Screening for hospitalization and nutritional risks among community-dwelling older persons

A hybrid machine learning framework to improve prediction of all-cause rehospitalization among elderly patients in Hong Kong

BACKGROUND

Accurately estimating elderly patients' rehospitalisation risk benefits clinical decisions and service planning. However, research in rehospitalisation and repeated hospitalisation yielded only models with modest performance, and the model performance deteriorates rapidly as the prediction timeframe expands beyond 28 days and for older participants.

METHODS

A temporal zero-inflated Poisson (tZIP) regression model was developed and validated retrospectively and prospectively. The data of the electronic health records (EHRs) contain cohorts (aged 60+) in a major public hospital in Hong Kong. Two temporal offset functions accounted for the associations between exposure time and parameters corresponding to the zero-inflated logistic component and the Poisson distribution's expected count. tZIP was externally validated with a retrospective cohort's rehospitalisation events up to 12 months after the discharge date. Subsequently, tZIP was validated prospectively after piloting its implementation at the study hospital. Patients discharged within the pilot period were tagged, and the proposed model's prediction of their rehospitalisation was verified monthly. Using a hybrid machine learning (ML) approach, the tZIP-based risk estimator's marginal effect on 28-day rehospitalisation was further validated, competing with other factors representing different post-acute and clinical statuses.

RESULTS

The tZIP prediction of rehospitalisation from 28 days to 365 days was achieved at above 80% discrimination accuracy retrospectively and prospectively in two out-of-sample cohorts. With a large margin, it outperformed the Cox proportional and linear models built with the same predictors. The hybrid ML revealed that the risk estimator's contribution to 28-day rehospitalisation outweighed other features relevant to service utilisation and clinical status.

CONCLUSIONS

A novel rehospitalisation risk model was introduced, and its risk estimators, whose importance outweighed all other factors of diverse post-acute care and clinical conditions, were derived. The proposed approach relies on four easily accessible variables easily extracted from EHR. Thus, clinicians could visualise patients' rehospitalisation risk from 28 days to 365 days after discharge and screen high-risk older patients for follow-up care at the proper time.

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

PURPOSE

Polypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI.

METHODS

This secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons' Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI.

RESULTS

Among 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains.

CONCLUSION

In a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.

Rapid Fire: Polypharmacy in the Geriatric Patient

Increasing prescription drug use trends in the United States affects patients across all ages, but especially the geriatric patient. As patients age, they are at increased risk for adverse events owing to natural changes in body composition and organ function, increased sensitivity to medications, and a higher chance of adverse events from drug-drug interactions and polypharmacy. Falls are common and can increase morbidity and mortality. To mitigate falls, it is imperative to have a comprehensive approach to screening home medication lists, be aware of and avoid high-risk medications, and deprescribe agents that are potentially inappropriate for this patient population.

Is mini-nutritional assessment a reliable tool in detecting malnutrition in elderly with body weight excess?

PURPOSE

The rising proportion of elderly population in high-income societies has resulted in increasing number of subjects with chronic disabling diseases and nutritional deficiency. Elderly's nutritional status is usually assessed through the mini-nutritional assessment (MNA^®). However, its effectiveness may be influenced by weight excess or obesity. We tested the performance of MNA^® questionnaire in subjects aged ≥ 65 years from Northern Sardinia, Italy, according to overweight/obesity, and we tried to identify the factors associated with malnutrition.

METHODS

A modified version of MNA^® (mMNA) test, not including BMI, was compared with the conventional MNA^® (cMNA) test, and the overall test performance was assessed by calculating sensitivity, specificity and accuracy. In addition, indexes of cognitive health, disability, comorbidity and polypharmacy were compared between patients with concordant and discordant MNA tests.

RESULTS

cMNA^® sensitivity, specificity and accuracy were 67%, 99% and 84% compared with the mMNA test, due to malnourished patients misclassified as normal because of excess weight. Predictors of malnutrition were: depression (p < 0.0001), disability (p < 0.0001) and polypharmacy (p < 0.0001). Interestingly, the average scores of the "global", "subjective" and "dietary" components of the cMNA^®, were significantly lower compared with the corresponding scores of the mMNA.

CONCLUSIONS

Excess of weight, a condition progressively rising in the elderly population, may reduce the performance of cMNA^® test in detecting malnutrition.

LEVEL OF EVIDENCE

Level III, case‒control analytic study.

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

The objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61-84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011-2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387-0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072-2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population.

MATERIALS AND METHODS

We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications.

RESULTS

Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3-2.8]). PIM was associated with adverse outcomes in 3 of 11 studies.

CONCLUSION

PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies.

IMPLICATIONS FOR PRACTICE

Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.

A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial

BACKGROUND

Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number of medications among older patients.

