The associations between diet quality, Body Mass Index (BMI) and Health and Activity Limitation Index (HALex) in the Geisinger Rural Aging Study (GRAS)

Worse health‐related quality of life, impaired functioning and psychiatric comorbidities are associated with excess mortality in patients with severe chronic pain

Background

Severe chronic pain that interferes with daily activities is associated with an increased risk of mortality. We assessed the overall mortality of tertiary chronic pain patients in comparison with the general population, with a special aim to analyse the association of health‐related quality of life (HRQoL) and its dimensions with the risk of death.

Methods

In this prospective observational follow‐up study, patients with non‐cancer chronic pain attended an outpatient multidisciplinary pain management (MPM) episode in a tertiary pain clinic in 2004–2012 and were followed until May 2019. Mortality between the patients and the general population was compared with standardized mortality ratios (SMR) in different age groups. Causes of death and comorbidities were compared among the deceased. Association of mortality and HRQoL and its dimensions, measured with the 15D instrument, was studied with Cox proportional hazards model.

Results

During a mean of 10.4‐year follow‐up of 1498 patients, 296 died. The SMR in the youngest age group (18–49 years) was significantly higher than that of the general population: 2.6 for males and 2.9 for females. Even elderly females (60–69 years) had elevated mortality (SMR 2.3). Low baseline HRQoL at the time of MPM, as well as poor ratings in the psychosocial dimensions of HRQoL, was associated with an increased risk of death.

Conclusions

Our results support the role of HRQoL measurement by a validated instrument such as the 15D in capturing both the physical and the psychological symptom burden, and consequently, an elevated risk of death, in patients with chronic pain.

Significance

Severe chronic pain is associated with elevated mortality. In patients in chronic pain under 50 years old, the mortality was 2.5–3 times higher than in the general population. Psychological distress appears to contribute to the increased mortality. Regular follow‐up by health‐related quality of life (HRQoL) measurement could be useful in identifying patients in chronic pain who are in need of intensive symptom management and to prevent early death.

The Dynamic Interplay of Healthy Lifestyle Behaviors for Cardiovascular Health

PURPOSE OF REVIEW

The recent rise in cardiovascular disease (CVD) deaths in the USA has sparked interest in identifying and implementing effective strategies to reverse this trend. Healthy lifestyle behaviors (i.e., healthy diet, regular physical activity, achieve and maintain a healthy weight, avoid tobacco exposure, good quality sleep, avoiding and managing stress) are the cornerstone for CVD prevention.

RECENT FINDINGS

Achieving all of these behaviors significantly benefits heart health; however, even small changes lower CVD risk. Moreover, there is interplay among healthy lifestyle behaviors where changing one may result in concomitant changes in another behavior. In contrast, the presence of one or more unhealthy lifestyle behaviors may attenuate changing another lifestyle behavior(s) (poor diet, inadequate physical activity, overweight/obesity, poor sleep quality, tobacco exposure, and poor stress management). It is important to assess all of these lifestyle behaviors with patients to plan an intervention program that is best positioned for adherence.

Oral Health and Undernutrition in the Frail Elderly Persons

INTRODUCTION

Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors.

MATERIALS AND METHODS

We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol).

RESULTS

We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)).

DISCUSSION

Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time.

CONCLUSION

We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.

Comparison of body mass index range criteria and their association with cognition, functioning and depression: a cross-sectional study in Mexican older adults

BACKGROUND

World population is living longer, demanding adjustments in public health policies. Body mass index (BMI) is widely known and used as a parameter and predictor of health status although an adapted criterion for older adults is usually overlooked. BMI has been extensively analysed in relation to mortality but fewer studies address its association with cognition, functioning and depression in older adults. The present study aimed at 1) comparing BMI distribution according to the ranges proposed by the World Health Organization (WHO) and the United States National Research Council Committee on Diet and Health (CDH), 2) analysing their association with cognitive functioning, physical functioning and depression and 3) analysing a possible, interaction of BMI criteria with sex on the outcome measures.

METHODS

This cross-sectional study included 395 participants recruited by convenience sampling; 283 (71.6%) women and 112 (24.58%) men. Mean age was 74.68 (SD = 8.50, range: 60-98). Outcome measures included the Short Portable Mental State Questionnaire for cognitive status, the Barthel's Index of Activities of Daily Living for physical functioning, and the Geriatric Depression Scale.

