Background: Income security is a determinant of health in most populations, but there is less evidence in very old men. Objective: To determine if self-reported current income adequacy or future expectation of income adequacy predicts death amongst older men. Design and Setting: We conducted an analysis of a prospective cohort of 3 983 men who have been followed since 1948. In 2006, 1001 men were alive, of whom 807 completed the annual survey without assistance. Two items in the 2006 survey were: “How well do you think your income and assets satisfy your current needs?” and “How well do you think your income and assets will satisfy your needs in the future?” We considered the categories: “very adequate, adequate and inadequate.” Time to death over the next 11 years was examined with the Cox proportional hazards models, and adjusted for age, marital status, and functional status. Results: The mean age in 2006 was 85 years old. The median follow-up time was 6.1 years, and 664 of the participants died. Satisfaction with current income did not predict mortality. Those with an expectation of inadequate future income had a higher risk of death: Hazard Ratio of 1.37 [(95%CI) 1.02, 1.84)] for “Not adequate” relative to “Very Adequate”. In models adjusted for age, marital status and functional status, this association was only marginally statistically significant (p=0.07). Conclusions: Perceived adequacy of future income predicts mortality in very old men. The effect may be confounded or mediated by functional decline.
{"title":"ADEQUACY OF CURRENT AND FUTURE INCOME AND ASSETS AND THE RISK OF MORTALITY IN A COHORT OF OLDER MEN – THE MANITOBA FOLLOW-UP STUDY","authors":"P. S. St John, R. Tate","doi":"10.14283/jarcp.2019.14","DOIUrl":"https://doi.org/10.14283/jarcp.2019.14","url":null,"abstract":"Background: Income security is a determinant of health in most populations, but there is less evidence in very old men. Objective: To determine if self-reported current income adequacy or future expectation of income adequacy predicts death amongst older men. Design and Setting: We conducted an analysis of a prospective cohort of 3 983 men who have been followed since 1948. In 2006, 1001 men were alive, of whom 807 completed the annual survey without assistance. Two items in the 2006 survey were: “How well do you think your income and assets satisfy your current needs?” and “How well do you think your income and assets will satisfy your needs in the future?” We considered the categories: “very adequate, adequate and inadequate.” Time to death over the next 11 years was examined with the Cox proportional hazards models, and adjusted for age, marital status, and functional status. Results: The mean age in 2006 was 85 years old. The median follow-up time was 6.1 years, and 664 of the participants died. Satisfaction with current income did not predict mortality. Those with an expectation of inadequate future income had a higher risk of death: Hazard Ratio of 1.37 [(95%CI) 1.02, 1.84)] for “Not adequate” relative to “Very Adequate”. In models adjusted for age, marital status and functional status, this association was only marginally statistically significant (p=0.07). Conclusions: Perceived adequacy of future income predicts mortality in very old men. The effect may be confounded or mediated by functional decline.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66885877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. McKeever, I. Farrar, S. Sulo, J. Partridge, Patricia M Sheean, M. Fitzgibbon
Background: Older adults (65 years and older) comprise a high-risk group that are susceptible to the development of malnutrition. Dietary intake and diet quality represent key modifiable risk factors to help prevent and to treat declines in nutrition status, with oral nutritional supplements (ONS) often being a cost-effective therapy for many to increase protein and caloric intake. The DETERMINE Checklist offers a series of questions capable of mapping the initial landscape of contextual factors that influence the dietary patterns of the at-risk populations. Objectives: To examine independent predictors of inadequate dietary intake and poor diet quality amongst a multi-ethnic sample of urban community-dwelling older adults in an effort to identify target groups of participants that could benefit most from an ONS intervention. Design: Cross-sectional. Participants: Chicago, Illinois, United States urban residents greater than 55 years of age who self-reported to be non-Hispanic White, non-Hispanic Black, or Hispanic. Methods: Telephone surveys were conducted to obtain basic demographic information. The DETERMINE Checklist was administered to (1) characterize participants’ nutritional risk, and (2) identify participants with inadequate intake and/or poor diet quality. Predictors of inadequate intake, defined as any participant who reported either to eat less than two meals per day and/or poor diet quality, defined as any participant who reported to eat few fruits, vegetables or dairy were used to identify groups of participants who could benefit most from ONS consumption. Mantel-Hanzel chi square, Breslow-day tests, and logistic regressions were conducted. Results: 1001 ethnically diverse participants were interviewed (37% non-Hispanic White, 37% non-Hispanic Black, and 26% Hispanic). Respondents were predominantly female (69%) with a mean age of 66.9 (± 6.4) years. The majority were found to be at either moderate or high nutrition risk (78.7%). Domains of the DETERMINE Checklist that predicted either inadequate dietary intake or poor diet quality included social isolation, lower levels of educational attainment, food insecurity, limitations in activities of daily living (ADL), polypharmacy, or three or more alcoholic drinks per day. Of the participants who met the criteria as those who would benefit from ONS, less than 50% had reported consuming ONS in the past six months. Conclusion: Older community-dwelling adults living in an urban setting, especially those with social isolation, lower levels of education, food insecurity, limitations with ADLs, polypharmacy, and those reporting heavy alcohol intake represent a population who could benefit from consuming ONS. Efforts should be made towards further understanding these contextual factors and providing nutrition education along with an ONS intervention that could be beneficial to supplement dietary inadequacies in this population.
