results of the drug monitoring programme and the survey show an association between hypnotic usage and source of admission: residents admitted from hospital being more likely to be taking sleeping tablets.A considerable change was found in the type of hypnotic currently prescribed with an increased preference being shown for short half-life hypnotics. A higher proportion of residents also were prescribed lower doses of hypnotics than previously, suggesting an increased awareness of the risks associated with hypnotic use in the elderly.     

诺和锐30治疗老年初诊2型糖尿病16例

目的探讨预混胰岛素类似物双相门冬胰岛素（诺和锐30）对老年初诊2型糖尿病（T2DM）的疗效和不良反应. 方法 16例初诊的老年T2DM使用诺和锐30治疗8周,观察空腹血糖（FBG）、餐后2h血糖（2 hPG）、糖化血红蛋白（HbA1c）的变化及低血糖等不良反应. 结果治疗8周后FBG平均下降3.44 mmol/L,2hPG平均下降8.52 mmol/L,HbA1c平均下降2.65%.未发生严重低血糖事件以及其他严重不良反应. 结论诺和锐30治疗老年初诊T2DM具有疗效确切、患者易于接受、低血糖反应少等特点,值得尝试推广使用.