METHODS

The Shed-MEDS study is a 5-year, randomized controlled clinical intervention trial comparing a patient-centered describing intervention with usual care among older (≥50 years) hospitalized patients discharged to PAC, either a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IPR). Patient measurements occur at hospital enrollment, hospital discharge, within 7 days of PAC discharge, and at 60 and 90 days following PAC discharge. Patients are randomized in a permuted block fashion, with block sizes of two to four. The overall effectiveness of the intervention will be evaluated using total medication count as the primary outcome measure. We estimate that 576 patients will enroll in the study. Following attrition due to death or loss to follow-up, 420 patients will contribute measurements at 90 days, which provides 90% power to detect a 30% versus 25% reduction in total medications with an alpha error of 0.05. Secondary outcomes include the number of medications associated with geriatric syndromes, drug burden index, medication adherence, the prevalence and severity of geriatric syndromes and functional health status.

DISCUSSION

The Shed-MEDS trial aims to test the hypothesis that a patient-centered deprescribing intervention initiated in the hospital and continuing through the PAC stay will reduce the total number of medications 90 days following PAC discharge and result in improvements in geriatric syndromes and functional health status. The results of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities.

TRIAL REGISTRATION

This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.

Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review

OBJECTIVES

To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons.

DESIGN

Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014).

SETTING

Community.

PARTICIPANTS

Observational studies examining health outcomes according to number of prescription medications taken.

MEASUREMENTS

Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding.

RESULTS

Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor.

CONCLUSION

Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.

Relationship between universal health outcome priorities and willingness to take medication for primary prevention of myocardial infarction

OBJECTIVES

To determine how well universal health outcome priorities represent individuals' preferences in specific clinical situations.

DESIGN

Observational cohort study.

SETTING

Community.

PARTICIPANTS

Community-dwelling adults aged 65 and older (N = 357).

MEASUREMENTS

Participants used three tools assessing universal health outcome priorities related to two common trade-offs: quality versus quantity of life and future health versus present inconveniences and burdens of treatment. The tools' ability to identify participants who were unwilling to take a medication that reduced the risk of myocardial infarction but caused dizziness and fatigue was analyzed.

RESULTS

There were consistent and significant associations between unwillingness to take the medication and prioritizing quality of life or future health for all three tools in the expected direction (P < .05). Despite these associations, the positive (PPV) and negative predictive values for the tools were generally modest (0.49-0.83). The tool with the most specific statements resembling the medication scenario had the best specificity (0.97) and PPV (0.83).

CONCLUSION

Universal health outcome priorities only modestly identified older persons who would be unwilling to take a medication for primary prevention of myocardial infarction that causes adverse effects. Although tools that are the most general in their assessment of priorities have the benefit of being applicable across the widest range of scenarios, tools with greater specificity may be necessary to inform individual treatment decisions.

Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

Objective:

The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients.

Materials and Methods:

A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18.

Results:

Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP.

Conclusion:

We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.

Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients

AIM

The aim of this study was to assess the occurrence of polypharmacy and excessive polypharmacy in very old hospitalized patients based on their comorbidities.

METHODS

The documentation of patients aged 80 years or older admitted to our department in the year 2010 was analyzed. Based on the Charlson index of comorbidity, a multiple logistic regression model with stepwise backward elimination was performed. Patients were stratified by gender and four age-groups, and factors of a change in the number of medications during the hospital stay were assessed.

RESULTS

Chronic pulmonary disease [odds ratio (OR): 2.40], diabetes mellitus with (OR: 4.65) or without (OR: 1.65) microvascular complications, congestive heart failure (OR: 2.37), connective tissue disease (OR: 3.02), and peripheral vascular disease (OR: 2.30) were statistically significantly associated with polypharmacy, while some of these diseases were also associated with excessive polypharmacy. The number of medications showed a gradual decrease with age, which was concordant with a decrease in total Charlson index score. "Admission for myocardial infarction" was associated with an increase in pharmaceuticals during hospital stay, whereas a known diagnosis of dementia or metastatic malignant disease was protective against a further increase in medications.

CONCLUSIONS

Several medical conditions seem to predispose to polypharmacy in very old patients. To attain old age seems to be associated with few comorbidities, which reduces the need for a high number of pharmaceuticals. Physicians should pay attention to the identified predictors in very old patients, as polypharmacy may lead to adverse events and unnecessary hospitalization.

The association of dietary patterns and weight change in rural older adults 75 years and older

Little is known about the relationship between weight change and dietary patterns (DP) in older adults, especially in those of advanced age (≥ 75 years). We examined the association of DP with obesity and five-year weight change in community-dwelling older adults (n = 270; mean ± SD age: 78.6 ± 3.9 years). Dietary data were collected from four, random, 24-hour dietary recalls over a 10-month period. Weight change was examined as: (1) 10-pound weight loss; (2) 10-pound weight gain; (3) 10% weight loss; and (4) 10% weight gain. Cluster analysis was used to derive 3 DP ("Health-conscious," "Sweets and dairy," and "Western"). Kaplan-Meier plots and Cox proportional hazards regression models were used. About 39% of participants lost at least 10 pounds during follow up. In the unadjusted model, five-year weight loss was not associated with dietary pattern. However, when stratified by gender, females who were characterized by the Sweets and Dairy and the Western DP were three and two times more likely to lose 10 pounds, respectively, compared to those in the Health-conscious DP (P < 0.05). These observations suggest that it is appropriate to recommend a Health-conscious DP for women 75 years and older who may be at risk for weight loss.