{"title":"NUTRITIONAL ADEQUACY AND ORAL NUTRITIONAL SUPPLEMENTATION IN OLDER COMMUNITY-DWELLING ADULTS","authors":"L. McKeever, I. Farrar, S. Sulo, J. Partridge, Patricia M Sheean, M. Fitzgibbon","doi":"10.14283/jarcp.2019.2","DOIUrl":"https://doi.org/10.14283/jarcp.2019.2","url":null,"abstract":"Background: Older adults (65 years and older) comprise a high-risk group that are susceptible to the development of malnutrition. Dietary intake and diet quality represent key modifiable risk factors to help prevent and to treat declines in nutrition status, with oral nutritional supplements (ONS) often being a cost-effective therapy for many to increase protein and caloric intake. The DETERMINE Checklist offers a series of questions capable of mapping the initial landscape of contextual factors that influence the dietary patterns of the at-risk populations. Objectives: To examine independent predictors of inadequate dietary intake and poor diet quality amongst a multi-ethnic sample of urban community-dwelling older adults in an effort to identify target groups of participants that could benefit most from an ONS intervention. Design: Cross-sectional. Participants: Chicago, Illinois, United States urban residents greater than 55 years of age who self-reported to be non-Hispanic White, non-Hispanic Black, or Hispanic. Methods: Telephone surveys were conducted to obtain basic demographic information. The DETERMINE Checklist was administered to (1) characterize participants’ nutritional risk, and (2) identify participants with inadequate intake and/or poor diet quality. Predictors of inadequate intake, defined as any participant who reported either to eat less than two meals per day and/or poor diet quality, defined as any participant who reported to eat few fruits, vegetables or dairy were used to identify groups of participants who could benefit most from ONS consumption. Mantel-Hanzel chi square, Breslow-day tests, and logistic regressions were conducted. Results: 1001 ethnically diverse participants were interviewed (37% non-Hispanic White, 37% non-Hispanic Black, and 26% Hispanic). Respondents were predominantly female (69%) with a mean age of 66.9 (± 6.4) years. The majority were found to be at either moderate or high nutrition risk (78.7%). Domains of the DETERMINE Checklist that predicted either inadequate dietary intake or poor diet quality included social isolation, lower levels of educational attainment, food insecurity, limitations in activities of daily living (ADL), polypharmacy, or three or more alcoholic drinks per day. Of the participants who met the criteria as those who would benefit from ONS, less than 50% had reported consuming ONS in the past six months. Conclusion: Older community-dwelling adults living in an urban setting, especially those with social isolation, lower levels of education, food insecurity, limitations with ADLs, polypharmacy, and those reporting heavy alcohol intake represent a population who could benefit from consuming ONS. Efforts should be made towards further understanding these contextual factors and providing nutrition education along with an ONS intervention that could be beneficial to supplement dietary inadequacies in this population.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66886310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eighty outpatients aged 80 years or more were face-to-face interviewed in order to assess the appropriate recall of six items of information about the 19 most commonly prescribed medications by means of a questionnaire cross-culturally adapted into Brazilian Portuguese. In some cases, the caregiver was interviewed instead. The frequency of medications whose information was appropriately recalled ranged from 36% to 100%, 36% to 100%, 18% to 90%, 9% to 63%, 0 to 25%, and 0 to 10% for respectively the following items dosage, form of administration, indication, storage, side effects, and precautions and warnings, indicating poor overall knowledge. The lowest frequency of dosage and form of administration was seen for alendronic acid (36% each), and the highest frequency of side effects was found for donepezil (25%). Octagenarians and their caregivers should be constantly counseled on medication information.
