Relationship between nutrition status and dental occlusion in community‐dwelling frail elderly people

Aim: This study aimed to determine the risk of malnutrition in some communities where the frail elderly receive public long‐term care insurance. We also clarified the dental problems in those at risk of malnutrition. Methods: A total of 716 frail elderly who lived in eight cities in Japan (240 males and 476 females with a mean age of 83.2 ± 8.6 years) were divided into three groups according to Mini Nutritional Assessment short form results: well nourished, at risk of malnutrition and malnourished. They were also divided into three groups in terms of remaining teeth occlusion and denture occlusion: group A, natural dentition with adequate function; group B, partially or fully edentulous, but maintaining functional occlusion with dentures in either or both jaws; and group C, functionally inadequate occlusion with no dentures. The relationship between nutrition status and dental occlusion was evaluated using logistic regression analysis with sex, age, activities of daily living and cognitive function as covariates. Results: The number of participants in each of the groups was as follows: 251 well nourished, 370 at risk of malnutrition and 95 malnourished. When they were divided into just two groups, (i) well nourished and (ii) at risk of malnutrition plus malnourished, in order to study malnutrition risk factors, there were significant relationships between their nutritious status and sex, Barthel index, and occlusion. Conclusion: This large‐scale cross‐sectional survey showed that loss of natural teeth occlusion was a risk factor for malnutrition among community‐dwelling frail elderly. Geriatr Gerontol Int 2013; 13: 50–54 .     

Research: The challenges of clinical trials in the exclusion zone: The case of the frail elderly

Frail older people have been systematically excluded from randomised controlled trials (RCT). We aim to recruit older, frail hospitalised patients in an RCT and evaluate the frailty index (FI) as a measure to describe the types of people included in the study. We recruited 315 hospitalised patients aged 65 years; age ranged from 60 to 102 years. Baseline assessment scores ranged as follow: Mini‐Mental Status Examination from 7 to 30, Barthel index from 5 to 100 and FI from 2 to 24. Total deaths were 20 (6%). We demonstrated that it is feasible to recruit frail older people into RCTs. The FI does not show any ‘floor’ or ‘ceiling’ effects. We can measure frailty in an RCT cohort, and we believe that clinical trials should include more frail older people and that the use of an FI can facilitate such trials and generate reliable data to guide future medical practice in a rapidly ageing society.     

Improving the health status of the rural elderly in Mali

On the basis of a seven-year study, 1984–1991, in a traditional Bambara community in the Sahel region of the Republic of Mali special problems of health in later life are reported against the background of general ecological conditions. Some quantification of age- and gender-specific features of illness is offered on the basis of parasitological and clinical tests administered. This article starts with the premise that the health of all age groups in traditional African society is assessed by their members in culturally specific ways influenced by their social organization and cosmology and by their sociocentric and cosmocentric interpretation of health and sickness.Future health measures in Mali should apply and transform some of these views and practices. On account of the seniority principle which underlies Bambara social organization, the demographically small group of elderly traditionally held a somewhat privileged position. Physical weakness in late phases of life were, and to some extent still are, embedded in strictly regulated kinship and community structures. Traditionally, health and sickness are viewed as related to forces outside the individual, emerging from nature or social conflict. But traditions deteriorate as competition, instrumentalism, person-centered social mobility aspirations, and the quest for individual liberties grow as a result of various processes of modernization (which penetrate even into the more isolated regions and villages). The article shows that certain traditional elements of the rural Bambara way of life (e.g., village committees) permit an organization of solidarity to replace the diminishing traditional social organization under the conditions of the appearance and, in part, availability of certain elements of Western medicine.     

Impact on hospital admissions of an integrated primary care model for very frail elderly patients

Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.     