Segurança alimentar em domicílios chefiados por idosos, Brasil

A segurança alimentar nos domicílios chefiados por idosos tem uma dimensão especial no que se refere às condições de saúde e bem-estar, uma vez que parece evidente a importância de garantir a este contingente populacional a possibilidade de continuar a contribuir na sociedade de forma ativa e produtiva. OBJETIVO: Determinar a prevalência de insegurança alimentar em domicílios cujos chefes são idosos, segundo características sociodemográficas. MÉTODOS: Trata-se de estudo descritivo com domicílios cujos chefes têm 60 anos ou mais de idade declarada, selecionados da Pesquisa Nacional de Amostra de Domicílios - PNAD 2004. Empregou-se a Escala Brasileira de Insegurança Alimentar, classificando-se os domicílios em segurança alimentar e insegurança alimentar leve, moderada e grave. A análise descritiva dos dados incluiu a distribuição de frequência dos domicílios de acordo com os níveis de insegurança alimentar nos estratos das variáveis sociodemográficas, levando-se em consideração o efeito do desenho. RESULTADOS: O estudo mostrou que 29,8% dos domicílios se encontravam na condição de insegurança alimentar e que tal condição estava significativamente associada com regiões menos abastadas (Norte/Nordeste, rural), com os segmentos populacionais mais desfavorecidos (mais pobres e menos escolarizados) e, ainda com características de gênero (mulheres) e raciais (indígenas, pardos e pretos) as quais sabidamente ocupam os níveis inferiores da hierarquia social. CONCLUSÃO: A distribuição da insegurança alimentar em domicílios chefiados por idosos segue tendência similar dos domicílios brasileiros, ratificando a maior prevalência desta condição nos estratos socioeconômicos mais desfavorecidos da população ou entre características associadas à pobreza.

Differences in medication use in the Alzheimer's disease neuroimaging initiative: analysis of baseline characteristics

INTRODUCTION

The ADNI (Alzheimer's Disease Neuroimaging Initiative) is a large longitudinal study of patients with probable Alzheimer's disease (AD), patients with mild cognitive impairment (MCI) and healthy elderly controls followed for at least 2-3 years. Many participants in the ADNI are being treated with medications, and these may have beneficial or deleterious effects.

OBJECTIVE

The goal of the study was to characterize baseline medication use in the ADNI.

METHODS

Diagnosis, demographics, medication status, psychometric data and MRI measures of hippocampal volume and entorhinal cortex thickness were obtained for 818 participants from the ADNI cohort. Total number of medications, Beers list (potentially dangerous) medications and AD treatments were also tabulated. ANOVA and logistic regression were used to assess associations between baseline pharmacotherapy and diagnosis, demographics, and selected clinical and MRI variables.

RESULTS

Of the 818 enrolled ADNI participants, 809 were available for analysis in the present study, including 184 patients with AD, 399 patients with MCI and 226 healthy elderly controls. Significant gender differences in recruitment were observed in the MCI group. The average number of medications per participant was 8 (SD 4) and 22% reported treatment with one or more Beers list medications. For symptomatic treatment of MCI or AD, donepezil and memantine were the most commonly reported drugs. As expected, MCI and AD patients with more severe impairment were more likely to be treated. Men received treatment more frequently than women. Older subjects and those with less education were less likely to receive treatment.

CONCLUSIONS

AD and MCI participants from the ADNI cohort were being treated with polypharmacy and many were also taking one or more medications with the potential for adverse effects. Off-label use of cholinesterase inhibitors and/or memantine for MCI was common, with more severely affected patients most likely to receive treatment. Differences in the frequency of symptomatic treatment were also observed as a function of age, years of education, gender and disease severity.

A hospital-based multidisciplinary approach improves nutritional status of the elderly living in long-term care facilities in middle Taiwan

Improvement in nutritional status using two different care models was assessed in 374 elderly people (mean +/- S.D. age = 78.8+/-7.2 years) living in eight long-term care facilities in middle Taiwan. The subjects were divided into two groups using randomized block design; a hospital-based multidisciplinary team was responsible for the care of the intervention group, and the control group received usual care for 6 months. A structured questionnaire, anthropometric measurements, and biomedical markers were checked for each subject before and after the intervention. No significant differences were observed in age, height, weight, body mass index, hemoglobin, and albumin between the intervention (n = 125) and control (n = 249) groups at baseline. After 6 months of intervention, 83 subjects in the intervention group and 182 subjects in the control group had completed the study. The change in albumin level was greater in the intervention group (1.58 g/l) than in the control group (0.15 g/l, p < 0.05). The prevalence of hypoalbuminemia (albumin < 35 g/l) decreased from 69.2% to 52.9% in the intervention group and from 70.3% to 67.0% in the control group. In conclusion, a hospital-based multidisciplinary care effectively improved the nutritional status of elderly patients living in long-term care facilities in middle Taiwan.

