Determinants of person-environment congruence in institutionalized elderly men and women

This study was designed to obtain information potentially of value in understanding and modifying the impact of the social environment on the perceived quality of life among institutionalized aged persons. It was hypothesized that Person-Environment (P-E) congruence, as assessed by the Environmental Perception. Preference and Importance Scale (EPPIS), would be related to (1) sex integration/segregation makeup of the health related facility (HRF) living units, and (2) quantity of social interaction between staff and residents. Analysis of a sex by unit sex-type interaction for 60 residents' Person-Environment (P-E) congruence scores revealed that elderly females on sex-integrated units reported a higher level of P-E congruence than those residing on female-only units; males on sex-integrated units, in contrast, reported a poorer level of P-E congruence than males on sex-segregated units. Furthermore, behavioral observations of staff-resident verbal interactions confirmed the hypothesis that residents living on units with high staff-resident interaction perceived the environment as more congruent with their preferences than residents on units low in verbal interaction. The observed relationships between the P-E congruence measure, resident-staff interaction, and unit sex-type were taken as further support for the relevance and value of the EPPIS measure as a tool for assessing and improving the institutional milieu.     

Pyuria in institutionalized elderly subjects

Two hundred and forty-three urine specimens from 76 elderly institutionalized residents were obtained for urine culture, quantitative leukocyte count and urinalysis. Significant bacteriuria was present in 153 specimens (63%), including 33 (22%) with more than one organism. Pyuria (greater than or equal to 10 leukocytes/mm(3)) was present in 214 specimens (88%), including 116 (97%) with single organism bacteriuria, 27 (82%) with multiple organism bacteriuria, and 71 (80%) without significant bacteriuria. The leukocyte esterase test had a positive predictive value of 99% for pyuria but a negative predictive value of only 30%. The quantitative level of pyuria was associated with the level of proteinuria and inversely with pH. A relatively constant level of pyuria tended to persist over months to years in a given individual if bacteriuria persisted. Pyuria is significantly associated with bacteriuria in the institutionalized elderly, but is also common in the nonbacteriuric. The clinical significance of pyuria requires further assessment.     

Sundown syndrome in institutionalized elderly

To describe sundown syndrome and determine factors related to its occurrence, 59 demented and 30 nondemented nursing home residents aged 60 years and above were observed in the morning and the evening over two consecutive days using a Confusion Inventory. Physiologic, psychosocial, and environmental data were also recorded. In addition, Pfeiffer's Short Portable Mental Status Questionnaire, the Philadelphia Geriatric Center Morale Scale, Face-Hand Test, and sensory screening were completed. Among the 89 subjects, 11 were found to be sundowners, a prevalence rate of one in eight in the facility. No clear pattern of behaviors evolved but sundowners were found to increase restless and verbal behavior as evening approached. Sundowners were more likely to be demented, with greater mental impairment and organic involvement than nonsundowners. Among physiologic factors, odor of urine, being awakened frequently on the evening shift, and fewer medical diagnoses were significantly associated with sundowning. Significant psychosocial factors were current room residence of less than one month, more recent admission to the facility, and higher evening levels of confusion. No environmental factors were related.     

Field dependence in the institutionalized elderly

The institutional-inducement hypothesis of field dependence regression in the elderly was assessed by administering the Children's Embedded Figures Test (CEFT) to a group of elderly upon admission to a nursing home and to a group of community-living elderly. Both groups were retested four months later. The institutionalized group exhibited significantly lower CEFT scores on initial testing than the community-living group. In addition, the CEFT scores for the institutionalized group declined significantly from pretest to posttest. The results suggested that greater field dependence in the institutionalized elderly may be due to pre-institutional dependence regression that continues after institutionalization. Additional measures of mental status and activity levels were also lower in the institutionalized group upon admission supporting a pre-institutional generalized regression effect.     

