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Ono S, Sasabuchi Y, Yamana H, Yokota I, Okada A, Matsui H, Itai S, Yonenaga K, Tonosaki K, Watanabe R, Ono Y, Yasunaga H, Hoshi K. Weight loss and functional decline in older Japanese people: A cohort study using large-scale claims data. Arch Gerontol Geriatr 2024; 120:105354. [PMID: 38309105 DOI: 10.1016/j.archger.2024.105354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The association between weight loss and subsequent functional decline is uncertain. The study aims to elucidate the association between weight loss over a year and subsequent functional decline requiring assistance in performing their activities of daily living in older individuals. METHODS The study used data from the publicly funded Long-Term Care Insurance service in Japan, which provides coverage for long-term care services for individuals unable to perform activities of daily living due to physical or cognitive impairment. The study enrolled people born in or before 1949, who underwent health checkups in both 2014 and 2015. The participants were followed from 2015 to the worsening of functional decline requiring long-term care services, death, or February 28, 2019, whichever occurred first. The risk of subsequent functional decline in each weight loss category was estimated using a Cox regression model adjusted for age, sex, baseline body mass index, smoking, and Charlson comorbidity index. RESULTS We identified 67,452 eligible individuals from the database. The median follow-up period was 1,284 days. The hazard ratios (95 % confidence interval) of functional decline for -1 %, -2 %, -3 %, -4 %, and ≤-5% weight change compared to 0 % weight change were 1.17 (1.03-1.32), 1.26 (1.11-1.43), 1.29 (1.12-1.49), 1.61 (1.39-1.87), and 1.79 (1.58-1.99), respectively. CONCLUSIONS AND IMPLICATIONS Older people with weight loss of 1 % or more were at risk of functional decline. Close weight monitoring may serve as an easy and inexpensive means of identifying older individuals at risk of functional decline.
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Affiliation(s)
- Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
| | - Yusuke Sasabuchi
- Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Tochigi, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Data Science Center, Jichi Medical University, Tochigi, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shunsuke Itai
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kazumichi Yonenaga
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kanata Tonosaki
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Rinji Watanabe
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Hideo Yasunaga
- Data Science Center, Jichi Medical University, Tochigi, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kazuto Hoshi
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
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Lv Y, Zhang Y, Li X, Gao X, Ren Y, Deng L, Xu L, Zhou J, Wu B, Wei Y, Cui X, Xu Z, Guo Y, Qiu Y, Ye L, Chen C, Wang J, Li C, Luo Y, Yin Z, Mao C, Yu Q, Lu H, Kraus VB, Zeng Y, Tong S, Shi X. Body mass index, waist circumference, and mortality in subjects older than 80 years: a Mendelian randomization study. Eur Heart J 2024:ehae206. [PMID: 38626306 DOI: 10.1093/eurheartj/ehae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 02/17/2024] [Accepted: 03/19/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND AND AIMS Emerging evidence has raised an obesity paradox in observational studies of body mass index (BMI) and health among the oldest-old (aged ≥80 years), as an inverse relationship of BMI with mortality was reported. This study was to investigate the causal associations of BMI, waist circumference (WC), or both with mortality in the oldest-old people in China. METHODS A total of 5306 community-based oldest-old (mean age 90.6 years) were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998 and 2018. Genetic risk scores were constructed from 58 single-nucleotide polymorphisms (SNPs) associated with BMI and 49 SNPs associated with WC to subsequently derive causal estimates for Mendelian randomization (MR) models. One-sample linear MR along with non-linear MR analyses were performed to explore the associations of genetically predicted BMI, WC, and their joint effect with all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. RESULTS During 24 337 person-years of follow-up, 3766 deaths were documented. In observational analyses, higher BMI and WC were both associated with decreased mortality risk [hazard ratio (HR) 0.963, 95% confidence interval (CI) 0.955-0.971 for a 1-kg/m2 increment of BMI and HR 0.971 (95% CI 0.950-0.993) for each 5 cm increase of WC]. Linear MR models indicated that each 1 kg/m2 increase in genetically predicted BMI was monotonically associated with a 4.5% decrease in all-cause mortality risk [HR 0.955 (95% CI 0.928-0.983)]. Non-linear curves showed the lowest mortality risk at the BMI of around 28.0 kg/m2, suggesting that optimal BMI for the oldest-old may be around overweight or mild obesity. Positive monotonic causal associations were observed between WC and all-cause mortality [HR 1.108 (95% CI 1.036-1.185) per 5 cm increase], CVD mortality [HR 1.193 (95% CI 1.064-1.337)], and non-CVD mortality [HR 1.110 (95% CI 1.016-1.212)]. The joint effect analyses indicated that the lowest risk was observed among those with higher BMI and lower WC. CONCLUSIONS Among the oldest-old, opposite causal associations of BMI and WC with mortality were observed, and a body figure with higher BMI and lower WC could substantially decrease the mortality risk. Guidelines for the weight management should be cautiously designed and implemented among the oldest-old people, considering distinct roles of BMI and WC.
