Journal of Nutrition in Gerontology and Geriatrics最新文献

People with dementia can develop resistive behavior that adversely affects the intake of food and fluids. This behavior, including (non-)verbal refusal, such as pushing away cutlery or an assisting person, can lead to malnutrition, dehydration, and increases mortality risk. However, it is unclear how common this behavior is in residents with young-onset dementia (YOD; symptoms under age 65) and how it compares to late-onset dementia (LOD). This study investigated the incidence and characteristics of these behaviors. We conducted a prospective cohort study with a twelve-month follow-up period, including thirty-six care units comprising 424 beds in twelve nursing homes across the Netherlands. Monthly registration of the total number of residents at risk informed the denominator, and the numerator was determined by the number of incident cases. Of forty reported cases, sixteen were incident, resulting in an incidence rate of 32/1000 person-years. The incidence rate was higher in residents with YOD (45/1000 person-years) than in LOD (26/1000 person-years). In all cases, at least two symptoms were observed. In fourteen of sixteen cases there was a prioritized global care goal aimed at providing comfort care and accept persisting resistive behavior. The findings might imply that young residents are at greater risk of developing these behaviors, and professional and informal caregivers should be prepared for the occurrence of specific resistive behaviors in younger residents.

This study investigated whether sufficient energy intake is associated with clinical trajectories in patients with end-stage aspiration pneumonia. A retrospective cohort study was conducted in patients with end-stage aspiration pneumonia in a long-term care ward (LTCW). Patients were classified into sufficient and poor energy intake groups, with sufficient intake defined as exceeding estimated energy needs. The primary outcome was swallowing recovery, defined as an improvement of ≥1 point on the Food Intake Level Scale (FILS). Secondary outcomes included survival discharge and 60-day survival in the LTCW. Multivariate logistic regression analyses were performed to assess associations between energy intake and outcomes, adjusting for confounders. Among 240 patients (mean age 84.6 ± 8.3 years, 51.3% male), 33 received sufficient energy intake. After adjustment for confounders, sufficient energy intake was significantly associated with swallowing recovery (OR: 5.29, p = 0.006) and survival discharge (OR: 8.33, p < 0.001). However, no significant association was observed between sufficient energy intake and 60-day survival (OR: 1.32, p = 0.530). Overall, sufficient energy intake may promote swallowing recovery and facilitate survival discharge in patients with end-stage aspiration pneumonia. These findings highlight the potential role of nutrition management in optimizing care strategies for this vulnerable population.

Despite the significant risk of nutritional problems among older adults in nursing homes, the impact of environmental and situational factors is understudied. This study explores the interaction between residents, food, and the nursing home environment, and asks "Why do residents eat what they do?." Using an ethnographic approach, the study investigates food environments in six rural nursing homes through approximately 2,000 hours of participant observations, nine interviews with residents, and four group interviews with care staff. Data analysis was conducted concurrently using the inductive methods of grounded theory. Using a "foodscape" to illustrate the nursing home environment provides valuable insights into where residents eat, how they eat, what and when they eat, and with whom they eat. Four primary concepts emerged: (1) the physical environment, (2) food patterns dictated by dietary concepts and care staff resources, (3) residents' passive involvement due to care staff's task-focused view of mealtimes, and (4) social perspectives on eating, whether in isolation or in a family-style setup. The foodscape contributes to understanding the residents' food intake and can be used to develop strategies to improve nutrition and life quality for this vulnerable group of people.

Background: Frailty screening and nutritional assessment are essential for identifying and managing frailty in older adults. This study investigates the predictive power of the Mini Nutritional Assessment (MNA) score and Body Mass Index (BMI) in assessing frailty among the elderly in the community of Bandung, Indonesia, using Kihon's Frailty Checklist (KCL).