Polypharmacy in older adults with cancer

The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.

Nutrition Risk in Home-Bound Older Adults: Using Dietician-Trained and Supervised Nutrition Volunteers for Screening and Intervention

Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n= 29) and volunteers (n= 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS©inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (≥80%) for most items but was higheramongvolunteers thanbetweenvolunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

The ability of the DETERMINE checklist to predict continued community-dwelling in rural, white women

This study evaluated the ability of the DETERMINE checklist to predict continued community-dwelling in rural elderly women. Using a stratified random sample (N = 249) of white women aged 65-94, in-home interviews were completed at baseline and a telephone interview at 3 years. Overall higher total DETERMINE checklist scores negatively predicted continued community-dwelling (p = 0.0005). Lower risk scores indicated continued community-dwelling, while mid-range scores were inconclusive. Regression analysis for each age bracket showed that total DETERMINE checklist scores was most predictive of those aged 75-84 (p = 0.0037). The DETERMINE checklist may be a useful tool to identify those with increased risk of losing independence.

A Single-Item Approach to Screening Elders for Oral Health Assessment

BACKGROUND

Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important.

OBJECTIVES

The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care.

METHODS

This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment.

RESULTS

A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n = 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n = 93), the item was less effective.

DISCUSSION

A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.

Older adults in the rural South are not meeting healthful eating guidelines

OBJECTIVE

To evaluate diet quality of rural older adults using national dietary guidelines and the Healthy Eating Index (HEI).

DESIGN

Five to six 24-hour recalls were conducted at monthly intervals over a 6-month period, using the Nutrition Coordinating Center food grouping system to calculate intake.

SUBJECTS

Included in this cross-sectional study were 63 females and 59 males aged 65 to 93 years residing in two rural North Carolina counties; one third of each sex group was African American, Native American, or white. Inclusion criteria included age>65 years, education<or=12 years, and low income.

ANALYSES

HEI scores were computed from the average of the recalls, and compared using one-way analysis of variance. Multiple regression modeling was utilized to evaluate effects of demographic and self-reported health variables on HEI score.

RESULTS

Most study participants did not meet minimum Food Guide Pyramid recommended servings of grains, fruits, vegetables, and dairy. They exceeded recommendations for discretionary calorie servings (median=3.3 and 5.3 for females and males, respectively). Using the HEI, 24% had poor diets, 75% needed improvement, and only 1% had good diets. Of the participants with an eighth-grade education or less, men had a mean HEI score 9.6 units lower than women.

CONCLUSION

These rural adults are not meeting recommended nutrition guidelines, and most are consuming diets considered poor or needing improvement. Health care providers should recognize barriers that put these older adults at risk for poor nutrition and should be prepared to initiate referrals to community resources. Nutrition counseling should include strategies to increase whole grain, fruit, vegetable, and reduced-fat dairy consumption with the ultimate goal of improving dietary intake to prevent declines in functional status and independence associated with aging.

Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice

In recent years there has been a proliferation of nutrition screening tools but undernutrition remains prevalent amongst older subjects. Screening tools commonly include BMI as the widely-accepted ‘gold standard’ indicator of malnutrition. Whilst BMI may be an appropriate tool for population studies when it can be measured accurately in research conditions, the use of BMI in clinical practice may mask important weight changes and result in a failure to alert healthcare staff to a nutritional problem. The inclusion of BMI has been identified as a barrier to completing the screening process at ward level. Also, feedback from dietitians working with older subjects indicates that 72.5% of those using BMI express concerns that it is of limited use for practical reasons or that the reference range (20–25 kg/m2) is not appropriate to older subjects. Further evidence questions whether or not BMI is applicable for inclusion in methods used to identify an older subject at risk of undernutrition in a variety of care settings. In view of these findings it is advocated that weight change over a period of time together with clinical judgement is a far superior prognostic indicator of undernutrition. Despite screening, there is evidence that inpatients continue to lose weight before discharge. Further experiential evidence from both community and ward settings suggests that inadequacies in care planning, food provision and a lack of assistance with feeding are common. In order to improve the management of undernutrition in older subjects it is therefore recommended that the focus of attention should be on addressing these practical issues and on the effective monitoring of these processes.

A dietary screening questionnaire identifies dietary patterns in older adults

Dietary patterns reflect habitual exposure of foods and nutrients and are a preferred means to assess diet and disease relations. Our objective was to design a screening tool to assess diet quality and dietary patterns among older adults and to relate the patterns to markers of general health and nutrition status. We used a population-specific data-based approach to design a diet screening instrument that was tested among subjects sampled from the Geisinger Rural Aging Study cohort (n=205). All participants attended a local clinic and had biochemical, anthropometric, and other health data collected. Dietary information was obtained via 24-h recall. We used principle components analysis to derive dietary patterns, which were then compared with nutritional outcomes using Pearson partial correlations, controlling for energy, age, BMI, and supplement use. Two dietary patterns were derived; 1 represented by more healthful foods and 1 by less optimal food choices. The healthy pattern was associated with more favorable biomarkers, more nutrient-dense diets, and lower waist circumference, whereas the converse was true for the second pattern. A screening tool can be used by older adults to identify dietary patterns that may relate to nutritional risk.

