The Journal of Nutrition, Health & Aging最新文献

Objectives: Pain is very common among older persons living in nursing home, affecting 45% to 80% of residents, interfering with daily activities and quality of life. Aims of the study are: 1) to measure the analgesics non-prescription in nursing home residents who present pain symptoms; 2) to identify the main determinants of analgesics non-prescription.

Design: Retrospective cross-sectional analysis.

Setting: Data from an observational study ('Incidence of pNeumonia and related ConseqUences in nursing home Residents' [INCUR] study).

Participants: 800 older persons living in 13 French nursing homes. Measurments: Pain symptoms were definied by one of the following criteria: i) Presence of pain affecting the individual's function in the Activities of Daily Living; ii) Presence of daily pain, and/or; iii) Severe pain measured with a visual analogue scale.

Results: Among the patients originally included in the study, 288 (36%) reported pain symptomatology (mean age 86.9 [SD 7.2] years, 220 (76%) participants women). Amongst these, 138 (47.9%) were treated with non-opioid analgesic drugs, 52 (18.1%) with opioids, and 98 (34%) did not receive any analgesic prescription. An adjusted logistic regression analysis found that the strongest determinant of analgesics non-prescription was the number of concomitantly prescribed drugs (p<0.001). Age, education, and frailty were not associated with prescription of analgesic drugs.

Conclusions: Pain undertreatment is very common among older persons living in nursing homes. The number of prescribed medications represents the most relevant risk factor for the analgesics non-prescription. Our findings document the importance of reviewing prescriptions in nursing home residents.

Objectives: The purpose of this study was to examine if there is a relationship between lower-extremity muscle performance (LEMP) and physical activity, especially the physical activity level (PAL) value, in community-dwelling middle-aged and older adults.

Design: Cross-sectional study.

Setting: Community-based.

Participants: Participants were 54 community-dwelling and independent middle-aged and older individuals (aged 54-89 years).

Measurements: Physical activity level was calculated from the total energy expenditure of each participant obtained using the doubly labeled water method (PALDLW) and estimated basal metabolic rate. Daily step count and intensity of physical activity was monitored with a triaxial accelerometer, and LEMP was assessed using the five-repetition sit-to-stand test (STS-5) and vertical jumping (VJ).

Results: The results of STS-5 nearly negatively correlated with those of PALDLW when analysing the middle-aged and older man and woman, separately. VJ positively correlated with PALDLW when analysing the middle-aged and older men and woman, separately. The relationship between LEMP (e.g. STS-5 and VJ) and PAL were maintained, regardless of sex and body composition. PALDLW was significantly positively correlated with LPA, MVPA, and steps, and significantly negatively correlated with sedentary time. The relationship PALDLW and steps was described as following equation: PALDLW = 0.0000392 × steps +1.531.

Conclusions: These findings suggest that PALDLW is a key contributor to increasing LEMP among middle-aged and older adults. Maintaining high PALDLW may be beneficial to independent living, and participation in recreational and social activities in middle-aged and older adults.

Objectives: Recently, the concept of oral frailty, defined as accumulated deficits in oral health, has been introduced in Japan. However, data about its association with nutritional status are limited. Thus, this cross-sectional study aimed to investigate the association between oral frailty and malnutrition among community-dwelling older adults.

Design: Cross-sectional study.

Setting: Community.

Participants: One thousand and fifty-four individuals (428 men and 626 women, mean age: 77.0 years) from the Takashimadaira Study.

Measurements: Based on a multifaceted oral health assessment, oral frailty was defined as greater than or equal to three of the following components: (1) low number of remaining teeth, (2) decreased masticatory performance, (3) reduced articulatory oral motor skill, (4) low tongue pressure, and difficulties in (5) eating and (6) swallowing. The nutritional status was evaluated using the Mini Nutritional Assessment®-Short Form (MNA®-SF) and serum albumin. An ordinal logistic regression model was used to evaluate the association between oral frailty and nutritional status.

Results: Oral frailty was observed in 217 (20.4%) participants. After adjusting for potential confounders, the participants with oral frailty had higher odds of more severe malnutrition evaluated using MNA®-SF (adjusted odds ratio: 2.17; 95% confidence interval: 1.58-2.98) and serum albumin level (adjusted odds ratio: 1.59; 95% confidence interval: 1.10-2.31).