Methods: A cross-sectional study was conducted among 71 elderly individuals attending community health centers routinely in Bandung. The mean age of participants was 67.1 ± 5.13 years with 81.6% female. Frailty status was assessed using the KCL, while nutritional status was evaluated using the short-form MNA and BMI. Predictive accuracy was analyzed through Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) values. DeLong's test was used to compare the predictive capacities of MNA and BMI.

Results: Of the participants, 30.99% were frail, 39.44% prefrail, and 29.58% robust. Nutritional status categorized by MNA revealed 59.15% with normal nutrition, 33.80% at risk of malnutrition, and 7.04% malnourished. BMI indicated 47.89% healthy weight, 32.39% overweight, 11.27% obese, and 8.45% underweight. The AUC for MNA (0.73; 95% CI: 0.67-0.79) demonstrated good discriminatory power, significantly outperforming BMI (AUC: 0.52; 95% CI: 0.46-0.58) in predicting frailty (p < 0.05).

Conclusion: The MNA score showed superior predictive power compared to BMI for identifying frailty in this elderly community population. MNA's multidimensional approach, capturing factors such as nutrition, cognitive function, and mobility, provides a more comprehensive assessment of frailty. This study underscores the importance of adopting comprehensive tools like MNA for frailty screening and highlights its potential for early intervention and improving elderly care in community settings. Further research is recommended to explore long-term outcomes and integration into routine health practices.

This study evaluated the perspectives of clinicians and dyads (adults with early-stage ADRD and caregivers) on virtually-delivered care and how it relates to the development of a health promotion intervention to slow cognitive decline. Ten clinicians and 10 dyads were recruited via various recruitment platforms. All participated in one semi-structured interview via Zoom focusing on cognitive challenges, barriers, their current virtual-based experiences, and the ideas to improve a proposed virtual-based exercise and nutrition-based intervention. Interviews were transcribed and analyzed using thematic analysis. Dyads' perspective identified four major themes for persons with cognitive challenges: (1) Barriers to receiving care for older adults with dementia; (2) Receptivity to receiving virtual-based care if this was balanced with in-person visits; and (3) Enthusiasm if an exercise and nutrition-based intervention delivered virtually can improve access to care but lead to increased anxiety about using technology. Clinicians believed that limited access to receiving care and limited time in clinic were barriers for persons with dementia but having a virtual-based intervention could potentially overcome these challenges and engage individuals. These perspectives aligned with those of the dyads. Participants overall supported virtual-based care and that with careful design, showed promise in developing an exercise and nutrition-based intervention as a possible means to slow cognitive decline.

This study aimed to evaluate the nutritional profile of very old individuals according to frailty, since dietary changes may be associated with this syndrome. Octogenarians were evaluated for phenotypic classification of frailty, including frail and non-frail individuals. Body Mass Index (BMI), upper arm circumference (AC), and calf circumference (CC) were obtained. The Food Frequency Questionnaire was used to assess eating habits in the last 6 months and the Mini Nutritional Assessment to assess nutritional status. Individuals aged 80 years or older had a median age of 84.5 years. Most ate 4 meals a day and had a normal nutritional status, despite the altered diet composition, with excess carbohydrates, a lower percentage of lipids, and lower protein intake than the current recommendation. Overall, there was a low intake of total fiber, vitamin D, calcium, iron, and potassium. Comparing frail and non-frail individuals, the former were older, had more comorbidities, worse nutritional status, and lower fiber and potassium intake. BMI, AC, and CC were not different between groups. Frailty was associated with worse nutritional status. This study emphasizes the importance of continuous nutritional assessment of very old individuals and identification of frailty syndrome so that appropriate interventions can be initiated.

Background: Isolation mitigated the risks of COVID-19 infection. For older adults, isolation itself can be harmful. Isolation and loneliness impact nutritional status which leads to other health consequences. This study identified the changes of 167 individuals 80+ years old pre and post COVID-19 isolation and the association of habitation and location.