Preventive home visits for community-dwelling frail elderly people based on Minimum Data Set-Home Care: Randomized controlled trial

Background:   Although preventive home visits for the elderly are mandatory in Japan, there has been little research into their effectiveness. The present study used the Minimum Data Set-Home Care (MDS-HC) as the basis for assessing community-dwelling frail elderly persons.
Methods:   The present study was a randomized controlled, community-based investigation of 368 elderly people aged 65 years and older who were dependent in the instrumental activities of daily living, but independent in activities of daily living. The participants were randomly assigned to an intervention group (184) or a control group (184). For 18 months, the intervention group received scheduled home visits by public health nurses who had been instructed that the primary objective of these visits was human interaction. The MDS-HC was used to assess the elderly person at each visit. The primary outcome was the EQ-5D score of the EuroQol and secondary outcomes were five items constituting the EQ-5D, self-rated health, and health behaviors. The types of advice given and subject compliance were also analyzed.
Results:   Intervention had no effect on the EQ-5D score, and positive results were limited to some aspects of health behavior. Subgroup analyses showed that the home visits were effective for elderly people who perceived their own health as poor at baseline, and for participants who complied with advice.
Conclusions:   The preventive home visits based on the MDS-HC were effective in selected groups of frail elderly people. Further modification in the use of the MDS-HC and more focused targeting are needed to make the visits more effective.     

Usefulness of the Mini-Nutritional Assessment (MNA) to evaluate the nutritional status of Japanese frail elderly under home care

Background:   The Mini-Nutritional Assessment (MNA) has proved useful in Western countries to predict long-term mortality of institutionalized elderly patients, as well as the elderly living at home. However, there are few reports on the usefulness of this evaluation in the elderly in Japan. Our objective was to examine the usefulness of the MNA to screen and diagnose malnutrition in the elderly in Japan and investigate the effect of nutritional status on their activities of daily living (ADL) and mortality.
Methods:   We recruited 181 frail elderly (62 men and 119 women) under home care whose age was 79.8 ± 8.8 years old. We assessed their nutritional status (anthropometric measurements, serum albumin, MNA) and ADL; then we followed up these patients for more than 2 years to see whether the MNA reflected their prognosis.
Results:   The MNA score correlated with anthropometric measurements, serum albumin and ADL ( P  < 0.01). The hazard ratio of mortality by all causes was significantly higher in the elderly with protein energy malnutrition (PEM) and risk for PEM, compared with well-nourished elderly patients.
Conclusion:   The MNA was useful to screen the elderly for nutritional status because it reflected the ADL and the prognosis, as well as conventional nutritional indexes such as anthropometric values and serum albumin.     

Predictors of discharge stability in the first year following hospital admission for a frail elderly population

The frail elderly are a group of patients who are at high risk of institutionalization and death. Specialist older person's health care aims to maximize function and independence. However, there is little published work on the long-term outcomes following hospitalization in a frail elderly population. This study examines the outcomes in the first year after hospitalization for this group. We find that 62% are able to remain in their own homes and that functional status is the strongest predictor of outcome, with age and living arrangements also significant.     

Management of frail older people with acute illness

Frailty status is intrinsically related to every aspect of older patients’ hospital journeys: the way in which they present to hospital, their health status at admission, vulnerability to complications in hospital and rate of recovery after an acute insult. In younger people, hospitalisation is usually the result of a serious illness or injury, such as sepsis or major trauma. Management can be underpinned by evidence‐based algorithms relating to the precipitating insult and recovery usually follows a predictable trajectory. In older people who are frail, on the other hand, admission to hospital may be triggered by an illness that may seem minor, such as a viral infection, which causes a geriatric syndrome. A fall or delirium with no major precipitant should be considered an indicator of frailty. Promptly recognising the acute illness and the increased risk for hospital‐associated complications is essential for providing safe systems of care for frail older people. Early consideration of health assets and engagement of families and community services can have an important role in successful recovery during and beyond the hospital stay. Effective decision‐making about clinical interventions can benefit from explicit assessment of frailty status and consideration of patient priorities.     