Conclusion: Oral frailty was associated with nutritional status among Japanese older adults. Maintaining comprehensive oral health and function may be effective for malnutrition prevention in community-dwelling older adults. However, further studies must be conducted to validate the generalizability of the results of the current study.

Objectives: The objective of this study was to investigate changes in physical activity (PA) between January (before the COVID-19 epidemic) and April (during the COVID-19 epidemic) 2020 in community-dwelling older adults in Japan.

Design: Cross-sectional online survey.

Setting and subjects: From April 23 to 27, 2020, an online survey was completed by 1,600 community-dwelling older adults in Japan.

Methods: We assessed the frailty status using the Kihon checklist, and other demographics and asked questions regarding PA at two time points: January and April 2020. We defined the total PA time (minutes) per week based on activity frequency and time.

Results: The study participants' mean age, proportion of women, and prevalence of frailty were 74.0±5.6 years, 50% (n=800), and 24.3% (n=388), respectively. We found a significant decrease in total PA time in April 2020 (median [interquartile range (IQR)], 180 [0 to 420]) when compared to January 2020 (median [IQR], 245 [90 to 480]) (P<0.001). We also performed a subgroup analysis according to the frailty category; total PA time significantly decreased in April 2020 when compared to January 2020 for all frailty categories (P<0.001).

Conclusion: In conclusion, due to the COVID-19 epidemic, the total PA time in April 2020 significantly decreased compared to that in January 2020 in older adults. This finding may lead to a higher incidence of disability in the near future in older people.

Objectives: Intrinsic capacity is a composite of five domains that summarizes the physical and mental capacities of an individual. Intrinsic capacity is increasing in relevance for adapting health systems to population ageing. Therefore, our objective was to analyse how intrinsic capacity has been assessed in older adults and if these measurements have been validated, as an initial step towards the construction of a standard intrinsic capacity index.

Design: Narrative review with electronic searches performed in PubMed and Cochrane databases, including the studies which used the term "intrinsic capacity" in the context of human ageing and health. The full text was then accessed to select studies with at least one operationalised domain of intrinsic capacity. We also looked for information on the validity and reliability of the reported measures of intrinsic capacity.

Results: We included ten articles reporting a quantitative measurement of intrinsic capacity. There were two intrinsic capacity scores which combined retrospective data on the intrinsic capacity domains sub-scores, with low concordance among tests chosen to measure each domain. Two studies reported on reliability and validity of the IC scores. The main gaps in the construction and validation process were a) analysis undertaken with each domain separately rather than for the construct of intrinsic capacity, b) lack of a clear conceptual and operational definition of the vitality domain, c) summary score that depends upon the distribution of the study sample.

Conclusion: Further validation of the intrinsic capacity concept is needed, together with more robust approaches to measure it. A standard index of IC has not been validated for translation into clinical or research purposes.

Importance: Muscle strength has been elevated to the forefront of sarcopenia diagnosis, with handgrip strength the preferred measure. Extant handgrip protocols adopt different handgrip strength (HGS) criteria. Paucity of direct comparison studies assessing the impact of HGS criterion on prevalence of sarcopenia and predictive validity on physical performance contributes to the lack of standardisation of HGS criteria in sarcopenia diagnosis.

Objectives: Our study aims to compare the effect of average (HGSave) versus maximum (HGSmax) HGS criterion on: (1) prevalence of low HGS and sarcopenia; and (2) association with physical performance at baseline and at 2 years.

Methods: We recruited 200 community dwelling, cognitively intact, and functionally independent older adults. Muscle strength, physical performance measures, cognitive tests and nutritional assessments were performed. Short Physical Performance Battery (SPPB) was administered at baseline and at 2 years. We compared HGSave and HGSmax to assess the prevalence of low HGS and sarcopenia. Univariate analysis was performed comparing baseline characteristics between low and normal groups for each HGS criterion. Significantly different variables were included in logistic regression analysis to examine association of low HGS and SPPB at baseline. Predictive validity of low HGS for SPPB<10 at 2 years was examined by performing logistic regression analysis for HGSave and HGSmax.

Results: The prevalence of low HGS and sarcopenia incorporating HGSave criterion is 40% and 33% respectively, whereas that of HGSmax criterion is 21% and 19.5% respectively. There is moderate agreement between the 2 HGS criteria for sarcopenia diagnosis (kappa=0.604) and poorer agreement for low HGS (kappa=0.570). There was no significant association with baseline SPPB for both HGS criteria. At 2 years, only low HGSmax was significantly associated with low SPPB (adjusted OR 3.91, 95% CI 1.24 - 12.33).

