Predictive equations for the estimation of basal metabolic rate in Malaysian adults

In the field of human energy expenditure, the measurement of basal metabolic rate (BMR) is an essential element to derive energy requirement estimates for any given population. Besides basic anthropometrics data, this paper reports the generation of predictive equation for basal metabolic rates of healthy Malaysian adult from prospective measurements on 307 male and 349 females aged 18-60 years, using the Douglas bag technique. These new equations based on body-weight reveal that the current FAO/WHO/UNU (1985) predictive equations overestimate BMR of adult Malaysian by an average of 13% in males and 9% in female subjects while differences of between 4-5% were observed when compared to Henry and Rees (1991) equations for tropical people. There is a good reason to believe that the capacity to slow down metabolism amidst the hot and humid climate experience throughout the year as a genuine phenomenon for Malaysians. Similarly, these findings suggest that at equal energy intake recommendation for similar body weight, the lower energy needs of Malaysian could put them at greater risk for developing obesity. These observed deviations must be taken into account in formulating energy requirements of the population.     

Predictive ability of various nutritional variables for mortality in elderly people

Nutritional indices (percentage ideal body weight [IBW], serum albumin, serum transferrin, total lymphocyte count [TLC] and delayed cutaneous hypersensitivity [DH] response) were assessed in 80 consecutive patients (aged 85-100 y) within 24 h of admission to determine their predictive value for mortality. Nine patients died. Pearson correlation analysis demonstrated that death was significantly (p less than 0.05 to less than 0.01) associated with sepsis, serum albumin less than 30 g/L, TLC less than or equal to 1500 cells/mm3, and percentage IBW less than or equal to 90%. However, when serum albumin was controlled for, logit regression analyses demonstrated that the impact of other nutritional indices on death was insignificant. The effect of serum albumin remained significant (p less than 0.05 to less than 0.01) even when age and physician's diagnosis were held constant. With the logit model, serum albumin greater than or equal to 30 g/L had a sensitivity of 0.33, specificity of 0.99, and overall predictive power of 0.91. Serum albumin is thus the simplest and best single predictor of mortality and can provide early identification of elderly people at increased risk of death.     

Predictive equations for the estimation of basal metabolic rate in Malaysia adolescents

A longitudinal study was conducted to relate basal metabolic rate (BMR) with growth during adolescence. Subjects comprise 70 boys and 69 girls aged between ten and thirteen years at the time of recruitment. Parameters studied include anthropometric measurements and BMR, which was measured by indirect calorimetry using the Deltatrac metabolic monitor. Measurements were carried out serially once every six months, with a total of 713 BMR data points collected over three years. Mean BMR of boys aged 11, 12, 13 and 14 years were 4.96 ± 0.63 MJ/day, 5.28 ± 0.71 MJ/day, 5.73 ± 0.68 MJ/day and 5.92 ± 0.63 MJ/day, respectively; while mean BMR of girls in the 10, 11, 12 and 13 year age groups were 4.96 ± 0.63 MJ/day, 4.85 ± 0.63 MJ/day, 5.05 ± 0.55 MJ/day and 4.94 ± 0.51 MJ/day, respectively. Comparison of measured BMR with BMR values predicted from the FAO/WHO/UNU (1985) equations shows that the predictive equations overestimated the BMR of Malaysian boys by 3% and that of girls by 5%. The Henry and Rees (1991) equations for populations in the tropics underestimated BMR of boys and girls by 1% and 2%, respectively. Linear regression equations to predict BMR based on body weight were derived according to sex and age groups. It is recommended that these predictive equations be used for the estimation of BMR of Malaysian adolescents.     

Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States

BACKGROUND: The accurate measurement of stature is not possible in many frail elderly persons because of problems affecting their ability to stand straight. In such cases, knee height may be used to estimate stature. OBJECTIVE: This study was designed to explore the applicability of published regression equations to estimate stature of Puerto Rican and other Hispanic elderly persons living in the northeastern United States and to formulate ethnicity-specific equations for these persons. DESIGN: The study subjects (60-92 y of age) included 569 Hispanics and a comparison group of 153 non-Hispanic whites. Equations to estimate stature of Hispanics and Puerto Ricans living in the northeastern United States were developed with regression models in a randomly selected subgroup of the Hispanics. These equations were tested with the remaining Hispanic subgroup. RESULTS: The published equations significantly overestimated stature of our Hispanic subjects. Equations developed for Massachusetts Hispanics and Puerto Ricans provided estimates of stature that did not differ significantly from measured stature. We found further that equations for non-Hispanic whites published in 1985 predicted statures of our relatively low-income, non-Hispanic white subjects better than did newer 1998 equations developed from a national sample. CONCLUSIONS: The stature of elderly Hispanics from the northeastern United States can be estimated by using equations derived from the same population. These, or similar equations, should be used to estimate stature of frail elderly persons for whom standing height cannot be taken accurately. Socioeconomic status as well as ethnicity may affect results when knee height equations are used.     