Inflammation as the key interface of the medical and nutrition universes: a provocative examination of the future of clinical nutrition and medicine

There has been tremendous interest in inflammation by researchers, the medical community, and the lay public. Modulation of injury response is felt to represent a tenuous balance of pro- and anti-inflammatory cytokines. Adverse outcomes may result from severe, sustained, or repeated bouts of inflammation. A critical observation is that nutrition support alone is inadequate to prevent muscle loss during active inflammation. It is necessary to take inflammation into consideration in conducting appropriate nutrition assessment, intervention, and monitoring. A host of medical conditions are actually inflammatory states that have important implications for nutrition care. Multifaceted interventions that may include anti-inflammatory diets, glycemic control, physical activity, appetite stimulants, anabolic agents, anti-inflammatory agents, anticytokines, and probiotics, will be necessary to blunt undesirable aspects of inflammatory response to preserve body cell mass and vital organ functions. Nutrition practitioners can seize this opportunity to be a part of the future medical team that brings highly individualized patient care to the bedside.

Outcomes of antipsychotic drug use in community-dwelling elders with dementia

This study used administrative data from a large health care insurer in the southeast United States to describe the utilization pattern and health care outcomes of antipsychotic drug use in community-dwelling elders with dementia. Claims data from 959 unique cases were analyzed to address research aims. Overall, 27% of the sample was dispensed antipsychotic drugs, with the most prevalent type being atypical antipsychotic drugs. Individuals on any type of antipsychotic drug experienced more delirium, depression, hip fracture, falls, and syncope than those not on these drugs, even after controlling for age, sex, comorbidity, and number of other drugs prescribed. Implications for practice are discussed.

Predicting the risk of hospital admission in older persons--validation of a brief self-administered questionnaire in three European countries

OBJECTIVES

To validate the Probability of Repeated Admission (Pra) questionnaire, a widely used self-administered tool for predicting future healthcare use in older persons, in three European healthcare systems.

DESIGN

Prospective study with 1-year follow-up.

SETTING

Hamburg, Germany; London, United Kingdom; Canton of Solothurn, Switzerland.

PARTICIPANTS

Nine thousand seven hundred thirteen independently living community-dwelling people aged 65 and older.

MEASUREMENTS

Self-administered eight-item Pra questionnaire at baseline. Self-reported number of hospital admissions and physician visits during 1 year of follow-up.

RESULTS

In the combined sample, areas under the receiver operating characteristic curves (AUCs) were 0.64 (95% confidence interval (CI)=0.62-0.66) for the prediction of one or more hospital admissions and 0.68 (95% CI=0.66-0.69) for the prediction of more than six physician visits during the following year. AUCs were similar between sites. In comparison, prediction models based on a person's age and sex alone exhibited poor predictive validity (AUC <or= 0.57). High-risk individuals (Pra score >or= 0.5) were 2.3 times as likely (95% CI=2.1-2.6) as low-risk individuals to have a hospital admission, and 2.1 times as likely (95% CI=2.0-2.2) to have more than six physician visits.

CONCLUSION

The Pra instrument exhibits good validity for predicting future health service use on a population level in different healthcare settings. Administrative data have shown similar predictive validity, but in practice, such data are often not available. The Pra is likely of high interest to governments and health insurance companies worldwide as a basis for programs aimed at health risk management in older persons.

Comparative strategies for using cluster analysis to assess dietary patterns

OBJECTIVES

To characterize dietary patterns using two different cluster analysis strategies.

DESIGN

In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit.

SUBJECTS

One hundred seventy-nine community-dwelling adults, aged 66 to 87 years, in rural Pennsylvania.

STATISTICAL ANALYSIS

Cluster analysis was performed.

RESULTS

The methods differed in the food subgroups that clustered together. Both methods produced clusters that had significant differences in overall diet quality as assessed by Healthy Eating Index (HEI) scores. The clusters with higher HEI scores contained significantly higher amounts of most micronutrients. Both methods consistently clustered subgroups with high energy contribution (eg, fats and oils and dairy desserts) with a lower HEI score. Clusters resulting from the percent energy method were less likely to differentiate fruit and vegetable subgroups. The higher diet quality dietary pattern derived from the number of servings method resulted in more favorable weight status.

CONCLUSIONS

Cluster analysis of food subgroups using two different methods on the same data yielded similarities and dissimilarities in dietary patterns. Dietary patterns characterized by the number of servings method of analysis provided stronger association with weight status and was more sensitive to fruit and vegetable intake with regard to a more healthful dietary pattern within this sample. Public health recommendations should evaluate the methodology used to derive dietary patterns.