RESULTS

WHO criterion classified most cases (65.3%) as overweight, followed by normal weight (32.2%) and underweight (2.5%) whereas CDH criterion considered most (48.1%) as normal weight, and followed by overweight (31.4%) and underweight (20.5%). Analysing cognitive status, independent physical functioning and depression mean scores, significant differences (p ≤ .001) were found when comparing the three weight groups (underweight, normal weight and overweight) using either the WHO- or the CDH criterion. Post-hoc tests revealed that in all comparisons the underweight group scored the lowest in all three outcome measures. According to the CDH criterion, overweight was favourable for females but unfavourable for males regarding cognitive status (interaction F(2,389) = 4.52, p ≤ .01) and independent functioning (interaction F(2,389) = 3.86, p ≤ .05).

CONCLUSIONS

BMI and its associations to relevant outcome measures in the older adults must rely on criteria that take into account the particular features of this population, such as the CDH criterion. Underweight was associated with decremented cognition, less independent physical functioning and more depression. Overweight seemed favourable for women but unfavourable for men.

Sociodemographic Predictors of Physical Functioning in the Elderly: A National Health Survey

We aimed to evaluate the prevalence of sociodemographic factors with the presence and different degrees of walking difficulties in elderly above 65 years, and to analyze association between evaluated variables and the presence and degree of waking difficulties. In the population based study, 3540 individuals age above 65 years from Serbia were recruited. Further predictors were analyzed: gender, age, level of education, marital status, body mass index (BMI), index of well-being and place of residence. We assessed difficulty in walking half a km on level ground without the use of any aid (Group-1); and difficulty in walking up or down 12 steps (Group-2). Walking difficulties were categorized as no difficulty, some difficulty, a lot of difficulty and cannot do at all. For present difficulty significant predictors were: age (Group-1 (OR-3.022)/Group-2 (OR-3.825)), gender (Group-1 (OR-0.337)/Group-2 (OR-0.311)), educational level (Group-1 (OR-0.689)/Group-2 (OR-0.556)) and place of residence (Group-2 (OR-1.523)) while for non-performing the task, significant predictors were: age (Group-1 (OR-1.998)/Group-2 (OR-2.096)), gender (Group-1 (OR-0.629)/Group-2 (OR-0.495)), BMI (Group-1 (OR-1.219)/Group-2 (OR-1.305)), marital status (Group-1 (OR 0.764)/Group-2 (OR-0.769)), educational level (Group-1 (OR-0.679)/Group-2 (OR-0.719)) and index of well-being (Group-2 (OR-0.764)). Understanding of predictors, and their role on functional decline in elderly is of great importance for the development of specific population-based health programs to prevent further functional loss and preserve achieved functional gains.

Associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China

PURPOSE

The aim of this study was to explore associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China.

METHODS

One thousand one hundred thirty-six (504 males and 632 females) community-dwelling adults aged ≥ 50 years old in Dongguan City, South China, were included in the cross-sectional study. All the participants were asked to complete all prepared multi-instrument questionnaire, including the Pittsburgh Sleep Quality Index (Chinese version), for the assessment of the sleep quality and information regarding socio-demographic characteristics, lifestyle, and physical health data. Physical fitness was measured by grip strength, one-leg standing test (OLST) with eyes open, back scratch test, and the forced vital capacity (FVC).

RESULTS

The percentage of poor sleep quality among elderly people (≥ 50 years old) was up to 18.2%. Lower FVC was associated with the poorer sleep quality (adjusted OR = 0.74 per SD increase; P = 0.009), and participants with lower performance in back scratch test were more likely to suffer poor sleep quality (adjusted OR = 1.17 per SD increase; P = 0.035). The independent contribution of physical fitness tests results on the risk of poor sleep quality was 22.1%.

CONCLUSIONS

Our results indicated that sleep quality was strongly associated with physical fitness among community-dwelling elderly people; the lower of the physical fitness predicted poorer sleep quality.

Dietary Patterns and Quality of Life in Older Adults: A Systematic Review

Dietary patterns may be related to quality of life (QoL) of older adults, although evidence from literature is conflicting. The demographic shifts toward ageing populations in many countries increases the importance of understanding the relationship between diet and QoL in older adults. This review was designed to investigate associations between dietary patterns and QoL in older adults. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases were searched to identify articles published in English from January 1975 to March 2018 that investigated associations between dietary patterns and QoL in older adults. Relevant studies were identified based on set inclusion and exclusion criteria, data were extracted and analysed to examine the relationships and possible implications for public health recommendations. The systematic review included 15 articles (One randomized control trial, six prospective cohorts and eight cross sectional). The studies looked at correlations between different dietary patterns and/or adherence to particular dietary patterns and self-reported QoL or self-rated health status. Excluding two studies which showed no significant association, healthy dietary patterns were associated with better self-rated health and QoL in one or more domains, and adherence to healthy dietary patterns like the Mediterranean diet were significantly associated with improvement in at least one of the QoL domains.