Analyses of serum concentrations of apolipoproteins in the demented elderly

OBJECTIVE: The aim was to analyze serum concentrations of apolipoproteins in the demented elderly to elucidate some biological markers related to dementia. PATIENTS AND METHODS: Serum concentrations of apolipoproteins (AI, AII, B, CII, CIII, E) of patients with Alzheimer type dementia (AD), vascular dementia (VD) and controls (C) without dementia were compared among the three groups (AD, VD, C) and 15 correlation coefficients among the 6 measured items of apolipoproteins were analyzed. RESULTS: Serum levels of apo CII were significantly lower in AD group compared with VD or C groups. Serum levels of apo B, CIII and E were significantly lower in AD group compared with VD group, but not with C group. Analyses of correlations among the items of apolipoproteins revealed high significant correlations between apo E and/or apo CII and other items in AD group. CONCLUSION: These results suggest that apolipoproteins such as apo CII, as well as apo E, might be involved in the pathogenesis of AD.     

Sexuality and the institutionalized elderly

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self-image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and families.     

Falls in the institutionalized elderly in Japan

Falls can be considered a vital factor in impeding successful aging in the elderly. The purpose of the study is to know rates of falls per year among the elderly, to observe the situations when falls occurred, and to clarify the association of falls with physical deterioration. The survey was carried out in 1406 residents aged 65 and over of the Tokyo Metropolitan Home for the Elderly in 1982. The rate of subjects who fell more than once during a one-year period was 14.5%. Females had a higher rate than males. Sixty per cent of all the falls occurred indoors. As for the cause of the falls, extrinsic factors were accounted three times as much as intrinsic factors. Among injuries sustained by the falls, fracture was more frequent in females than in males. Length of time of standing on one leg was shorter for fallers than for non-fallers in both sexes. However, the differences were not significant when age was controlled. Fall is attributed not only to physical factors but also to environmental factors. Therefore, it should be encouraged to design an environment with devices.     

Determinants of within-subject variation of fasting serum leptin concentrations in healthy subjects.

The hormone leptin is considered to contribute to body weight regulation through modulation of feeding behavior and energy expenditure. The aim of the present study was 1) to assess the day-to-day within-subject variation (biovariability) of serum leptin concentrations in healthy subjects and 2) to investigate whether this variation is associated with food intake, exercise, anthropometric measurements or various metabolic covariates (insulin, C-peptide and glucagon, glucose, lactate, 3-hydroxybutyrate (3-OHB), triglycerides, non-esterified-fatty acids and glycerol). Serum leptin levels were taken daily on 12 consecutive days after an overnight fast in 12 healthy subjects with a mean (SD) age of 22.7 (1.5) yr. and a BMI of 22.8 (1.6) kg/m2. Food intake, exercise, anthropometric measurements and various metabolic covariates were also determined during this period. The overall mean of serum leptin concentration was 33.3 pmol/L with a within-subject SD range of 27-41 pmol/L and a between-subject SD range of 18-61 pmol/L. The within-subject variance of serum leptin as a proportion of total variance was 9.5%. Within-subject variation of serum leptin concentrations is small in relation to between-subject variation in healthy, normal weight subjects. This has implications for the power of interventional or prospective studies. In men, 6.7% of the variation in serum leptin concentration was associated with body weight measured on the same day (p= 0.037). In women, however, 66% of the variation was negatively associated with 3-OHB measured on both the same and the previous day (p=0.0003 and 0.002), and positively associated with triglyceride concentration measured on the previous day (p=0.0017) and insulin measured on the same day (p=0.0002). Within-subject associations in women could be due to phasic changes in unmeasured variables, possibly related to the menstrual cycle or might suggest that energy balance may exert a delayed influence on serum leptin levels, with plasma 3-OHB and triglycerides acting as markers for the state of the fat stores that regulate leptin secretion. The differences between the genders remain unexplained, however.     

Oral mucosal disorders in institutionalized elderly people

The aim of the study was to investigate the type and incidence of oral mucosal disorders in the elderly, any relationship between these disorders and the wearing of dentures, and the associated subjective symptoms of pain. The subjects were 480 residents of 24 municipal old people's homes in different parts of Finland: 153 males and 327 females, age range 65-100 years. The methods used were clinical examination and interview. Clinical examination showed about 60% of the elderly to have one or more oral mucosal disorders. Altogether, 431 pathological conditions were recorded, with changes of the surface of the tongue the most frequent. Hyperplasia and/or denture-related ulcerations and press-points were found in 43% of denture wearers. The interviews revealed that only 17% of those with oral mucosal disorders had symptoms of pain, most frequently caused by press-points and ulcerations. The absence of subjective symptoms emphasizes the importance of frequent oral examinations, especially of the oral mucosa.     