The anorexia of aging in humans

Energy intake is reduced in older individuals, with several lines of evidence suggesting that both physiological impairment of food intake regulation and non-physiological mechanisms are important. Non-physiological causes of the anorexia of aging include social (e.g. poverty, isolation), psychological (e.g. depression, dementia), medical (e.g. edentulism, dysphagia), and pharmacological factors. Physiological factors include changes in taste and smell, diminished sensory-specific satiety, delayed gastric emptying, altered digestion-related hormone secretion and hormonal responsiveness, as well as food intake-related regulatory impairments for which specific mechanisms remain largely unknown. Studies in healthy elderly individuals have shown that men who consume diets over several weeks providing either too few or too many calories relative to dietary energy needs subsequently do not compensate for the resulting energy deficit or surplus when provided an ad libitum diet. Healthy elders have also been shown to be less hungry at meal initiation and to become more rapidly satiated during a standard meal compared to younger adults. Studies in animal models are required to investigate potential mechanisms underlying these observations, while human studies should focus on examining the potential consequences of this phenomenon and practical therapeutic strategies for the maintenance of appropriate energy intake with increasing age. In light of this need, we have recently demonstrated that low reported hunger assessed using a simple questionnaire predicts unintentional weight loss in a sample of healthy older women, and thus may provide a clinically useful tool for identifying older individuals at risk for undesirable weight change and therefore at high priority for intervention.

Obesity is a risk factor for reporting homebound status among community-dwelling older persons

OBJECTIVE

To test the a priori hypothesis that obesity is a predictor of risk for reporting homebound status.

RESEARCH METHODS AND PROCEDURES

A longitudinal cohort study was conducted with 21,645 community-dwelling men and women 65 to 97 years old. A nutrition risk screen was administered baseline between 1994 and 1999 and again 3 to 4 years later. Univariate analyses identified baseline variables associated with subsequent reporting of homebound status. Multivariable logistic regression models were created to identify baseline variables that were significant independent predictors of reporting homebound status.

RESULTS

At baseline, 24% of the cohort had BMI > or = 30. There were 12,834 (45% men) respondents at follow-up (68% response). Non-responders at follow-up differed little from responders except for greater baseline age (72.2 +/- 6.2 vs. 71.4 +/- 5.6 years, p < 0.001) and reporting of any functional limitations (9.2% vs. 4.9%, p < 0.001). At follow-up, those who reported homebound status (n = 169) were significantly (p < 0.001) older (80.3 +/- 7.3 vs. 75.1 +/- 5.5 years) and more likely to report functional limitations (83.4% vs. 10.8%). Univariate analyses identified 16 baseline variables that were eliminated stepwise until five significant independent predictors remained: age > or = 75 years (2.21, 1.55 to 3.15/odds ratio, 95% confidence interval), BMI > or = 35 (1.75, 1.04 to 2.96), poor appetite (2.50, 1.29 to 4.86), low income (1.59, 1.00 to 2.56), and any functional limitation (10.67, 7.36 to 15.46).

DISCUSSION

Obesity remained a significant independent predictor for reporting homebound status and should be considered in screening of older populations and in the planning, implementation, and evaluation of services for homebound older persons.

Health outcomes and polypharmacy in elderly individuals: an integrated literature review

The purpose of this integrated literature review was to determine the extent of research available related to polypharmacy and its effect on the health outcomes of the elderly population. A search of the Cumulative Index of Nursing and Allied Health Literature and Medline was conducted for studies published between 1995 and 2003 that linked polypharmacy and outcomes in the elderly population. The 16 studies in this integrative literature review were conducted in the United States, Canada, Australia, and Europe. Polypharmacy was shown to be a statistically significant predictor of hospitalization, nursing home placement, death, hypoglycemia, fractures, impaired mobility, pneumonia, and malnutrition. The effect of polypharmacy on elderly individuals is significant as demonstrated by this literature review. Nurses are in a unique position to monitor and potentially eliminate adverse effects of a complex medication regimen. Nursing research on polypharmacy and its effects on nursing-sensitive outcomes will help define guidelines for prevention and intervention.

Hospital Readmission From a Transitional Care Unit

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.

Nutrition risk screening: the interrelationship of food insecurity, food intake, and unintentional weight change among homebound elders

Nutrition risk screening is a key component of the homedelivered meals program. To examine direct and indirect relationships among individual components of nutrition risk, path analysis was conducted on routinely collected data from 908 homebound elders who received home-delivered meals. The good fit of the model revealed that specific nutrition risk factors and indicators of nutritional risk were directly and indirectly associated with meal frequency and unintended weight change. With the heightened vulnerability for poor nutritional health among homebound elders who report food insecurity, policymakers and service providers should strengthen efforts to target individual components of nutrition risk rather than aggregate scores or categorical measures.