Methods: We collected demographic (age, gender, cohabitation, and isolation) and clinical (BMI and nutritional) information from patients 80+ years old prior to and 6 months after COVID-19 began in the region. We collected nutritional data using the mini-nutritional assessment short form (MNA-SF).

Results: Averages for the studied cohort (n = 167) were age = 85.1, BMI = 26.5, and MNA-SF = 11.8. Females (-0.51; P = 0.015) and those living alone (-0.66; P < 0.001) had greater decreases in BMI after 6 months. Nutritional status worsened significantly for females (-0.74; P < 0.001), those living alone (-0.82; P = 0.015), and those in rural (-0.70; P < 0.001) and isolated (-0.61; P = 0.031) locations.

Conclusion: Females, those living alone, and those in rural and isolated locations had a greater decline in nutritional status during the COVID-19 isolation period. This identifies a disparity in an already vulnerable population of older adults that should be addressed with further research targeted toward prevention and treatment.

The present study aimed at investigating the nutritional state of functionally dependent older adults belonging to the indigenous communities (i.e., tribal communities) in West Bengal, India, and its association with other covariates. The nutritional state of older adults was measured using the MNA tool. Results indicated that those individuals with poor functional capacity had 6.52 times [AOR:6.52; CI:1.55,27.41] and 8.53 times [AOR:8.53; CI:2.53,28.84] higher chances of being malnourished or at risk of being malnourished, respectively. Older adults with multiple chronic illnesses, poor self-perceived health status, experiencing depression, and consuming alcohol were significantly more likely to suffer from malnutrition. Respondents who were aged 80 years and older, female and widowed, or having poor family income were more likely to have malnutrition than their counterparts. The study concluded that functionally dependent older adults in indigenous communities are vulnerable to being malnourished and suggested a policy intervention in the form of appropriate nutritional programmes for improving the worsening condition of such older people in India.

Body Mass Index (BMI) use in older adults has been questioned as it does not account for the loss of height with age, overestimating weight status. We explored age-height loss adjusted BMI (BMI-A) correlation with health variables, the significance of these associations for each BMI category, and concordance between BMI and BMI-A. This is a secondary analysis of three different population studies of older adults: SABE Ecuador 2009, SABE Colombia 2015, and MHAS 2015 (total n = 30,904). BMI-A was based on expected physiological loss, adding centimeters based on patient's age range. A descriptive analysis was performed, and concordance and correlation between models was tested. The correlation of each model divided by anthropometrical categories was tested with outcomes. Mean age was 69.8 (SD 7.59) years, 54.24% were females. BMI-A value was lower. For BMI-A the most common category was normal weight, compared to BMI where overweight was the most common. Correlation and agreement between models were good. For the general sample, all correlations were statistically significant, except for albumin. However, for the different categories, significance was reduced, and specifically in people with low weight any relationship was significant. Relying exclusively on BMI for clinical decisions in older adults may not be optimal.

The aim of this study was to investigate the effect of individually tailored dietary counseling on frailty status among older family caregivers (FC). This study is part of the LifEstyle, NutriTion, and Oral health in caregivers (LENTO) intervention study. There were a total of 113 participants, with a mean age of 74 years (SD 8.0). This randomized intervention included individually tailored nutritional guidance given by the clinical nutritionist at the baseline and at the 2-month visit and the intervention period was 6 months. At the baseline frailty prevalence was 68% (n = 43 out of 63) in the intervention group and 78% (n = 39 out of 50) in the control group. At the end of the 6-month intervention the prevalence in the intervention group had decreased to 41% (n = 24 out of 59) but remained stable in the control group with 79% (n = 37 out of 47). There was a significant difference in the change of the prevalence of frailty between the groups (P < 0.001). The intervention resulted in increased protein intake in the intervention group from 0.95 g/kg/d (SD 0.34) to 1.05 g/kg/d (SD 0.37) (P = 0.003). The results suggest that frailty among older caregivers can be decreased with personalized nutritional guidance.