1
|
Malvuccio C, Kamavuako EN. The Effect of EMG Features on the Classification of Swallowing Events and the Estimation of Fluid Intake Volume. SENSORS (BASEL, SWITZERLAND) 2022; 22:3380. [PMID: 35591068 PMCID: PMC9104476 DOI: 10.3390/s22093380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022]
Abstract
Nowadays, society is experiencing an increase in the number of adults aged 65 and over, and it is projected that the older adult population will triple in the coming decades. As older adults are prone to becoming dehydrated, which can significantly impact healthcare costs and staff, it is necessary to advance healthcare technologies to cater to such needs. However, there has not been an extensive research effort to implement a device that can autonomously track fluid intake. In particular, the ability of surface electromyographic sensors (sEMG) to monitor fluid intake has not been investigated in depth. Our previous study demonstrated a reasonable classification and estimation ability of sEMG using four features. This study aimed to examine if classification and estimation could be potentiated by combining an optimal subset of features from a library of forty-six time and frequency-domain features extracted from the data recorded using eleven subjects. Results demonstrated a classification accuracy of 95.94 ± 2.76% and an f-score of 94.93 ± 3.51% in differentiating between liquid swallows from non-liquid swallowing events using five features only, and a volume estimation RMSE of 2.80 ± 1.22 mL per sip and an average estimation error of 15.43 ± 8.64% using two features only. These results are encouraging and prove that sEMG could be a potential candidate for monitoring fluid intake.
Collapse
Affiliation(s)
| | - Ernest N. Kamavuako
- Department of Engineering, King’s College London, London WC2R 2LS, UK;
- Faculté de Médecine, Université de Kindu, Site de Lwama II, Kindu, Maniema, Congo
| |
Collapse
|
2
|
Rosi IM, Milos R, Cortinovis I, Laquintana D, Bonetti L. Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: an observational diagnostic study. Nutrition 2022; 101:111695. [DOI: 10.1016/j.nut.2022.111695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
|
3
|
Chronic Dehydration in Nursing Home Residents. Nutrients 2020; 12:nu12113562. [PMID: 33233662 PMCID: PMC7709028 DOI: 10.3390/nu12113562] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/12/2023] Open
Abstract
Chronic dehydration mainly occurs due to insufficient fluid intake over a lengthy period of time, and nursing home residents are thought to be at high risk for chronic dehydration. However, few studies have investigated chronic dehydration, and new diagnostic methods are needed. Therefore, in this study, we aimed to identify risk factors for chronic dehydration by measuring serum osmolality in nursing home residents and also to evaluate whether examining the inferior vena cava (IVC) and determining the IVC collapsibility index (IVC-CI) by ultrasound can be helpful in the diagnosis of chronic dehydration. A total of 108 Japanese nursing home residents aged ≥65 years were recruited. IVC measurement was performed using a portable handheld ultrasound device. Fifteen residents (16.9%) were classified as having chronic dehydration (serum osmolality ≥295 mOsm/kg). Multivariate logistic regression analysis showed that chronic dehydration was associated with dementia (odds ratio (OR), 6.290; 95% confidential interval (CI), 1.270–31.154) and higher BMI (OR, 1.471; 95% CI, 1.105–1.958) but not with IVC or IVC-CI. Cognitive function and body weight of residents should be considered when establishing a strategy for preventing chronic dehydration in nursing homes.