Persistent oral health problems associated with comorbidity and impaired diet quality in older adults

Chewing, swallowing, and mouth pain (CSP) are identified as indicators of nutritional risk in older adults. Previous research has shown that oral health problems in community-living older rural adults were associated with increased hospitalization. The purpose of this study was to characterize older adults with self-reported persistent CSP problems at baseline and one-year follow-up. Participants were from the Geisinger Rural Aging Study, either with persistent oral problems (PCSP; n=22) or without problems (NCSP; n=125). Demographic, health, and anthropometric data were collected via home visit; diet information was assessed by five, 24-hour recalls collected over 10 months. PCSP subjects reported almost twice the number of medications (4.2 vs 2.6, respectively, P=.008) and diseases (7.0 vs 4.2, respectively, P=.001), with higher occurrence of type 2 diabetes mellitus, peptic ulcers/gastritis, and angina. PCSP participants had lower Healthy Eating Index scores (66.6 vs 70.6, respectively, P=.04), significantly lower intakes of vitamin A, and higher prevalence of inadequate intakes of vitamins B-6 and A. These results indicate that impaired intake of certain foods and nutrients is associated with persistent oral health problems. Oral status is an important component of overall health and should be monitored for intervention.

Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira

As alterações do estado nutricional (desnutrição e obesidade) são relacionadas com sérios agravos para a saúde. O presente trabalho de revisão da literatura tem por objetivo descrever os principais métodos de avaliação do estado nutricional, com finalidade de facilitar o diagnóstico dos problemas nutricionais e acompanhar intervenções dietoterápicas. Descreve o método clínico, detalha aspectos da antropometria e os exames laboratoriais utilizados em avaliação do estado nutricional. Relaciona alguns dos principais índices múltiplos, utilizados tanto com fins diagnósticos e prognósticos. Informa a respeito da impedância bioelétrica, completando abordagem sobre os métodos convencionais, além de descrever as principais vantagens e desvantagens dos métodos não-convencionais. Finaliza com revisão sobre a situação nutricional da população brasileira, através da análise de dados obtidos em três inquéritos populacionais (1974, 1989, 1997).

Nutritional Risk Predicts Quality of Life in Elderly Community-Living Canadians

BACKGROUND

Although nutrition parameters have been linked to quality of life (QOL), few studies have determined if nutritional risk predicts changes in QOL over time in older adults.

METHODS

367 frail older adults were recruited from 23 service agencies in the community. Baseline interview included nutritional risk as measured by SCREEN (Seniors in the Community: Risk Evaluation for Eating and Nutrition), as well as a wide variety of covariates. Participants were contacted every 3 months for 18 months to determine QOL as measured by three questions from the Behavioral Risk Factor Surveillance System (BRFSS), a general whole-life satisfaction question, and a general change in QOL question. "Good physical health days" from the BRFSS was the focus of bivariate and multivariate analyses, adjusting for influential covariates.

RESULTS

Seniors with high nutritional risk had fewer good physical health days and whole-life satisfaction at each follow-up point compared with those at low risk. In general, participants reported decreases in general QOL from baseline, with those in the moderate nutritional risk category most likely to report this change. Nutritional risk predicted change in good physical health days over time. Other important covariates include: gender, number of health conditions, perceived health, and age.

CONCLUSIONS

Nutritional risk is an independent predictor of change in health-related QOL. The results also indicate a relationship between nutrition and the more holistic view of QOL. Evaluation studies of interventions for older adults need to include QOL measures as potential outcomes to further demonstrate the benefits of good nutrition.

Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors?

OBJECTIVES

We assessed which factors contribute to the high level of nutritional risk detected by the Mini Nutritional Assessment (MNA) test in institutionalized older women. To this end, we undertook a complete nutritional assessment.

METHODS

A cross-sectional study in 89 older women (age range, 72-98 y) living in two private nursing homes in Granada (Spain) was carried out. The MNA test was used as an assessment tool to detect nutritional risk. The nutritional assessment included anthropometric measurements (body mass index, triceps and subscapular skinfold thicknesses, and mid-arm and calf circumferences), quantification of dietary intake (7-d weighed-food records), clinical and functional evaluations (number of drugs, Katz index, and Red Cross cognitive scale), and biological markers (albumin, prealbumin, transferrin, and lymphocyte counts).

RESULTS

We found that 7.9% (n = 5) of the older women were malnourished (MNA score, 14.5 +/- 1.4), 61.8% (n = 56) were at risk of malnutrition (MNA score, 20.6 +/- 2.1), and 30.3% (n = 28) were well nourished (MNA score, 25.0 +/- 1.1) according to the MNA test.

CONCLUSIONS

This high prevalence of risk of malnutrition detected by the MNA test in healthy institutionalized older women was due mainly to risk situations and self-perception of health and did not depend on age. Inadequate micronutrients intake may contribute to the development of malnutrition in this population.

Effects of two models of nutritional intervention on homebound older adults at nutritional risk

OBJECTIVE

To test the feasibility of two models of home meal delivery with Meals-on-Wheels (MOW) applicants who were identified as being malnourished or "at-risk" as determined by the validated Mini Nutritional Assessment (MNA).

DESIGN

A 6-month, prospective comparative study of two nutrition intervention models with data collection at baseline, 3 months, and 6 months. Randomized treatment assignment was followed, with a few exceptions linked to particular client circumstances.