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Affiliation(s)
- Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
| | - Yue Zhang
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Xinwei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Yongyong Ren
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Luojia Deng
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Lanjing Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
| | - Bing Wu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xingyao Cui
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Zinan Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yanbo Guo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yidan Qiu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Lihong Ye
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
| | - Chenfeng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Occupational Health and Environment Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yufei Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- Department of Occupational Health and Environment Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhaoxue Yin
- Division of Non-Communicable Disease and Healthy Aging Management, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Hui Lu
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Virginia Byers Kraus
- Department of Medicine, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Yi Zeng
- Center for Study of Healthy Aging and Development Studies, Peking University, Beijing, China
| | - Shilu Tong
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China
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Dericioglu D, Methven L, Clegg ME. Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population. Proc Nutr Soc 2024:1-13. [PMID: 38557431 DOI: 10.1017/s0029665124002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.
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Affiliation(s)
- Dilara Dericioglu
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
| | - Lisa Methven
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- Food Research Group, Department of Food and Nutritional Sciences, University of Reading,Whiteknights, Reading RG6 6DZ, UK
| | - Miriam E Clegg
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Wang Y, Ma L, Pei J, Li W, Zhou Y, Dou X, Wang X. The level of life space mobility among community-dwelling elderly: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 117:105278. [PMID: 37988853 DOI: 10.1016/j.archger.2023.105278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Multiple countries have conducted surveys on the level of life space mobility for community-dwelling elderly through the Life-Space Assessment, the results vary greatly, from 41.7 to 88.6. However, there is no meta-analysis on the current situation of community-dwelling elderly life space mobility. OBJECTIVE To systematically assess the global level of life space mobility for community-dwelling elderly, to identify potential covariates such as geographical regions, survey years, gender, and age that contribute to the heterogeneity between the studies, and to identify the dynamic trend based on survey years. DESIGN Systematic review and meta-analysis. DATA SOURCES Two reviewers searched the following 8 electronic bibliographic databases from inception until May 28, 2023: PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database, China Knowledge Resource Integrated Database, WanFang, and Weipu Database. REVIEW METHODS This review was conducted using the Stata 14.1 and R 4.3.1. The Cochrane's Q statistical and I2 index were used to test for heterogenicity and assess the degree of heterogenicity, respectively. Studies were appraised using the Agency for Healthcare Research and Quality tool, the Newcastle-Ottawa Scale for the quality of cross-sectional studies, cohort studies, respectively. RESULTS A total of 29 studies were selected from databases and reference lists. The pooled score of Life-Space Assessment was 66.84 (95% CI: 63.30-70.39) and the prevalence of restricted life space was 42% (95% CI: 0.27-0.57). The geographical regions, survey years, gender were found to be a significant covariate of the pooled score of life space mobility estimate in the subgroup analysis. The mean score of Life-Space Assessment gradually achieved stability after 2017. CONCLUSIONS The life space mobility of community-dwelling elderly in the global is at a moderate level, with 42% of them experiencing restricted life space. South America, females and earlier survey years have a lower level of life space mobility. In the future, the government should identify vulnerable groups for targeted intervention to promote the level of LSM in the community-dwelling elderly. REGISTRATION PROSPERO [CRD42023443054].