家庭结构与老年人身心健康关系的研究

随机抽取武汉市某社区中６０岁以上的老年人，采用个人访谈法对家庭结构类型与老年人的身心健康进行了初步研究。调查结果表明：老年人的家庭结构类型主要为联合型家庭（占５２．４％）、直系型家庭（占４．２％）、核心型家庭（占２４．５％）及单独生活型（占１８．９％）；大部分老年人同已婚或未婚的子女生活在一起，但单独生活的老年人比例也有所增加；ｔ检验结果表明：联合型家庭老人的生活满意度显著高于核心型家庭老人（Ｐ＜０．０５），三代同堂的联合型家庭老人的生活满意度显著高于单独生活型的一个独居老人（Ｐ＜０．０５）和核心型家庭无老伴的老人（Ｐ＜０．０３）；单独生活型老人无老伴者的抑郁症状显著多于有老伴者（Ｐ＝０．０５）和联合型家庭中有老伴的老人（Ｐ＜０．０５）；直系型家庭的老人对健康的自我评价显著好于核心型家庭（Ｐ＜０．０２）和单独生活型中一人独居的老人（Ｐ＜０．０５）。多元逐步回归分析结果表明：生活在联合型家庭和直系型家庭中的老人身心健康状况较好，而生活于核心型家庭及独身生活的老年人身心健康状况较差。     

Using the Short Physical Performance Battery to screen for frailty in young‐old adults with distinct socioeconomic conditions

Aim: To analyze the Short Physical Performance Battery's (SPPB) ability in screening for frailty in community‐dwelling young elderly from cities with distinct socioeconomic conditions. Methods: Elderly (65–74 years‐of‐age) from Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64) were evaluated with the SPPB to assess physical performance. Frailty was defined as the presence of ≥3 of the following criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. Linear regression and receiver operating characteristics analyses were carried out. Results: The SPPB correlated with frailty (R² = 0.33), with better results for Saint Bruno. A cut‐off of 9 in the SPPB had good sensitivity (92%) and specificity (80%) in discriminating frail from non‐frail in Saint Bruno (area under the curve [AUC] = 0.81), but showed fair results in Santa Cruz (AUC = 0.61, sensitivity = 81% and specificity = 52%). Conclusions: The SPPB better discriminated frailty in elderly with higher socioeconomic conditions (Saint Bruno). Geriatr Gerontol Int 2013; 13: 421–428 .     

老年性骨质疏松症患者衰弱状态对预后的影响

目的 探讨老年原发性骨质疏松症患者衰弱状态与再入院、死亡的关系。方法 采取前瞻性队列研究,纳入2017年1月至2019年12月首都医科大学附属复兴医院综合科住院的骨质疏松症患者227例(≥65岁)。入院后根据临床衰弱量表(CFS-09)确定是否衰弱,将老年性骨质疏松症患者分为2组:衰弱组121例(CFS≥5)和非衰弱组106例(CFS＜5)。收集患者性别、年龄、病史及口服药种类等一般资料,进行认知功能、营养风险等老年综合评估。出院后随访1~3 (1.8±0.7)年,记录患者再入院及死亡信息。采用SPSS 23.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ²检验。采用Cox回归分析衰弱状态与再入院、死亡的关系。结果 患者年龄为67～100(85.1±5.0)岁,衰弱患者121例(53.3%)。衰弱组中年龄(P＜0.001)、查尔森共病指数(P＜0.001)、口服药种类(P=0.004)、服用潜在不适当用药(PIM)的人数(P=0.004)和种类(P=0.001)、存在营养风险人数(P＜0.001)、认知功能障碍(P＜0.001)、日常生活能力受损(P＜0.001)均高于非衰弱组。Cox回归分析结果显示,在校正年龄、共病及潜在不适当用药(PIM)因素后,衰弱状态(CFS≥5)对死亡、再入院无明显影响。将衰弱分组进一步限制为中度以上,其中衰弱组64例(CFS≥6)和轻度衰弱及非衰弱组163例(CFS＜6),校正年龄、共病及PIM因素后,中度以上衰弱(CFS≥6)明显增加全因死亡(HR=3.260,95%CI 1.626~6.538,P=0.001)和再入院(HR=1.727,95%CI 1.213~2.458,P=0.002)的风险。结论 以CFS-09确定的中度以上衰弱(CFS≥6)增加老年原发性骨质疏松患者死亡、再入院风险。临床医师应重视骨质疏松患者衰弱评估,尽早采取干预措施,减少患者死亡和再入院的风险。     