Relationship between Diet Quality, Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007-2014 National Health and Nutrition Examination Survey

BACKGROUND

A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults.

OBJECTIVES

To investigate the relationship between diet quality, physical activity, and HRQOL.

DESIGN

A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014.

MEASUREMENTS

HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling.

RESULTS

Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (β =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (β =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (β =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (β =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days.

CONCLUSIONS

Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.

Differences in Psychosocial and Behavioral Variables by Dietary Screening Tool Risk Category in Older Adults

BACKGROUND

The Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.

OBJECTIVE

The aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.

DESIGN

This study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.

PARTICIPANTS/SETTING

Community-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).

MAIN OUTCOME MEASURES

DST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).

STATISTICAL ANALYSES PERFORMED

Multiple analysis of variance and χ² analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.

RESULTS

Participants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).

CONCLUSIONS

Older adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.

Animal-Derived Protein Consumption Is Associated with Muscle Mass and Strength in Community-Dwellers: Results from the Milan EXPO Survey

OBJECTIVES

Behavioral factors, including protein intake, influence the quantity and quality of skeletal muscle. The aim of this study was to explore the relationship between animal-derived protein intake and muscle mass and function in a large sample of unselected community-dwellers.

MATERIAL AND METHODS

The VIP (Very Important Protein) study, conducted during Expo 2015 in Milan, was a population survey aimed at assessing major health metrics in a population outside of the research setting, with a special focus on the relation between animal-derived protein intake and muscle mass and function. A brief questionnaire exploring lifestyle habits, dietary preferences and the consumption of selected foods was administered. Muscle mass was estimated by calf circumference (CC) and mid-arm muscle circumference (MAMC) of the dominant side. Muscle strength of upper and lower extremities was assessed through handgrip strength testing and repeated chair stand test, respectively.

RESULTS

The mean age of the 1,853 participants was 50.3 years (standard deviation: 15.7; range: 18-98 years), of whom 959 (51.7%) were women. Participants in the highest tertile of protein consumption showed better performance at both the handgrip strength (p <0.001) and chair stand tests than those in the lowest tertile (p <0.01). The same results were found for CC (p <0.001) and MAMC (p <0.001). Participants with high protein intake and engaged in regular physical activity showed the higher scores in all the assessed domains.

CONCLUSIONS

The results of the VIP survey suggest an association between animal-derived protein intake and muscle mass and strength across ages. Our findings also indicate a synergistic effect of animal-derived protein intake and physical activity on muscle-related parameters.

Wise Choices: Nutrition and Exercise for Older Adults: A Community-Based Health Promotion Intervention

Effective interventions for older adults are needed to address lifestyle behaviors linked to chronic illnesses. We implemented a 12-week group behavioral intervention for 118 racially diverse older adults at 6 community-based senior centers to improve eating and physical activity. Assessments were completed pre- and postintervention, with 85.6% retention. We documented increases in fruit, vegetable, and whole grain intake; pace of walking; number of city blocks walked; daily steps walked; functional mobility; and self-rated general health (P < .05). Findings indicate that a relatively low-intensity lifestyle intervention can effectively be implemented for community-dwelling older adults. Further development of this approach is warranted.

Dietary patterns and successful ageing: a systematic review

PURPOSE

Nutrition is a key determinant of chronic disease in later life. A systematic review was conducted of studies examining dietary patterns and quality of life, physical function, cognitive function and mental health among older adults.

METHODS

Literature searches in MEDLINE complete, Academic Search Complete, CINAHL Complete, Ageline, Global health, PsycINFO, SCOPUS and EMBASE and hand searching from 1980 up to December 2014 yielded 1236 results. Inclusion criteria included dietary pattern assessment via dietary indices or statistical approaches, a sample of community-dwelling adults aged 45 years and over at baseline and a cross-sectional or longitudinal study design. Exclusion criteria included a single 24-h recall of diet, evaluation of single foods or nutrients, clinical or institutionalised samples and intervention studies. Risk of bias was assessed using the six-item Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies.

RESULTS

There were 34 articles (11 cross-sectional and 23 longitudinal) included with 23 studies examining dietary indices and 13 studies using empirical analysis. Most studies examined mental health (n = 10) or cognitive function (n = 18), with fewer studies examining quality of life (n = 6) and physical function (n = 8). Although dietary pattern and outcome assessment methods varied, most studies reported positive associations between a healthier diet and better health outcomes.

CONCLUSION

Overall, the number of studies using dietary patterns to investigate diet and successful ageing is small, and further investigation in longitudinal studies is needed, particularly for quality-of-life outcomes. This review provides support for the importance of a healthy diet for the ageing population globally.