{"title":"KNOWLEDGE OF COMMONLY PRESCRIBED MEDICATIONS TO OCTOGENARIANS","authors":"T. V. N. Didone, D. Melo, E. Ribeiro","doi":"10.14283/jarcp.2019.12","DOIUrl":"https://doi.org/10.14283/jarcp.2019.12","url":null,"abstract":"Eighty outpatients aged 80 years or more were face-to-face interviewed in order to assess the appropriate recall of six items of information about the 19 most commonly prescribed medications by means of a questionnaire cross-culturally adapted into Brazilian Portuguese. In some cases, the caregiver was interviewed instead. The frequency of medications whose information was appropriately recalled ranged from 36% to 100%, 36% to 100%, 18% to 90%, 9% to 63%, 0 to 25%, and 0 to 10% for respectively the following items dosage, form of administration, indication, storage, side effects, and precautions and warnings, indicating poor overall knowledge. The lowest frequency of dosage and form of administration was seen for alendronic acid (36% each), and the highest frequency of side effects was found for donepezil (25%). Octagenarians and their caregivers should be constantly counseled on medication information.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66885635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Hormozi, M. Alizadeh-Khoei, F. Sharifi, M. Chehrehgosha, R. Esmaeili, F. Rezaie-Abhari, R. Aminalroaya, Z. Madadi
Background: Since malnutrition of geriatric hospitalized patients has an impact on treatment and care management, the aim was to define the accuracy of Malnutrition Universal Screening Test (MUST) for malnutrition screening in the Iranian hospitalized elderly. Methods: In this cross-sectional study elderly 60 ≥ years (N= 192) were selected from two hospitals, anthropometric measures (BMI, MAC, and CC), laboratory test (Albumin), and nutrition tool (Full-MNA) applied and analyzed at P<0.05 level. Results: Elderly participants had a mean age of 68.86 ± 7.46 years and BMI 24.08± 4.64. Elderly patients (28%) lost their weight (>10%) in the last six months and loss of appetite observed in (33.4%) participants. In MUST tool rating, high-risk elderly patients for malnutrition were 33.3%. The AUC for MUST, according to Full-MNA was obtained 90.41%, with sensitivity 90.0% and specificity 73.25%. The MUST showed the strongest correlation with Full-MNA (r = -0.7) and BMI (r = - 0.51); but, the lowest correlation observed with Alb (r= -0.274). Most AUC was belonging to weight loss (0.96) and BMI (0.94). NConclusion: The MUST tool like full-MNA could diagnose malnutrition in geriatric patients in the hospital setting.
{"title":"VALIDITY OF MALNUTRITION UNIVERSAL SCREENING TOOL (MUST) IN GERIATRIC PATIENTS: APPROPRIATE SCREENING TOOL IN HOSPITAL; MUST OR FULL-MNA?","authors":"S. Hormozi, M. Alizadeh-Khoei, F. Sharifi, M. Chehrehgosha, R. Esmaeili, F. Rezaie-Abhari, R. Aminalroaya, Z. Madadi","doi":"10.14283/jarcp.2019.13","DOIUrl":"https://doi.org/10.14283/jarcp.2019.13","url":null,"abstract":"Background: Since malnutrition of geriatric hospitalized patients has an impact on treatment and care management, the aim was to define the accuracy of Malnutrition Universal Screening Test (MUST) for malnutrition screening in the Iranian hospitalized elderly. Methods: In this cross-sectional study elderly 60 ≥ years (N= 192) were selected from two hospitals, anthropometric measures (BMI, MAC, and CC), laboratory test (Albumin), and nutrition tool (Full-MNA) applied and analyzed at P<0.05 level. Results: Elderly participants had a mean age of 68.86 ± 7.46 years and BMI 24.08± 4.64. Elderly patients (28%) lost their weight (>10%) in the last six months and loss of appetite observed in (33.4%) participants. In MUST tool rating, high-risk elderly patients for malnutrition were 33.3%. The AUC for MUST, according to Full-MNA was obtained 90.41%, with sensitivity 90.0% and specificity 73.25%. The MUST showed the strongest correlation with Full-MNA (r = -0.7) and BMI (r = - 0.51); but, the lowest correlation observed with Alb (r= -0.274). Most AUC was belonging to weight loss (0.96) and BMI (0.94). NConclusion: The MUST tool like full-MNA could diagnose malnutrition in geriatric patients in the hospital setting.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66885782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in older patients and both conditions are related to poor outcome. For the management of (risk of) malnutrition in patients with oropharyngeal dysphagia pre-thickened oral nutritional supplements are available. Objective: The objective of the study is to describe tolerance parameters (stool frequency and incidence and intensity of gastrointestinal symptoms), study product intake (compliance), product appreciation and product properties of a pre-thickened oral nutritional supplement compared to a manually-thickened standard oral nutritional supplement. Design: A randomized, open label, controlled, parallel group study. Setting: participants were recruited through nine general practices in Ireland, one nursing home in The Netherlands, and one hospital in Germany. Participants: Fifty patients requiring oral nutritional support (twenty-four of fifty cases (48%) with dysphagia) were divided into two groups: test group (N = 27) and control group (N = 23). Intervention: During four weeks the test group received a ready-to-use, low volume (125 mL), and energy dense pre-thickened oral nutritional supplement, and the control group a manually-thickened iso-caloric oral nutritional supplement (200 mL) with a similar viscosity. Measurements: Compliance and stool frequency were recorded daily, evaluation of the product appreciation and properties and gastrointestinal tolerability were assessed with questionnaires. Results: Incidence and intensity of gastrointestinal symptoms was not statistically different between groups. Pre-thickened oral nutritional supplement scored significantly better on compliance in week 4 (p = 0.019), on thickness appreciation by patients (day 14, p = 0.035) and on product properties evaluation by carers (appearance, preparation time, ease of preparation and change in thickness, all p < 0.001) compared to the manually-thickened ONS. Conclusion: These results substantiate the use of pre-thickened oral nutritional supplement for the dietary management of patients in need of nutritional support and with oropharyngeal dysphagia.