Detectable serum levels of tumor necrosis factor alpha may predict early mortality in elderly institutionalized patients

OBJECTIVE: To determine if detectable serum tumor necrosis factor alpha (TNF) levels are associated with higher mortality in nursing home residents. SUBJECTS AND METHODS: The basal serum concentrations of TNF and interleukin-1 alpha (IL-1) were measured in 129 elderly nursing home patients (mean age of 89 years), and survival in the cohort was monitored over a 13-month period. RESULTS: At 4 months follow-up, seven out of 33 patients with detectable serum TNF levels had died (21.2%), and only three out of 96 patients with undetectable serum TNF levels had died (3.1%) (P less than 0.001). The difference in mortality remained significant up to 13 months of follow-up (P less than 0.05). Those with detectable serum TNF levels and those with undetectable levels were comparable in age, body mass index, hematocrit, lymphocyte counts, and serum level of albumin, prealbumin, and retinol-binding protein. When patients with detectable serum IL-1 levels were compared to those with undetectable levels, there were no significant differences in mortality over a 13-month period. CONCLUSION: Detectable serum TNF levels in elderly nursing home patients may be a predictor of early mortality.     

Twelve-month surveillance of infections in institutionalized elderly men

Surveillance of infectious episodes in institutionalized elderly men permanently resident on two wards of a veterans' hospital was undertaken for a 12-month period. One-hundred eleven episodes were identified in 50 residents (74 per cent). The most frequent infections included lower respiratory tract infections (incidence 59/100 patient-years), febrile episodes with no source (43.4), skin and soft tissue infections (36.5), and gastroenteritis (33). Only pneumonia was associated with significant mortality. A specific etiologic agent was seldom identified other than for skin and soft tissue infections. Antimicrobial therapy was prescribed for 87 per cent of all infections. Ward staff absenteeism was associated with peak occurrences of infections in residents. Resident characteristics that correlated with infection were incontinence of bladder and of bowel. Mental status or degree of mobility did not correlate. While infections occur frequently in this population, mortality is common only with pneumonia. Infections occur more frequently in residents who have greater functional impairment.     

Microbiology of severe aspiration pneumonia in institutionalized elderly

We sought to investigate prospectively the microbial etiology and prognostic indicators of 95 institutionalized elders with severe aspiration pneumonia, and to investigate its relation to oral hygiene in using quantitative bronchial sampling. Data collection included demographic information, Activity of Daily Living, Plaque Index, antimicrobial therapy, and outcome. Out of the 67 pathogens identified, Gram-negative enteric bacilli were the predominant organisms isolated (49%), followed by anaerobic bacteria (16%), and Staphylococcus aureus (12%). The most commonly encountered anaerobes were Prevotella and Fusobacterium species. Aerobic Gram-negative bacilli were recovered in conjunction with 55% of anaerobic isolates. The Plaque Index did not differ significantly between the aerobic (2.2 +/- 0.4) and the anaerobic group (2.3 +/- 0.3). Functional status was the only determinant of the presence of anaerobic bacteria. Although seven cases with anaerobic isolates received initially inadequate antimicrobial therapy, six had effective clinical response. The crude mortality was 33% for the aerobic and 36% for the anaerobic group (p = 0.9). Stepwise multivariate analysis identified hypoalbuminemia (p < 0.001) and the burden of comorbid diseases (p < 0.001) as independent risk factors of poor outcome. In view of the rising resistance to antimicrobial agents, the importance of adding anaerobic coverage for aspiration pneumonia in institutionalized elders needs to be reexamined.     