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Affiliation(s)
- Yingqiao Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Li Ma
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Juhong Pei
- First College of Clinical Medicine of Lanzhou University, China
| | - Weiping Li
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yihan Zhou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinman Dou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinglei Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China; Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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Taylor RA, Bakitas M, Wells R, Dionne‐Odom JN, Kennedy R, Williams GR, Frank J, Li P. Restricted life-space mobility impacts physical but not mental quality of life in older cancer survivors. Cancer Med 2023; 13:e6850. [PMID: 38140781 PMCID: PMC10807608 DOI: 10.1002/cam4.6850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Older cancer survivors often value quality of life (QOL) over survival. Life-space mobility (LSM), defined as the individual's spatial geographic mobility range, is an important QOL indicator in older adults with chronic illnesses; however, this relationship is unexplored in older cancer survivors. METHODS We examined the longitudinal associations and causal relationships between LSM and QOL in 153 older cancer survivors (≥65 years) from the University of Alabama at Birmingham (UAB) Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C), and QOL was assessed by the SF-12 Mental Component Score (MCS12) and Physical Component Score (PCS12) at 0 (study entry), 6, 18, 36, 54, and 72 months. We examined the causal relationship between LSM and QOL using a cross-lagged panel model (CLPM). RESULTS The cohort (n = 153) was 76 years old on average and predominantly White (58%), female (58%), and married (55%). Longitudinal analyses found LSM decreased over time (p < 0.0001), and this decrease was associated with decreased QOL (PCS12, p < 0.0001, MCS12, p < 0.0001). In the CLPM causal analysis, lower LSM resulted in worse PCS12 (p < 0.001), but not worse MSC12. CONCLUSIONS Restricted LSM resulted in worse physical QOL over 72 months in a sample of 153 older cancer survivors. Developing and evaluating interventions to preserve greater LSM could be a promising approach to improving QOL.
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Affiliation(s)
- Richard A. Taylor
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Marie Bakitas
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - J. Nicholas Dionne‐Odom
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Medicine—Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard Kennedy
- Department of Medicine—Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Grant R. Williams
- Department of Medicine—Division of Hematology & OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jennifer Frank
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Peng Li
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Okumura K, Ichikawa S, Wakabayashi H, Hong YJ, Tokudome Y, Takemura Y. Effectiveness of individual nutrition counselling for the prevention of undernutrition among elderly people living in depopulated areas: secondary analysis of a model project in Tsu city. BMJ Nutr Prev Health 2023; 6:127-138. [PMID: 38618552 PMCID: PMC11009543 DOI: 10.1136/bmjnph-2022-000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/30/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives To examine the effectiveness of nutrition counselling (NC) in preventing undernutrition in elderly people living in depopulated areas. Design Participants were elderly people aged at least 65 years living in a depopulated area. Participants completed self-administered questionnaires evaluating nutritional status, frailty and body composition at the start of the study, after a non-NC period (3-month control) and after an NC period (3-month intervention). During the NC period, participants attended monthly 1-hour NC sessions over 3 months. Sessions were conducted in three areas (A, B and C), and the schedule was staggered so that the NC period in one area was conducted simultaneously with the non-NC period of the next. All sessions within an area were attended by the same registered dietitian. Outcomes were assessed three times: before the non-NC period, after the non-NC period and after the NC period. The effects of NC were assessed by comparing the results between the non-NC and NC periods of all participants, using the Cochran-Mantel-Haenszel stratified test. Outcome measures The primary outcome was undernutrition, as determined by the Mini Nutritional Assessment-Short Form. Secondary outcomes were Dietary Diversity Score (DVS), body weight and frailty. Body composition was also assessed. Results Of 106 individuals who joined the project, 61 completed the project and were analysed. The NC in this study had no effect on the primary outcome. DVS in area A was significantly higher after the NC period than after the non-NC period (p=0.012). Frailty in area C was significantly lower after the NC period than after the non-NC period (p=0.025). NC had no significant effects on the other outcomes. Conclusions NC improved food variety but did not improve nutritional status, frailty or body composition.
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Affiliation(s)
- Keiko Okumura
- Faculty of Health and Human, The University of Nagano, Nagano, Japan
| | - Shuhei Ichikawa
- Faculty of General Medicine, Department of Clinical Medical Science, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideki Wakabayashi
- Department of Community Medicine, Mie University School of Medicine, Tsu, Japan
| | - Young Jae Hong
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Tokudome
- Institute of Health and Nutrition, Nagoya University of Arts and Sciences, Nisshin, Aichi, Japan
| | - Yousuke Takemura
- Department of General Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Blondal BS, Geirsdottir OG, Beck AM, Halldorsson TI, Jonsson PV, Sveinsdottir K, Ramel A. HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge. Eur J Clin Nutr 2023; 77:45-54. [PMID: 36028775 PMCID: PMC9876791 DOI: 10.1038/s41430-022-01195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION This study was registered at ClinicalTrials.gov ( NCT03995303 ).