{"title":"TOLERABILITY, COMPLIANCE, AND PRODUCT EVALUATION OF A PRE-THICKENED ORAL NUTRITIONAL SUPPLEMENT FOR DISEASE RELATED MALNUTRITION IN PATIENTS WITH DYSPHAGIA","authors":"T. Dennehy, F. Veldkamp, M. Lansink, R. Schulz","doi":"10.14283/jarcp.2019.15","DOIUrl":"https://doi.org/10.14283/jarcp.2019.15","url":null,"abstract":"Background: Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in older patients and both conditions are related to poor outcome. For the management of (risk of) malnutrition in patients with oropharyngeal dysphagia pre-thickened oral nutritional supplements are available. Objective: The objective of the study is to describe tolerance parameters (stool frequency and incidence and intensity of gastrointestinal symptoms), study product intake (compliance), product appreciation and product properties of a pre-thickened oral nutritional supplement compared to a manually-thickened standard oral nutritional supplement. Design: A randomized, open label, controlled, parallel group study. Setting: participants were recruited through nine general practices in Ireland, one nursing home in The Netherlands, and one hospital in Germany. Participants: Fifty patients requiring oral nutritional support (twenty-four of fifty cases (48%) with dysphagia) were divided into two groups: test group (N = 27) and control group (N = 23). Intervention: During four weeks the test group received a ready-to-use, low volume (125 mL), and energy dense pre-thickened oral nutritional supplement, and the control group a manually-thickened iso-caloric oral nutritional supplement (200 mL) with a similar viscosity. Measurements: Compliance and stool frequency were recorded daily, evaluation of the product appreciation and properties and gastrointestinal tolerability were assessed with questionnaires. Results: Incidence and intensity of gastrointestinal symptoms was not statistically different between groups. Pre-thickened oral nutritional supplement scored significantly better on compliance in week 4 (p = 0.019), on thickness appreciation by patients (day 14, p = 0.035) and on product properties evaluation by carers (appearance, preparation time, ease of preparation and change in thickness, all p < 0.001) compared to the manually-thickened ONS. Conclusion: These results substantiate the use of pre-thickened oral nutritional supplement for the dietary management of patients in need of nutritional support and with oropharyngeal dysphagia.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66886234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"AMYLOIDß, APP, AND DISCOVERIES IN THE TREATMENT OF ALZHEIMER’S DISEASE","authors":"G. Webb, T. Clemons","doi":"10.14283/jarcp.2019.5","DOIUrl":"https://doi.org/10.14283/jarcp.2019.5","url":null,"abstract":"","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66886481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kinoshita, S. Satake, Y. Matsui, S. Kawashima, H. Arai
Objectives: To evaluate the effects of β-hydroxy-β-methylbutyrate (HMB) on muscle strength, physical performance, and muscle mass without additional exercise training in older adults with low physical function. Design: Randomized, controlled trial (Open-label study). Setting: Outpatients. Participants: 34 senior outpatients with low physical function who do not exercise regularly. Intervention: 2.4 g of HMB (3.0 g of calcium β-hydroxy-β-methylbutyrate [CaHMB]) per day was given for 60 days, and subjects in the control group were asked to engage in daily activities as normal. Measurements: Weakness or low function was defined by the Asian Working Group for Sarcopenia criteria, then the participants were assigned to the HMB group or the control group. All participants underwent several evaluations such as grip strength, the timed up and go test, the 5-times chair stand test (5CS), and skeletal muscle mass index by the bioimpedance method at baseline and at the end of intervention or control period. Results: An intragroup comparison of pre- to post-treatment values showed significant improvement in grip strength and the 5CS in the HMB group (grip strength: HMB, 16.6±6.1 kg to 18.2±6.4 kg, P=.001; control, 16.5±4.3 kg to 16.7±4.7 kg, P=.729; 5CS: HMB, 11.0 [8.8-13.0] s to 10.1 [8.5-12.6] s, P=.011; control, 11.1 [8.6-13.8] s to 10.0 [8.8-11.3] s, P=.246). Two-way repeated measures analysis of variance (ANOVA) used to compare the HMB and control groups showed a significant improvement in grip strength in the HMB group compared with the control group (P=.029). Conclusion: A supplementation of HMB without additional exercise may improve muscle strength in older patients with low muscle strength.