Results of nutritional screening in institutionalized elderly in Hungary

Dietetics contributes to life-long, sustainable health and optimal life quality of people. The knowledge of the nutritional state can be informative and normative in order to optimize personal care. The aims of this study were to summarize the relevant legislative considerations of nourishing the elderly in different long-term residential social institutions and to screen the nutritional state of those living there. No investigation of this type has ever been carried out in Hungary or in central eastern Europe before. We used the malnutrition universal screening tool (MUST) screening program for the evaluation of nutritional status. Our survey was done in 20 Hungarian nursing homes in 2006. The sample (n=1381) was representative of regional distribution and number of residents. In our study population 38.2% of the patients were endangered in point of malnutrition. The results of our survey call attention to the elevated number of elderly people at risk of malnutrition in nursing homes. As malnutrition has serious consequences regarding also quality of life, nutritional screening of nursing home residents is not only a basic economical interest, but is also in full harmony with the idea "not only to feed, but to nourish" and it is a basic moral duty.     

Taste acuity in institutionalized and noninstitutionalized elderly men

Taste detection thresholds were determined in young men (18 to 25 years of age, n = 15), noninstitutionalized elderly men (63 to 88 years of age, n = 17), and institutionalized elderly men (61 to 92 years of age, n = 15). The technical procedure utilized a single blind format. The tastants were presented to the subjects in a multiple forced-choice sample presentation with an ascending series. Additional testing conditions included adequate oral hygiene, 10 ml of tastant, timed intervals, and deionized water rinses. The major findings were that sour, salt, and bitter thresholds increased with age. Sweet threshold did not change with age. The institutionalized elderly men had significantly higher sour detection thresholds when compared with the noninstitutionalized elderly men. The use of salt and tobacco had no apparent effect on detection thresholds for sweet, salt and bitter, but medication ingestion elevated the sour thresholds. Elderly subjects on antihypertensive medications had significantly higher salt detection thresholds.     

Severe vitamin D deficiency in the institutionalized elderly

Severe vitamin D deficiency has been found to be prevalent in institutionalized elderly persons in several countries. The aim of the present work was to assess the vitamin D status of institutionalized elderly and compare it to that of community-living independent elderly in southern Greece during summer. Serum 25-hydroxyvitamin D [25(OH)D] and plasma PTH were measured in 58 (aged 68-103 yr, median 83.5) elderly inmates of a nursing home (IE) in the town of Kalamata (latitude N 37 degrees ) and in 48 (aged 60-89 yr, median 72) community-dwelling elderly (CDE) in Athens (latitude N 38 degrees ). The CDE had mean serum 25(OH)D 67.6 nmol/l [95% confidence interval (CI) 57.4 to 79.5], not far from the value of 80 nmol/l which is generally considered to be the lower limit of vitamin D sufficiency. The IE had significantly lower mean 25(OH)D 19.0 nmol/l (17.1 to 21.1); values of 25(OH)D below 20 nmol/l characterize severe vitamin D deficiency and may cause osteomalacia. The group of CDE had significantly lower mean plasma PTH 1.5 pmol/l (1.0 to 1.8) compared to 4.5 (3.9 to 5.3) of IE. Ninety percent of CDE had normal plasma PTH whereas 60% of IE had secondary hyperparathyroidism (PTH values >4.0 pmol/l). In conclusion, the majority of institutionalized elderly in southern Greece had severe vitamin D deficiency and secondary hyperparathyroidism in contrast to the fairly good vitamin D status and lack of hyperparathyroidism in the community-living elderly during summer. These findings indicate the need for vitamin D and calcium supplementation of the institutionalized elderly throughout the year.     

Dental status and mortality in institutionalized elderly people

Background:   Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.
Methods:   Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).
Results:   Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2-year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36, P  = 0.047). Furthermore, the 5-year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88, P  = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.
Conclusion:   Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.     

Changes in relative weight among institutionalized elderly adults

Weight-for-height and weight changes over a 2-year period among 335 institutionalized elderly adults at a geriatric care facility are described. Weight-for-height at admission was compared with several current standards for elderly persons. Mean relative weight and proportions of underweight and obese patients varied with the standards used. Although changes in group mean weights were slight, 73% of the patients gained or lost 4.5 kg or more in 2 years. Patients who lost 4.5 kg or more in the interval had a lower 4-year survival rate (p less than .05) than patients who gained weight or remained stable. Fluctuations in weight may be more prevalent among institutionalized elderly persons than previously thought, or than are apparent in analyses of group trends. Monitoring an individual's weight is simple and may be more meaningful than comparison to a standard, especially because weight loss is associated with mortality, until age appropriate standards are developed.