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Affiliation(s)
- B S Blondal
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland.
| | - O G Geirsdottir
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - A M Beck
- University College Copenhagen, Institute of Nursing and Nutrition, Sigurdsgade 26, 2200, Copenhagen, Denmark
- The Dietetic and Nutritional Research Unit, EFFECT, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - T I Halldorsson
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - P V Jonsson
- The Icelandic Gerontological Research Institute, Tungata 26, 101, Reykjavik, Iceland
- Faculty of Medicine, School of Health, University of Iceland, Reykjavík, Iceland
- Department of Geriatrics, The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - A Ramel
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
- Matís ohf, Vinlandsleið 12, 113, Reykjavik, Iceland
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Shirley L, Lord N, Cheung L, Graham G. Recognising eating disorders in older people. Nurs Older People 2022; 34:e1399. [PMID: 36286010 DOI: 10.7748/nop.2022.e1399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/16/2023]
Abstract
Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them. The authors describe a framework that nurses can use when assessing older people to determine whether they may have an eating disorder.
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Affiliation(s)
- Louisa Shirley
- Division of Psychology and Mental Health, University of Manchester, Manchester, England
| | - Natasha Lord
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, England
| | | | - Gemma Graham
- Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, England
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Shen J, Chen H, Zhou T, Zhang S, Huang L, Lv X, Ma Y, Zheng Y, Yuan C. Long-term Weight Change and its Temporal Relation to Later-life Dementia in the Health and Retirement Study. J Clin Endocrinol Metab 2022; 107:e2710-e2716. [PMID: 35420682 PMCID: PMC9202702 DOI: 10.1210/clinem/dgac229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Weight loss among middle-aged and older adults has been associated with a higher risk of subsequent dementia. However, most studies have limited follow-up durations or suboptimal control for the potential influence of physical frailty (PF). OBJECTIVE Our study aimed to investigate the long-term and temporal relations of weight change to risk of dementia among middle-aged and older adults in the United States. METHODS A total of 5985 participants aged 65 years and older were included from the Health and Retirement Study. History of long-term weight change was calculated using 9 repeated body mass index measurements during 1992-2008. We then followed participants' dementia status from 2008 to 2018. Multivariable Cox proportional hazard models were used. RESULTS During the study follow-up period (mean = 7.54 years), a total of 682 (11.40%) dementia cases were documented. After adjustment for basic demographic and lifestyle factors, participants with weight loss (median: -0.23 kg/m2 per year) were at a significantly higher risk of dementia (HR = 1.60; 95% CI, 1.33, 1.92), compared with the stable weight group (median: 0.11 kg/m2 per year). This association was attenuated but remained strong and significant after further adjustment for PF (HR = 1.57; 95% CI, 1.30, 1.89). Significant association was observed for weight loss assessed approximately 14 to 18 years preceding dementia diagnosis (HR = 1.30; 95% CI, 1.07, 1.58), and was consistent closer to diagnosis. CONCLUSION Both recent and remote weight loss were associated with a higher risk of later-life dementia among middle-aged and older adults independent of PF status.
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Affiliation(s)
| | | | - Tianjing Zhou
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Simei Zhang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhen Lv
- Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Yuan Ma
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Yan Zheng
- Yan Zheng, MD, PhD, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, 200043, China.