Conclusion: Our study demonstrates that HGS criteria matters in diagnosis of sarcopenia and we support extant HGS protocols using HGSmax criterion in view of better predictive validity for poor physical performance.

The aim of the study was to assess the relationship between underweight and falls. It was a cross-sectional study in community-based participants from China Hainan Centenarian Cohort Study (CHCCS). A total of 942 centenarians (mean ages were 102.4 years in men and 102.9 years in women, 21.8% were semi-supercentenarians, and 3.2% were supercentenarians) were enrolled from July 2014 to December 2016. Height and weight were measured according to the standard protocol. Participants were interviewed face to face to self-report falls for recent 3 months. The risks of future falls were evaluated by Morse Fall Scale (MFS). The mean body mass index (BMI) was 19.04±2.79 kg/m2 in men and 18.07±3.27 kg/m2 in women. The 3-month incidences of once fall were 10.3% in men and 13.4% in women, recurrent falls were 15.4% in men and 13.4% in women, future high risks of falls were 36.6% in men and 44.3% in women. There were underweight by gender interactions on at least one fall (OR=1.39, 95% CI=1.04-1.86, P=0.026) and future high fall risk (OR=1.39, 95% CI=1.07-1.80, P=0.014). Men with underweight had higher ratios of at least one fall (OR=4.12, 95% CI=1.59-10.70, P=0.004), recurrent falls (OR=6.71, 95% CI=1.69-26.63, P=0.007) and high risk of future falls (OR=2.44, 95% CI=1.27-4.70, P=0.007), while women with underweight was only associated with high risk of future falls (OR=1.37, 95% CI=1.01-1.85, P=0.043). Compared with normal weight and overweight, underweight in men had a higher MFS Score (increased by average 7.6 points, P=0.010), yet this trend was not observed in women counterparts. Underweight was associated with incidences of 3-month and future high fall risk in centenarians, which was more pronounced in men. Underweight could be a marker in identifying potential falls in long-lived people, especially men, who need further measures to gaining weight to normal and preventing falling.

Background: Sarcopenia can be characterized by European Consensus for Sarcopenia (EWGSOP2) criteria, but it methods are not easily accessible. Likewise, the Strength, Assistance with walking, Rise from a Chair, Climb stairs and Falls (SARC-F) has been proposed.

Objective: The aim of this study was i) to evaluate the prevalence for risk sarcopenia and ii) to correlate the SARC-F with components of the EWGSOP2 consensus in hemodialysis (HD) patients.

Measurements: This cross-sectional study enrolled ninety-five (male n= 59; 62%) HD older patients. Sarcopenia risk was assessed using the SARC-F, which ≥4 score indicates sarcopenia risk. Sarcopenia was confirmed through of the EWGSOP2 consensus, including the handgrip strength (HGS <27kg for men and <16kg for women) using the dynamometer, muscle mass through appendicular muscle mass (ASMI/m2 <7.0 kg/m2 for men and 5.5 kg/m2 for women) using the bioimpedance electrical, and physical performance through of gait speed (GS <0.8 m/s).

Results: From 95 patients, n=21(22%) presented sarcopenia risk. SARC-F ≥4 group are older (64.9±13.9 vs. 56.9±14.6 y, p= 0.028), presented lower ASMI (7.4±1.2 vs. 8.3±1.8 kg/m2, p=0.033), HGS (20.5±5.7 vs. 27.2±10.2 kg, p=0.005), and GS (0.5±0.1 vs. 0.7±0.1 m/s, p=0.001) than SARC-F<4 group. SARC-F score was negatively correlated with EWGSOP2 components: ASMI x SARC-F (r=-0.27, p=0.007), HGS x SARC-F (r=-0.35, p=0.0005), and GS x SARC-F (r=-0.47, p<0.0001). Although, no difference of number of patients with low or normal ASMI values was found, 62% and 95% of SARC-F≥4 group patients presented low HGS and gait speed, respectively.

Conclusions: In older HD patients, 22% presented sarcopenia risk. In addition, SARC-F is better correlated with muscle function indicators (HGS and gait speed) than muscle mass.

Background: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly.

Objectives: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients.

Design, setting, and participants: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed.

Measurements: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI).

Results: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90).

Conclusions: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.