目的:评价β-羟基-β-甲基丁酸盐(HMB)对身体机能低下的老年人在没有额外运动训练的情况下肌肉力量、体能表现和肌肉质量的影响。设计:随机对照试验(开放标签研究)。设置:门诊病人。参与者:34例身体机能低下、不经常运动的老年门诊患者。干预措施:每天给予2.4 g HMB (3.0 g β-羟基-β-甲基丁酸钙[CaHMB])，持续60天，对照组正常进行日常活动。测量:虚弱或低功能由亚洲肌少症工作组定义，然后参与者被分配到HMB组或对照组。在基线和干预期或控制期结束时，所有参与者都接受了生物阻抗法的握力、计时起跑测试、5次椅站测试(5CS)和骨骼肌质量指数等多项评估。结果:组内比较治疗前后握力和5CS值，HMB组握力:HMB, 16.6±6.1 kg ~ 18.2±6.4 kg, P=.001;对照组为16.5±4.3 kg ~ 16.7±4.7 kg, P=.729;5 cs: HMB, 11.0(8.8 - -13.0)到10.1(8.5 - -12.6)年代,P = .011;控制、11.1(8.6 - -13.8)到10.0(8.8 - -11.3)年代,P = .246)。采用双向重复测量方差分析(ANOVA)对HMB组和对照组进行比较，结果显示HMB组握力较对照组有显著改善(P= 0.029)。结论:在没有额外运动的情况下补充HMB可以改善老年低肌力患者的肌力。
{"title":"EFFECT OF ß-HYDROXY-ß-METHYLBUTYRATE (HMB) ON MUSCLE STRENGTH IN OLDER ADULTS WITH LOW PHYSICAL FUNCTION","authors":"K. Kinoshita, S. Satake, Y. Matsui, S. Kawashima, H. Arai","doi":"10.14283/JARCP.2019.1","DOIUrl":"https://doi.org/10.14283/JARCP.2019.1","url":null,"abstract":"Objectives: To evaluate the effects of β-hydroxy-β-methylbutyrate (HMB) on muscle strength, physical performance, and muscle mass without additional exercise training in older adults with low physical function. Design: Randomized, controlled trial (Open-label study). Setting: Outpatients. Participants: 34 senior outpatients with low physical function who do not exercise regularly. Intervention: 2.4 g of HMB (3.0 g of calcium β-hydroxy-β-methylbutyrate [CaHMB]) per day was given for 60 days, and subjects in the control group were asked to engage in daily activities as normal. Measurements: Weakness or low function was defined by the Asian Working Group for Sarcopenia criteria, then the participants were assigned to the HMB group or the control group. All participants underwent several evaluations such as grip strength, the timed up and go test, the 5-times chair stand test (5CS), and skeletal muscle mass index by the bioimpedance method at baseline and at the end of intervention or control period. Results: An intragroup comparison of pre- to post-treatment values showed significant improvement in grip strength and the 5CS in the HMB group (grip strength: HMB, 16.6±6.1 kg to 18.2±6.4 kg, P=.001; control, 16.5±4.3 kg to 16.7±4.7 kg, P=.729; 5CS: HMB, 11.0 [8.8-13.0] s to 10.1 [8.5-12.6] s, P=.011; control, 11.1 [8.6-13.8] s to 10.0 [8.8-11.3] s, P=.246). Two-way repeated measures analysis of variance (ANOVA) used to compare the HMB and control groups showed a significant improvement in grip strength in the HMB group compared with the control group (P=.029). Conclusion: A supplementation of HMB without additional exercise may improve muscle strength in older patients with low muscle strength.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66885847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Costanzo, S. Kozmic, S. Sulo, F. Dabbous, B. Warren, J. Partridge, Alan S. Brown, K. Sriram
Background: Patients with cardiopulmonary diagnoses are at high risk for hospital readmissions and prolonged hospitalizations. Nutrition-focused quality improvement programs (QIPs) can improve the care of malnourished hospitalized patients. Objectives: Data collected previously was analyzed to evaluate the impact of a nutrition-focused QIP on health outcomes in patients with cardiopulmonary diseases. Design: The QIP consisted of malnutrition risk screening, prompt initiation of oral nutritional supplements (ONS), and nutrition education. Setting: A total of 4 hospitals implemented the QIP–2 teaching hospitals and 2 community hospitals. Participants: Eligible QIP participants were hospitalized patients