| | - Changzheng Yuan
- Correspondence: Changzheng Yuan, ScD, School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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10
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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11
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Wong ML, Shi Y, Smith AK, Miaskowski C, Boscardin WJ, Cohen HJ, Lam V, Mazor M, Metzger L, Presley CJ, Williams GR, Loh KP, Ursem CJ, Friedlander TW, Blakely CM, Gubens MA, Allen G, Shumay D, Walter LC. Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study. J Am Geriatr Soc 2022; 70:136-149. [PMID: 34611887 PMCID: PMC8742783 DOI: 10.1111/jgs.17474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Maintenance of function during cancer treatment is important to older adults. Characteristics associated with pretreatment life-space mobility and changes during non-small cell lung cancer (NSCLC) treatment remain unknown. METHODS This mixed methods cohort study recruited adults age ≥65 with advanced NSCLC starting palliative chemotherapy, immunotherapy, and/or targeted therapy from a Comprehensive Cancer Center, Veterans Affairs, and safety-net clinic. Patients completed geriatric assessments including Life-Space Assessment (LSA) pretreatment and at 1, 2, 4, and 6 months after treatment initiation. LSA scores range from 0 to 120 (greater mobility); LSA <60 is considered restricted. We used mixed-effects models to examine pretreatment LSA, change from 0 to 1 month, and change from 1 to 6 months. A subgroup participated in semistructured interviews pretreatment and at 2 and 6 months to understand the patient experience of life-space change. For each interview participant, we created joint displays of longitudinal LSA scores juxtaposed with illustrative quotes. RESULTS Among 93 patients, median age was 73 (range 65-94). Mean pretreatment LSA score was 67.1. On average, LSA declined 10.1 points from pretreatment to 1 month and remained stable at 6 months. Pretreatment LSA score was associated with several demographic, clinical, geriatric assessment, and symptom characteristics. LSA decline at 1 month was greater among patients with high anxiety (slope = -12.6 vs. -2.3, p = 0.048). Pretreatment body mass index <21 kg/m2 was associated with LSA improvement from 1 to 6 months (slope = 4.1 vs. -0.04, p = 0.003). Joint displays illustrated the impact of different life-space trajectories on patients' lives in their words. CONCLUSION Older adults with NSCLC have low pretreatment life space with many developing restricted life space during treatment. Incorporating life-space assessments into clinical cancer care may help older adults concretely visualize how treatment might impact their daily function to allow for informed decision making and identify early changes in mobility to implement supportive interventions.
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Affiliation(s)
- Melisa L. Wong
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Ying Shi
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - W. John Boscardin
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Vivian Lam
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Mazor
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Carolyn J. Presley
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center. Columbus, OH, USA
| | - Grant R. Williams
- Divisions of Hematology/Oncology & Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Carling J. Ursem
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology-Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Terence W. Friedlander
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology-Oncology, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Collin M. Blakely
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew A. Gubens
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory Allen
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Dianne Shumay
- Department of Psychiatry, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Louise C. Walter
- Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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12
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Murayama H, Liang J, Shaw BA, Botoseneanu A, Kobayashi E, Fukaya T, Shinkai S. Short-, Medium-, and Long-term Weight Changes and All-Cause Mortality in Old Age: Findings From the National Survey of the Japanese Elderly. J Gerontol A Biol Sci Med Sci 2021; 76:2039-2046. [PMID: 33626135 DOI: 10.1093/gerona/glab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people. METHODS Data were obtained from the National Survey of the Japanese Elderly, which included 4869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered 3 indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥ 5%, loss 2.5%-4.9%, stable (±2.4%), gain 2.5%-4.9%, and gain ≥ 5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category. RESULTS Weight loss ≥ 5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all 3 intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline. CONCLUSIONS These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.
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Affiliation(s)
- Hiroshi Murayama
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Jersey Liang
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, USA
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, University of Michigan-Dearborn, USA
| | - Erika Kobayashi
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Taro Fukaya
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shoji Shinkai
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
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Gana W, De Luca A, Debacq C, Poitau F, Poupin P, Aidoud A, Fougère B. Analysis of the Impact of Selected Vitamins Deficiencies on the Risk of Disability in Older People. Nutrients 2021; 13:3163. [PMID: 34579039 PMCID: PMC8469089 DOI: 10.3390/nu13093163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Vitamin deficiencies have a serious impact on healthy aging in older people. Many age-related disorders have a direct or indirect impact on nutrition, both in terms of nutrient assimilation and food access, which may result in vitamin deficiencies and may lead to or worsen disabilities. Frailty is characterized by reduced functional abilities, with a key role of malnutrition in its pathogenesis. Aging is associated with various changes in body composition that lead to sarcopenia. Frailty, aging, and sarcopenia all favor malnutrition, and poor nutritional status is a major cause of geriatric morbidity and mortality. In the present narrative review, we focused on vitamins with a significant risk of deficiency in high-income countries: D, C, and B (B6/B9/B12). We also focused on vitamin E as the main lipophilic antioxidant, synergistic to vitamin C. We first discuss the role and needs of these vitamins, the prevalence of deficiencies, and their causes and consequences. We then look at how these vitamins are involved in the biological pathways associated with sarcopenia and frailty. Lastly, we discuss the critical early diagnosis and management of these deficiencies and summarize potential ways of screening malnutrition. A focused nutritional approach might improve the diagnosis of nutritional deficiencies and the initiation of appropriate clinical interventions for reducing the risk of frailty. Further comprehensive research programs on nutritional interventions are needed, with a view to lowering deficiencies in older people and thus decreasing the risk of frailty and sarcopenia.