Collapse
|
4
|
Chan HYL, Cheng A, Cheung SSS, Pang WW, Ma WY, Mok LC, Wong WK, Lee DTF. Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery. J Clin Nurs 2018; 27:3679-3686. [DOI: 10.1111/jocn.14336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Helen Y L Chan
- The Nethersole School of Nursing; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong City SAR China
| | - Anthony Cheng
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Susana S S Cheung
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Wai-wah Pang
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Wai-yiu Ma
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Long-chau Mok
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Wai-kuen Wong
- Department of Orthopaedics and Traumatology; Pamela Youde Nethersole Eastern Hospital; Hong Kong City Hong Kong
| | - Diana T F Lee
- The Nethersole School of Nursing; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong City SAR China
| |
Collapse
|
5
|
Duarte M, Bouça-Machado R, Domingos J, Godinho C, Ferreira JJ. Feasibility of using risk prompts to prevent falls, dehydration and pulmonary aspiration in nursing homes: a clinical study protocol. Pilot Feasibility Stud 2018; 4:39. [PMID: 29416872 PMCID: PMC5785817 DOI: 10.1186/s40814-018-0236-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background Evidence has shown a relationship between dehydration, falls, and pulmonary aspiration among older adults in nursing homes, all of which contribute to loss of independence and quality of life. It is believed that improving communication among healthcare professionals in nursing homes (physicians, nurses, rehabilitation team, psychologist, social workers, dieticians and medical assistants) decreases the number of adverse events in institutionalized patients. This study will evaluate the feasibility of using a set of written signs, designed to caution against the risk of falls, dehydration, and pulmonary aspiration, and will enable the proposal of tailored interventions to manage these events in nursing homes. Methods/Design All patients from Campus Neurológico Sénior (CNS) nursing home, at risk of falls and/ordysphagia and/or dehydration will be invited to participate in the study. Patients will undertake a screeningrisk assessment and the corresponding risk prompts will be attributed. Study duration will be a minimum ofthree months per participant, including daily record of falls, dehydration and pulmonary aspiration eventsand monthly interview assessments, conducted by a member of the research team. Data of the events that occur will be compared with historical data extracted retrospectively from medical and nursing charts. This study has been approved by the Ethics Committee of the Medical Academic Center of Lisbon, Faculty of Medicine, University of Lisbon (Ref. 176/15). All participants will give their written informed consent before entering the study. Discussion This study is unique in evaluating the feasibility of a communication system in preventing the three major risks in nursing home. Thoughtful selection and display of proper risk prompts in nursing homes could be an essential step along a path toward efficient communication of risks among healthcare teams. We expect that the displays will be easily applicable given their simplicity, low complexity, and minimal physical requirements. Trial registration NCT03123601. March 7, 2017. Retrospectively registered.
Collapse
Affiliation(s)
- Márcia Duarte
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Raquel Bouça-Machado
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,2Instituto de Medicina Molecular, Lisbon, Portugal
| | | | - Catarina Godinho
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,2Instituto de Medicina Molecular, Lisbon, Portugal.,3Centro de Investigação Interdisciplinar Egas Moniz, Escola Superior de Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Joaquim J Ferreira
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,2Instituto de Medicina Molecular, Lisbon, Portugal.,4Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | |
Collapse
|
6
|
Morley JE. A Decade of JAMDA. J Am Med Dir Assoc 2017; 18:993-997. [PMID: 29169742 DOI: 10.1016/j.jamda.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO.
| |
Collapse
|
7
|
Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2016. J Am Med Dir Assoc 2017; 17:978-993. [PMID: 27780573 DOI: 10.1016/j.jamda.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
Collapse
Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| |
Collapse
|
8
|
van der Steen JT, Di Giulio P, Giunco F, Monti M, Gentile S, Villani D, Finetti S, Pettenati F, Charrier L, Toscani F. Pneumonia in Nursing Home Patients With Advanced Dementia: Decisions, Intravenous Rehydration Therapy, and Discomfort. Am J Hosp Palliat Care 2017; 35:423-430. [PMID: 28532225 PMCID: PMC5794105 DOI: 10.1177/1049909117709002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Comfort may be an appropriate goal in advanced dementia. Longitudinal studies on physician decision-making and discomfort assessed by direct observation are rare, and intravenous rehydration therapy is controversial. METHODS To assess treatment decisions and discomfort in patients with advanced dementia and pneumonia and to compare by intravenous rehydration therapy, we used data from the observational multicenter Italian End of Life Observatory-Prospective Study On DEmentia patients Care. We analyzed 109 episodes of pneumonia, which involved decisions in 77 nursing home patients with Functional Assessment Staging Tool stage 7. We assessed decisions, decision-making, and treatments every fortnight. Trained observers assessed discomfort with the Discomfort Scale-Dementia Alzheimer Type (DS-DAT). RESULTS Most decisions referred to treatment with antibiotics (90%; 98 of 109) and intravenous rehydration therapy (53%; 58 of 109), but hospitalization was rare (1%). Selecting decisions with antibiotics, with rehydration therapy, the prognosis was more frequently <15 days (34% vs 5% without rehydration therapy; P = .001), and a goal to reduce symptoms/suffering was more common (96% vs 74%; P = .005) while there was no difference in striving for life prolongation (a minority). With rehydration therapy, the decision was more often discussed with family rather than communicated only. Mean DS-DAT scores over time proximate to the first decision ranged between 9.2 and 10.5. CONCLUSIONS Italian nursing home patients with advanced dementia and pneumonia frequently received invasive rehydration therapy in addition to antibiotics, however, mostly with a palliative intent. Discomfort was high overall and symptom relief may be improved. Relations between invasive rehydration therapy and discomfort need further study.