with any diagnosis, 18 years of age or older, at risk for malnutrition at admission, and able to consume food and beverages orally. Measurements: Data collected from the QIP patients was compared to data from historical controls to assess differences in readmission rates and length of stay (LOS). Results: Patients were mainly older adults (66 ± 17.4 years) and non-obese (85%). Univariate analysis showed significant reductions in 30-day readmission rates for the QIP group when compared with the controls (13.9% for QIP vs. 26.4% for controls), with the QIP group experiencing a 55% reduction in the odds of being readmitted (OR = 0.45, p = 0.006). Similarly, a significant reduction in LOS was reported for the QIP group (5.4 ± 5.7 days for QIP vs. 6.8 ± 5.7 days for controls) corresponding to a relative risk reduction (RR) of 20% (RR = 0.80, p = 0.0085). Logistic regression adjusting for patient characteristics showed that the QIP patients were 33% less likely to be readmitted (p = 0.33), and had a 6% RR (RR = 0.94, p = 0.55) in LOS versus controls. Conclusions: Malnourished hospitalized cardiopulmonary patients participating in a nutrition-focused QIP experienced fewer readmissions and improved LOS compared to controls. These results underscore the importance of nutrition-focused interventions as a key part of treatment for cardiopulmonary patients.
背景:被诊断为心肺疾病的患者再次住院和延长住院时间的风险较高。以营养为重点的质量改善计划(QIPs)可以改善对营养不良住院患者的护理。目的:分析先前收集的数据，以评估以营养为重点的QIP对心肺疾病患者健康结局的影响。设计:QIP包括营养不良风险筛查、及时开始口服营养补充剂(ONS)和营养教育。环境:共有4家医院实施了QIP-2教学医院和2家社区医院。参与者:合格的QIP参与者为任何诊断的住院患者，18岁或以上，入院时有营养不良风险，能够口服食物和饮料。测量:将从QIP患者收集的数据与历史对照组的数据进行比较，以评估再入院率和住院时间(LOS)的差异。结果:患者以老年人(66±17.4岁)和非肥胖者(85%)为主。单因素分析显示，与对照组相比，QIP组30天再入院率显著降低(QIP组为13.9%，对照组为26.4%)，QIP组再入院率降低55% (OR = 0.45, p = 0.006)。同样，QIP组的LOS显著降低(QIP组为5.4±5.7天，对照组为6.8±5.7天)，相对风险降低(RR) 20% (RR = 0.80, p = 0.0085)。对患者特征进行Logistic回归调整显示，QIP患者再入院的可能性降低33% (p = 0.33)，与对照组相比，LOS的RR为6% (RR = 0.94, p = 0.55)。结论:与对照组相比，参加以营养为重点的QIP的营养不良住院心肺患者的再入院率更低，LOS得到改善。这些结果强调了以营养为重点的干预措施作为心肺患者治疗的关键部分的重要性。
{"title":"ASSESSING THE IMPACT OF A NUTRITION-FOCUSED QUALITY IMPROVEMENT PROGRAM IN CARDIOPULMONARY PATIENTS","authors":"M. Costanzo, S. Kozmic, S. Sulo, F. Dabbous, B. Warren, J. Partridge, Alan S. Brown, K. Sriram","doi":"10.14283/jarcp.2019.11","DOIUrl":"https://doi.org/10.14283/jarcp.2019.11","url":null,"abstract":"Background: Patients with cardiopulmonary diagnoses are at high risk for hospital readmissions and prolonged hospitalizations. Nutrition-focused quality improvement programs (QIPs) can improve the care of malnourished hospitalized patients. Objectives: Data collected previously was analyzed to evaluate the impact of a nutrition-focused QIP on health outcomes in patients with cardiopulmonary diseases. Design: The QIP consisted of malnutrition risk screening, prompt initiation of oral nutritional supplements (ONS), and nutrition education. Setting: A total of 4 hospitals implemented the QIP–2 teaching hospitals and 2 community hospitals. Participants: Eligible QIP participants were hospitalized patients with any diagnosis, 18 years of age or older, at risk for malnutrition at admission, and able to consume food and beverages orally. Measurements: Data collected from the QIP patients was compared to data from historical controls to assess differences in readmission rates and length of stay (LOS). Results: Patients were mainly older adults (66 ± 17.4 years) and non-obese (85%). Univariate analysis showed significant reductions in 30-day readmission rates