Cardiovascular responses during bed‐to‐wheelchair transfers in frail elderly who live at home*

Background: The objective of this study is to determine the changes in cardiovascular responses during bed‐to‐wheelchair transfers in frail elderly people living at home and to determine the differences associated with different methods of transfer. Methods: Cardiovascular responses during such transfers were measured in 22 frail elderly subjects (mean age, 79.7 years) and 11 healthy elderly subjects (mean age, 79.8 years) living at home. The frail elderly subjects consisted of: 11 subjects who required additional help during the transfer; and 11 subjects who could perform the transfer either with some help or independently. Results: In the healthy subjects, diastolic blood pressure increased significantly 15 min after the transfer compared with the pretransfer measurement (P < 0.05). In the dependent group, there was no significant change in blood pressure after the transfer in three subjects. Only four subjects exhibited normal heart rate variability after the transfer. In the partially dependent or independent group, there was a significant increase in blood pressure just after the transfer (P < 0.05). The change in mean blood pressure in the dependent group was significantly lower than that of the partially dependent or independent group from just before the transfer to 15 min after the transfer (P < 0.05). Conclusion: These results suggest poor cardiovascular responsiveness in the ‘dependent’ subjects. In partially dependent or independent patients, independent transfers might result in cardiac overload. Blood pressure responses during bed‐to‐wheelchair transfers in frail elderly subjects living at home might differ according to the method of transfer.     

The effect of medicated chewing gums on oral health in frail older people: a 1-year clinical trial

OBJECTIVES: To determine the effects of a medicated chewing gum on the oral health of frail older people. DESIGN: A controlled, double-blind trial using three groups based on random allocation of residential homes. SETTING: Sixteen residential homes in West Hertfordshire, England. PARTICIPANTS: One hundred eleven dentate subjects aged 60 and older who completed the 12-month study. INTERVENTION: Subjects were assigned to a chlorhexidine acetate/xylitol gum (ACHX) group, a xylitol gum (X) group, or a no-gum (N) group. Subjects in the gum groups chewed two pellets for 15 minutes twice daily for 12 months. MEASUREMENTS: Primary outcome measures were salivary flow rate, denture debris score, prevalence of angular cheilitis, and denture stomatitis; secondary outcome measures were salivary levels of caries-associated microorganisms. A single examiner, who was blinded to group allocation, made all measurements at baseline before gum usage and at subsequent examinations after 3, 6, 9, and 12 months. Separate analyses were performed for subjects with dentures. RESULTS: Subjects in the three groups were similar in most of their baseline characteristics. The stimulated whole saliva flow rate +/- standard deviation increased significantly for the ACHX (1.4 +/- 0.7 mL/min) and X (1.6 +/- 0.9 mL/min) groups (P <.01) over baseline (ACHX = 0.9 +/- 0.6 mL/min, X = 0.8 +/- 0.6 mL/min) and N group levels (0.6 +/- 0.9 mL/min). The levels of mutans streptococci, lactobacilli, and yeasts significantly increased (P <.05) in the X and N groups. Denture debris status was significantly lower in the ACHX and X groups than at baseline or in the N group (P <.01). The reductions of 91% and 75% in denture stomatitis and angular cheilitis prevalence, respectively, that occurred in the ACHX group were significantly greater (P <.01) than the reductions in the X group (denture stomatitis 62%, angular cheilitis 43%). Prevalence of denture stomatitis and angular cheilitis were not significantly changed in the N group. CONCLUSION: The use of a medicated chewing gum significantly improved oral health in older occupants of residential homes. Chewing gums should be considered as a potential adjunct to other oral hygiene procedures in older subjects.