Collapse
Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands
- Jenny T. van der Steen, PhD, Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- IRCCS Mario Negri Institute, Milano, Italy
| | - Fabrizio Giunco
- Istituto “L. Palazzolo”–Fondazione Don Gnocchi, Milano, Italy
| | - Massimo Monti
- Geriatric Institute “Pio Albergo Trivulzio”–Milano, Italy
| | - Simona Gentile
- Rehabilitation and Alzheimer’s Disease Evaluation Unit, “Ancelle della Carità” Hospital, Cremona, Italy
| | - Daniele Villani
- Neurorehabilitation and Alzheimer’s Disease Evaluation Unit, “Figlie di San Camillo” Hospital, Cremona, Italy
| | - Silvia Finetti
- Lino Maestroni Foundation–Palliative Medicine Research Institute, Cremona, Italy
| | - Francesca Pettenati
- Lino Maestroni Foundation–Palliative Medicine Research Institute, Cremona, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Franco Toscani
- Lino Maestroni Foundation–Palliative Medicine Research Institute, Cremona, Italy
| |
Collapse
|
9
|
Morley JE. Nutrition and Aging Well. J Am Med Dir Assoc 2017; 18:91-94. [DOI: 10.1016/j.jamda.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
|
10
|
Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
|
11
|
Hooper L, Bunn DK, Abdelhamid A, Gillings R, Jennings A, Maas K, Millar S, Twomlow E, Hunter PR, Shepstone L, Potter JF, Fairweather-Tait SJ. Water-loss (intracellular) dehydration assessed using urinary tests: how well do they work? Diagnostic accuracy in older people. Am J Clin Nutr 2016; 104:121-31. [PMID: 27225436 DOI: 10.3945/ajcn.115.119925] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 04/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Water-loss dehydration (hypertonic, hyperosmotic, or intracellular dehydration) is due to insufficient fluid intake and is distinct from hypovolemia due to excess fluid losses. Water-loss dehydration is associated with poor health outcomes such as disability and mortality in older people. Urine specific gravity (USG), urine color, and urine osmolality have been widely advocated for screening for dehydration in older adults. OBJECTIVE We assessed the diagnostic accuracy of urinary measures to screen for water-loss dehydration in older people. DESIGN This was a diagnostic accuracy study of people aged ≥65 y taking part in the DRIE (Dehydration Recognition In our Elders; living in long-term care) or NU-AGE (Dietary Strategies for Healthy Ageing in Europe; living in the community) studies. The reference standard was serum osmolality, and index tests included USG, urine color, urine osmolality, urine cloudiness, additional dipstick measures, ability to provide a urine sample, and the volume of a random urine sample. Minimum useful diagnostic accuracy was set at sensitivity and specificity ≥70% or a receiver operating characteristic plot area under the curve ≥0.70. RESULTS DRIE participants (women: 67%; mean age: 86 y; n = 162) had more limited cognitive and functional abilities than did NU-AGE participants (women: 64%; mean age: 70 y; n = 151). Nineteen percent of DRIE participants and 22% of NU-AGE participants were dehydrated (serum osmolality >300 mOsm/kg). Neither USG nor any other potential urinary tests were usefully diagnostic for water-loss dehydration. CONCLUSIONS Although USG, urine color, and urinary osmolality have been widely advocated for screening for dehydration in older adults, we show, in the largest study to date to our knowledge, that their diagnostic accuracy is too low to be useful, and these measures should not be used to indicate hydration status in older people (either alone or as part of a wider tranche of tests). There is a need to develop simple, inexpensive, and noninvasive tools for the assessment of dehydration in older people. The DRIE study was registered at www.researchregister.org.uk as 122273. The NU-AGE trial was registered at clinicialtrials.gov as NCT01754012.
Collapse
Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Rachel Gillings
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Katie Maas
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Sophie Millar
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Elizabeth Twomlow
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | | |
Collapse
|
12
|
Response to the Letter from Robert A. Zorowitz, “Intravenous and Subcutaneous Infusions in Nursing Homes”. J Am Med Dir Assoc 2015; 16:527. [DOI: 10.1016/j.jamda.2015.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
|
13
|
Both Intravenous and Subcutanous Infusion Can Be Done in Nursing Homes. J Am Med Dir Assoc 2015; 16:527. [DOI: 10.1016/j.jamda.2015.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 11/17/2022]
|