for the QIP group when compared with the controls (13.9% for QIP vs. 26.4% for controls), with the QIP group experiencing a 55% reduction in the odds of being readmitted (OR = 0.45, p = 0.006). Similarly, a significant reduction in LOS was reported for the QIP group (5.4 ± 5.7 days for QIP vs. 6.8 ± 5.7 days for controls) corresponding to a relative risk reduction (RR) of 20% (RR = 0.80, p = 0.0085). Logistic regression adjusting for patient characteristics showed that the QIP patients were 33% less likely to be readmitted (p = 0.33), and had a 6% RR (RR = 0.94, p = 0.55) in LOS versus controls. Conclusions: Malnourished hospitalized cardiopulmonary patients participating in a nutrition-focused QIP experienced fewer readmissions and improved LOS compared to controls. These results underscore the importance of nutrition-focused interventions as a key part of treatment for cardiopulmonary patients.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66885575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Malnutrition is defined as a disproportion of nutrients caused by either an excess intake of nutrients or a nutritional deficit. One of the most common nutritional problems in older people (aged 60 years and over) is under nutrition. Worldwide studies revealed that the prevalence of under nutrition in people of old age is high. Objective: To assess the prevalence of under nutrition and its associated factors among old people in Debre Markos town, Northwest Ethiopia, 2015. Methods and materials: A cross sectional study design was conducted among 423 study subjects of old age in Debre Markos town from August 4 to August 30, 2015. Primary data was collected using a pre tested Mini Nutritional Assessment Short-Form (MNA-SF) screening tool and structured questionnaires by trained data collectors. The data that was collected was entered and cleaned using EpiData version 3.1 statistical software then exported to the SPSS version 20 statistical package for further data analysis. Descriptive statistics of frequency, tables and graphs were used and summary measures were calculated to determine the prevalence of under nutrition. The data was also used to describe the distribution of the independent variables among study subjects. Bivariate and multivariate logistic regression models were utilized to calculate crude and adjusted odds ratios in order to identify factors associated with under nutrition of study participants at 0.05 level of significance. Result: The prevalence of under nutrition among study participants was found to be 22.7% (95%CI 18.7-26.7). A number of independent variables have a significant association with under nutrition, including gender (females (AOR 7.95 95% CI (2.86, 22.08)), age (Oldest Old and Middle Old, (AOR=3.45 95%CI (1.44, 8.26) and (AOR=5.25, 95%CI (2.48, 11.13) respectively), marital status (widowed elderly individuals (ARO 3.29 95 % CI (1.54, 7.06)), individuals with eating difficulty (AOR 10.73 95 % CI (4.49, 25.63), individuals with vision problems (AOR 5.67 95 % CI (2.80, 11.48) and meal frequency (ARO 6.71 95 % CI (3.31, 13.63). Conclusion and recommendation: Prevalence of under nutrition among study participants was 22.7%. Gender, age, marital status, eating difficulty, visual problems and meal frequency were found to be independent determinant factors of under nutrition among study subjects. The government, family members and other stakeholders should give more attention to older individuals especially older females.