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Affiliation(s)
- Wassim Gana
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Arnaud De Luca
- Nutrition Mobile Unit, Regional University Hospital Centre, 37000 Tours, France;
- Inserm UMR 1069, Nutrition, Croissance et Cancer, 37032 Tours, France
| | - Camille Debacq
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Fanny Poitau
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
| | - Pierre Poupin
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Amal Aidoud
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Bertrand Fougère
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Education, Ethics, Health (EA 7505), Tours University, 37000 Tours, France
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Sotos-Prieto M, Ortolá R, López-García E, Rodríguez-Artalejo F, García-Esquinas E. Adherence to the Mediterranean Diet and Physical Resilience in Older Adults: The Seniors-ENRICA Cohort. J Gerontol A Biol Sci Med Sci 2021; 76:505-512. [PMID: 33152061 DOI: 10.1093/gerona/glaa277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND No prior studies have studied the association between diet and physical resilience, thus our aim was to assess the association between the adherence to the Mediterranean diet and other healthy dietary patterns and physical resilience, assessed empirically as a trajectory through exposure to chronic and acute stressors, in older adults participating in the Seniors-ENRICA (The Study on Nutrition and Cardiovascular Risk in Spain) cohort. METHODS Data were assessed from 1301 individuals aged 60 and older, participating in the ENRICA prospective cohort study and recruited in 2008-2010 and followed up to 2012 (trial registration: NCT02804672). A Mediterranean Diet Adherence Screener score and the Alternate Healthy Eating Index 2010 were derived at baseline from a validated diet history. Health status was assessed at baseline and at the end of follow-up with a 52-item health Deficit Accumulation Index (DAI) including 4 domains (physical and cognitive function, mental health, self-rated health/vitality, and morbidity); higher DAI values indicate worse health. Physical resilience was defined as accumulating fewer health deficits than the expected age-related increase in DAI over follow-up, despite exposure to chronic and acute stressors. RESULTS Over a 3.2-year follow-up, 610 individuals showed physical resilience. In multivariate analyses, the odds ratio (95% confidence interval) of physical resilience for the highest versus lowest tertile (lowest adherence) of the Mediterranean Diet Adherence Screener score was 1.47 (1.10-1.98). The association held for those maintaining or improving the DAI over follow-up (over-resilience): 1.58 (1.10-2.26). Results were consistent in those with unintentional weight loss (2.21 [1.10-4.88]) or hospitalization (2.32 [1.18, 4.57]) as acute stressors. CONCLUSION In older adults, a higher adherence to the Mediterranean diet is associated with a greater likelihood of physical resilience.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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15
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Mümken SA, Gellert P, Stollwerck M, O'Sullivan JL, Kiselev J. Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults. BMJ Open 2021; 11:e049926. [PMID: 34230022 PMCID: PMC8261868 DOI: 10.1136/bmjopen-2021-049926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults. DESIGN Cross-sectional validation study. SETTING Two study centres in urban and rural German outpatient hospital settings. PARTICIPANTS In total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men). PRIMARY AND SECONDARY OUTCOME MEASURES The final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure. RESULTS In the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=-0.26; 95% CI=-0.42 to -0.08), Timed Up and Go Test (β=-0.37; 95% CI=-0.68 to -0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=-0.22; 95% CI=-0.41 to -0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=-0.19; 95% CI=-0.42 to 0.03) and male gender (β=0.15; 95% CI=-0.04 to 0.35) were not significant. CONCLUSION The LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings. TRIAL REGISTRATION NUMBER DRKS00019023.