Prediction of stature in the Italian elderly

Adequate quantification of weight and stature is essential in order to determine levels of nutritional support and to monitor the effects of nutritional intervention. Traditional anthropometric techniques are difficult to apply in elderly or handicapped patients chair or bed-bound. The purpose of the present study is to elaborate regression equations for the estimation of stature in the italian elderly population from other anthropometric measures that can be more easily determined. We have found a single model valid for both sexes (in which the value of the variable "sex" equals 0 if woman and 1 if man) to predict stature in italian elderly: Stature = 94.87 + 1.58 knee-height - 0.23 age + 4.8 sex. Cross validation on a control sample of 30 males and 54 females yielded pure errors of 3.1 cm for men and 2.74 cm for women.     

Body composition in elderly people: effect of criterion estimates on predictive equations

The purposes of this study were to determine whether there are significant differences between two- and four-compartment model estimates of body composition, whether these differences are associated with aqueous and mineral fractions of the fat-free mass (FFM); and whether the differences are retained in equations for predicting body composition from anthropometry and bioelectric resistance. Body composition was estimated in 98 men and women aged 65-94 y by using a four-compartment model based on hydrodensitometry, 3H2O dilution, and dual-photon absorptiometry. These estimates were significantly different from those obtained by using Siri's two-compartment model. The differences were associated significantly (P less than 0.0001) with variation in the aqueous fraction of FFM. Equations for predicting body composition from anthropometry and resistance, when calibrated against two-compartment model estimates, retained these systematic errors. Equations predicting body composition in elderly people should be calibrated against estimates from multicompartment models that consider variability in FFM composition.     

衰弱的内涵及其概念框架

  目的  了解高龄老人的衰弱进程、日常照护及精神慰藉需求状况,分析衰弱程度与日常照护及精神慰藉需求的相关性。  方法  于2016年7月 — 2017年1月采用分层随机整群抽样方法抽取河北省唐山市2家医院的10个社区卫生服务中心辖区≥ 75岁老年人,使用衰弱综合评估工具（CFAI）、日常生活能力量表（ADL）、孤独量表进行（UCLA）评测。  结果  3 448名高龄老人衰弱率为100 %,随年龄的增加其衰弱程度呈加重趋势,差异有统计学意义（χ² = 133.355,P < 0.001）;日常照护低需求者860人（24.9 %）,高需求者804人（23.3 %）,而高龄老人自评需要生活照护者占61.0 %,高于ADL评估结果,选择需要子女照顾者2 021人次,占58.6 %;精神慰藉低需求1 071人（31.06 %）,中等需求1 598人（46.35 %）,中上等需求679人（19.69 %）,高需求100人（2.90 %）,精神照护中等及以上需求者占68.94 %,远高于日常生活照顾需求者。而高龄老人自评需要精神照护者2 441人,占70.17 %,2组数据基本持平。选择需要子女提供精神照护者1 906人次,占78.08 %。多因素分析显示,年龄、衰弱程度是高龄老人日常照护和精神慰藉需求的影响因素。  结论  应加强对高龄老人日常生活和精神生活的照护,依据衰弱程度提供相应的照护。     

Risk of infection in institutions for elderly people

The infectious risk in long-term care facilities and nursing homes is significant. Patients living in those facilities are very old, with a poor health status, and a high degree of dependency. The risk for epidemic outbreaks, in particular with viruses, is very high. A simple system for surveillance and action, in relation with hospital infection control units, is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, anti-viral and pneumococcal vaccination. The program must be simple, pragmatic, allowing to maintain social links and quality of life, which are essential for these patients. A strong cooperation between these long-term care facilities and nursing homes, general practitioners, healthcare team, and relatives is necessary.     

Utility of an ADL index for institutionalized elderly people: Examining possible applications for independent elderly people

The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on condition of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.     

Housing for frail elderly people.