SUBJECTS

A total of 203 older adults (age range = 60 to 90 years) newly applying for homebound meal service were enrolled. At baseline, the body mass index (BMI) was 26.3+/-7.2 (mean+/-SD) in the "Traditional" MOW model (101 subjects including 30 malnourished), and the BMI was 27.6+/-9.0 in the "New" MOW model (102 subjects including 26 malnourished) (P = ns).

INTERVENTION

Study participants received either the Traditional MOW program of five hot meals per week, meeting 33% of the Daily Reference Intake (DRI) or the restorative, comprehensive New MOW program of three meals and two snacks per day, 7 days a week, meeting 100% of the DRI. Assessments were conducted in the home of the participants. Main outcome measures The MNA was used to evaluate nutritional risk and status of participants at baseline, 3 months, and 6 months. Standardized functional impairment scales, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) evaluated limitations in activities of daily living and life management skills. Statistical analysis Comparisons between treatment groups were calculated with t tests or Wilcoxon rank-sum tests when appropriate. Comparisons among time periods between treatment groups were conducted with repeated measures analysis of variance. A general linear model was used to evaluate the relationship between change in functional status and BMI, controlling for sex.

RESULTS

The New MOW group gained significantly more weight between baseline and 3 months than did the Traditional MOW group (2.78 lb vs -1.46 lb, respectively, P =.0120) and again between baseline and 6 months (4.30 lb vs -1.72 lb, respectively, P =.0004). MNA improved faster in the New MOW group. Functional change appeared to be related more to BMI and age than to treatment intervention. The malnourished participants in both groups took longer to affect positive change in nutrition measurements, with the New MOW group showing the most improvement over the 6-month measurement period. Both delivery models were well accepted.

CONCLUSIONS

Applicants for home meal delivery have varying nutrition needs. By addressing nutritional risk, interventions can be targeted to meet these needs. A new, restorative, comprehensive meal program improved nutritional status and decreased nutritional risk and can possibly impact independence and functionality.

Nutritional risk assessment and obesity in rural older adults: a sex difference

BACKGROUND

Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators.

OBJECTIVE

This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk.

DESIGN

This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers.

RESULTS

Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference).

CONCLUSIONS

Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.

Variations in nutritional risk among black and white women who receive home-delivered meals

The maintenance of good nutritional status is a cornerstone of health, function, and quality of life. To assess indicators and correlates of high levels of nutritional risk, sociodemographic, functional status, and nutritional data were collected from a diverse sample of 729 older women. Results from ordered logit analysis indicated that being Black, having an income < or = 125% of the federal poverty level, living alone, and being in the younger-old age group (ages 60 to 74 years) were associated with moderately high and very high levels of nutritional risk. An examination of individual and multiple nutritional risk indicators suggested a heightened vulnerability of Black women to inadequate dietary intake, even net of income and other influential variables. With demographic projections of an increasingly numerous and diverse older population who may face health and nutritional challenges, researchers must strengthen efforts to assist policymakers and service providers to properly target nutrition services.

Oral health, nutrient intake and dietary quality in the very old

BACKGROUND

Limited food choices and inadequate nutrient intake are linked to poor oral health. The authors describe relationships between dietary variety, nutrient intake and oral health measures in community-dwelling, rural Iowans aged 79 years and older.

METHODS

Dental examinations were conducted by trained and calibrated examiners, and trained interviewers completed standardized interviews in subjects' homes. Subjects (n = 220) then completed three-day dietary records. Adequate nutrient intakes were defined using the Dietary Reference Intakes of the Food and Nutrition Board of the National Academy of Sciences.

RESULTS

Mean daily nutrient intakes were significantly lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures than in subjects who had more teeth or did not have these problems. Adequacy of intakes was lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures. Mean daily nutrient intakes did not differ between subjects with well-fitting dentures (either complete or partial) and subjects with natural teeth. Neither mean daily intake nor adequacy of intake was associated with subjects' perceptions of oral health problems, chewing difficulties or temperature sensitivity.

CONCLUSIONS

The presence of natural teeth and well-fitting dentures were associated with higher and more varied nutrient intakes and greater dietary quality in the oldest old Iowans sampled. Clinical Implications. Maintenance of natural dentition or provision and maintenance of adequate mandibular prostheses are important for nutrient intakes to support systemic health.

Facilitated feeding in disabled elderly

Nutrition and health are major concerns to older individuals. Whereas illness associated with overnutrition has been well characterized, poor health associated with undernutrition has received less attention. Malnutrition continues to plague the elderly in developed and underdeveloped countries alike, and is becoming of more concern as global demographic changes predict increasing proportions of elderly in all societies. Nutrition influences many chronic disease processes affecting older individuals. In addition, changes in physiology, metabolism, and function accompanying aging result in altered nutritional requirements. The enhancement and maintenance of health and function are now more possible with the new knowledge of nutritional needs in old age. Designing nutritional therapy to treat malnutrition associated with illness in older patients requires an understanding of the aging processes, a careful setting of treatment goals, and multidisciplinary collaboration.