{"title":"PREVALENCE OF UNDER NUTRITION AND ASSOCIATED FACTORS AMONG PEOPLE OF OLD AGE IN DEBRE MARKOS TOWN, NORTHWEST ETHIOPIA, 2015","authors":"Z. K. Adhana, G. Tessema, G. Getie","doi":"10.14283/jarcp.2019.4","DOIUrl":"https://doi.org/10.14283/jarcp.2019.4","url":null,"abstract":"Background: Malnutrition is defined as a disproportion of nutrients caused by either an excess intake of nutrients or a nutritional deficit. One of the most common nutritional problems in older people (aged 60 years and over) is under nutrition. Worldwide studies revealed that the prevalence of under nutrition in people of old age is high. Objective: To assess the prevalence of under nutrition and its associated factors among old people in Debre Markos town, Northwest Ethiopia, 2015. Methods and materials: A cross sectional study design was conducted among 423 study subjects of old age in Debre Markos town from August 4 to August 30, 2015. Primary data was collected using a pre tested Mini Nutritional Assessment Short-Form (MNA-SF) screening tool and structured questionnaires by trained data collectors. The data that was collected was entered and cleaned using EpiData version 3.1 statistical software then exported to the SPSS version 20 statistical package for further data analysis. Descriptive statistics of frequency, tables and graphs were used and summary measures were calculated to determine the prevalence of under nutrition. The data was also used to describe the distribution of the independent variables among study subjects. Bivariate and multivariate logistic regression models were utilized to calculate crude and adjusted odds ratios in order to identify factors associated with under nutrition of study participants at 0.05 level of significance. Result: The prevalence of under nutrition among study participants was found to be 22.7% (95%CI 18.7-26.7). A number of independent variables have a significant association with under nutrition, including gender (females (AOR 7.95 95% CI (2.86, 22.08)), age (Oldest Old and Middle Old, (AOR=3.45 95%CI (1.44, 8.26) and (AOR=5.25, 95%CI (2.48, 11.13) respectively), marital status (widowed elderly individuals (ARO 3.29 95 % CI (1.54, 7.06)), individuals with eating difficulty (AOR 10.73 95 % CI (4.49, 25.63), individuals with vision problems (AOR 5.67 95 % CI (2.80, 11.48) and meal frequency (ARO 6.71 95 % CI (3.31, 13.63). Conclusion and recommendation: Prevalence of under nutrition among study participants was 22.7%. Gender, age, marital status, eating difficulty, visual problems and meal frequency were found to be independent determinant factors of under nutrition among study subjects. The government, family members and other stakeholders should give more attention to older individuals especially older females.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66886468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study examine the prevalence, characteristics and associated factors of alcohol use and alcohol related problems among Belgian community dwelling older adults. Design: Retrospective cross-sectional study by extensive examination survey. Setting: The participants were questioned in their homes or in community centres. Participants: Overall, 1,366 adults ≥65 years participated in this study. Method: Information about self-reported alcohol use during the past year, Health Related Quality of Life (HRQL) and alcohol related problems was gathered with respectively the AUDIT, SF36 and MAST-G. Results: Of the total sample, 84.4% reported alcohol consumption. Using the NIAAA guidelines, the overall prevalence for at risk drinking was 26.6% and for binge drinking 14.8%, both risky alcohol patterns. Logistic regression analyses were performed on the drinking sample to determine the predictors associated with at risk drinking, binge drinking and hazardous drinking. Being male, a smoker of former smoker and living alone were associated with at risk drinking. Being male, being aged 65-74 years, being a smoker, reporting polypharmacy, MCS and having recent loss experience were associated with binge drinking. More than 25% of respondents were classified as hazardous drinking (score ≥5 on MAST-G). Associated factors with hazardous drinking were being male, having a family history of alcohol problems, PCS and MCS. Conclusions: The prevalence rates for at risk alcohol patterns and alcohol related problems were higher than in previous studies. As older adults are more vulnerable to the adverse consequences of alcohol use, awareness about alcohol use should be raised among older adults, as well as amongst health care givers and researchers.
{"title":"PREVALENCE AND CHARACTERISTICS ASSOCIATED WITH ALCOHOL USE AND ALCOHOL RELATED PROBLEMS IN COMMUNITY DWELLING OLDER ADULTS","authors":"Y. V. Gils, E. Franck, S. V. Alphen, E. Dierckx","doi":"10.14283/JARCP.2019.6","DOIUrl":"https://doi.org/10.14283/JARCP.2019.6","url":null,"abstract":"Objective: This study examine the prevalence, characteristics and associated factors of alcohol use and alcohol related problems among Belgian community dwelling older adults. Design: Retrospective cross-sectional study by extensive examination survey. Setting: The participants were questioned in their homes or in community centres. Participants: Overall, 1,366 adults ≥65 years participated in this study. Method: Information about self-reported alcohol use during the past year, Health Related Quality of Life (HRQL) and alcohol related problems was gathered with respectively the AUDIT, SF36 and MAST-G. Results: Of the total sample, 84.4% reported alcohol consumption. Using the NIAAA guidelines, the overall prevalence for at risk drinking was 26.6% and for binge drinking 14.8%, both risky alcohol patterns. Logistic regression analyses were performed on the drinking sample to determine the predictors associated with at risk drinking, binge drinking and hazardous drinking. Being male, a smoker of former smoker and living alone were associated with at risk drinking. Being male, being aged 65-74 years, being a smoker, reporting polypharmacy, MCS and having recent loss experience were associated with binge drinking. More than 25% of respondents were classified as hazardous drinking (score ≥5 on MAST-G). Associated factors with hazardous drinking were being male, having a family history of alcohol problems, PCS and MCS. Conclusions: The prevalence rates for at risk alcohol patterns and alcohol related problems were higher than in previous studies. As older adults are more vulnerable to the adverse consequences of alcohol use, awareness about alcohol use should be raised among older adults, as well as amongst health care givers and researchers.","PeriodicalId":73537,"journal":{"name":"JAR life","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66886494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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