A national survey followed by an evaluation has recently been undertaken of very sheltered housing for elderly people. This enhanced sheltered housing usually provides 24-hour warden cover, meals and help with domiciliary and personal tasks. It is increasingly being provided by local authorities and housing associations. The evaluation took into account the views of management, staff, elderly people and cost. It was a successful form of housing but more expensive than staying at home with a package of care. In some cases elderly people had moved from institutional care to very sheltered housing. There were, however, people in the schemes who neither wanted nor needed to be there. There were also some problems such as doctors' unrealistic expectations of the schemes and unqualified staff being involved in medication.     

Medical care for institutionalised elderly people in Singapore

Abstract: This study examined physical and financial arrangements for medical care of institutionalised elderly people in Singapore. Chief administrators of all long-term care facilities were interviewed on the existing arrangements for medical care of their residents. Results showed that 66 out of a total of 68 (97%) homes arranged medical care for residents. Of those, 29 homes offered on-site medical care with alternative arrangements when the in-house facilities were not operating. While government-owned homes would pay for all medical costs incurred by their residents, over 48% of voluntary homes and 87% of commercial homes required residents to be financially responsible for their care. The availability of financial support given to residents for payment of medical care was found to be associated with the type of sponsorship of the homes. While there was adequate physical access to medical care, the lack of financial support would pose a potential barrier to use of medical care for institutionalised elderly people.     

Videoconferencing in facilities providing care for elderly people

Two studies were conducted to test the feasibility of delivering care by videoconferencing to facilities providing care for elderly people. Both used equipment connected by ISDN lines at 384 kbit/s. During the first study, no consultations, care plans or assessments were conducted. During the second study, 120 assessments were conducted in just over two weeks, both face to face and by videoconference. Why was one project so successful and the other not? The reasons related to ownership, planning, participants and location. A comparison of the two projects highlights some of the considerations necessary to ensure the success of any telehealth project.     

Videoconferencing in facilities providing care for elderly people

Two studies were conducted to test the feasibility of delivering care by videoconferencing to facilities providing care for elderly people. Both used equipment connected by ISDN lines at 384 kbit/s. During the first study, no consultations, care plans or assessments were conducted. During the second study, 120 assessments were conducted in just over two weeks, both face to face and by videoconference. Why was one project so successful and the other not? The reasons related to ownership, planning, participants and location. A comparison of the two projects highlights some of the considerations necessary to ensure the success of any telehealth project.     

中国肾小球滤过率评估方程应用于老年慢性肾脏病患者评价

目的评价现有在中国人群基础上开发的肾小球滤过率(GFR)评估方程对老年慢性肾脏病(CKD)患者的适用性。方法选择103例老年CKD患者,用中国方程、瑞金方程分别预测GFR值,与体表面积标准化99mTc DTPA测的GFR(sGFR)进行比较。结果Bland-Altman分析显示瑞金方程估计的GFR和sGFR的一致性最好,但所有方程估计的GFR和sGFR的一致性限度均超过事先规定的专业界值。线性回归结果显示,瑞金方程估测的GFR与X轴的斜率比其他方程更小。瑞金方程、MDRD1方程和中国5方程估测GFR15%符合率、30%符合率和50%符合率均较高,但所有方程估测GFR30%符合率依然低于70%。在CKD的不同分期中,瑞金方程和MDRD1方程估测GFR15%符合率、30%符合率和50%符合率均较高。结论当血肌酐的测定方法为酶法时,如果直接应用目前在中国人群基础上开发出的GFR评估方程预测老年CKD患者的GFR,可能会产生明显的偏差。     

Risk factors for mortality among elderly people

OBJECTIVE: The risk factors for diseases and premature deaths are important in drawing up preventive measures. This study had the aim of analyzing the risk factors for death among elderly people. METHODS: This study was carried out among participants in the SABE (Health, Wellbeing and Aging) study, in the city of S?o Paulo in 2000. Interviews were conducted with 2,143 elderly people (60 years old or over), using a standardized questionnaire for the SABE study. The sample was obtained from census tracts, in two stages, with replacements and with probability proportional to the population, and with supplementation of the sample of people aged 75 years or over. The final data were weighted so that they could be expanded. Between the two data collection times, there were 38 deaths which comprised study sample. Logistic regression was utilized for the data analysis, with a significance level of 5%. RESULTS: The risk factors found were: locomotion difficulty, advanced age, male gender, self-assessment of health as "bad" and difficulty in going to the bathroom, OR=3.15; 2.93; 2.90; 2.69 and 2.51, respectively. CONCLUSIONS: The results may contribute towards the adoption of preventive measures for elderly people, with the aim of diminishing the expected number of fatal outcomes.