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Affiliation(s)
- Sandra Angelika Mümken
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany
| | - Malte Stollwerck
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany
| | - Julie Lorraine O'Sullivan
- Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany
| | - Joern Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany
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Maleki MR, Doosty F, Yarmohammadian MH, Rasi V, Tanner EI. Designing an Elderly Hospital Admission Risk Prediction Model in Iran's Hospitals. Int J Prev Med 2021; 12:22. [PMID: 34084319 PMCID: PMC8106286 DOI: 10.4103/ijpvm.ijpvm_433_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Background: The identification of elderly at risk of new functional disabilities in activities of daily living at admission to the hospital may facilitate referral for purposive interventions to prevent decline and institutionalization. This study was aimed at designing a risk prediction model for identifying the elderly at risk of admission in Iran's hospitals. Materials and Methods: This is a cross-sectional descriptive study conducted in 2017. In order to formulate and validate a prediction model, the study was done in two development and validation cohort study. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow-up compared with preadmission status. Results: In development cohort, the mean age was 71 years including 54% of men and 46% women, 22% of men and 17% of women experienced functional decline after 3 months. In the validation cohort, the mean age was 70 years, including 49% of men and 51% women, 19% of men and 15% of women, functional decline after 3 months was observed. Conclusion: On the basis of the findings, aging at risk of hospital admission can be identified by easy designed model with four questions: (1) Is the patient's age more than 85 years? (2) Does the patient's mini mental status <22? (3) Does the patient need help for using general transporting? (4) Has the patient lost weight <5% over the past 6 months and body mass index <18.5? And also geriatrics experts can use the designed model as a predictive tool in order to improve the quality level of healthcare services to elderly as a vulnerable and high risk group. The important point of model is easy to use even for nonspecialists.
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Affiliation(s)
- Mohammad R Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Doosty
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Yarmohammadian
- Health Management and Economic Research Center, Health Services Administration, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Rasi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elizabeth Ibby Tanner
- Interprofessional Education and Practice, Center for Innovative Care in Aging Johns Hopkins School of Nursing, Baltimore, United States of America
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Age-Group Differences in Body Mass Index, Weight, and Height in Adults With Down Syndrome and Adults With Intellectual Disability From the United States. Adapt Phys Activ Q 2021; 38:79-94. [PMID: 33310929 DOI: 10.1123/apaq.2020-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022] Open
Abstract
The authors examined if body mass index (BMI), weight, and height across age groups differ between adults with Down syndrome (DS) and adults with intellectual disability but without DS. They conducted secondary analyses of cross-sectional data from 45,803 individuals from the United States from 2009 to 2014 of the National Core Indicators Adult Consumer Survey across five age groups: 18-29, 30-39, 40-49, 50-59, and 60+ years. For both men and women with DS, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups and decreased thereafter. For both men and women with intellectual disability, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups, stayed about the same until the 50- to 59-year age group, and decreased thereafter. Height demonstrated a small but significant decrease with older age in all groups. These cross-sectional comparisons indicate that BMI and weight may start decreasing at a younger age in adults with DS than in adults with intellectual disability.
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Kuzuya M. Nutritional status related to poor health outcomes in older people: Which is better, obese or lean? Geriatr Gerontol Int 2020; 21:5-13. [PMID: 33200583 DOI: 10.1111/ggi.14088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/14/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
Good nutritional status is crucial for maintaining growth and health in all stages of life. However, the relationship between nutritional status and health and the effect on various health-related outcomes differ, depending on the life stage. Many adverse outcomes in older adults, directly linked to different nutritional status, are not present in middle-aged adults, and their ideal nutritional status may differ. This article will review the optimal nutritional status, mainly evaluated by anthropometric measurements such as body mass index, for older adults from various perspectives. Overall, in older adults low body mass index is at higher risk of health problems such as mortality and difficulties in physical functioning compared with middle-aged adults, reducing the risk of health problems for overweight and (abdominal) obesity. Overweight may be more beneficial than lower level of normal weight in older-old and vulnerable older people. While, with or without obesity, skeletal muscle loss or weakness as well as unintentional weight loss induces health problems in older adults. The impact of metabolic syndrome on the prognosis of older adults is clearly reduced compared with middle-aged adults, requiring a shift in medical attention in older adults from metabolic syndrome to frailty. There are still many unclear points regarding the optimal nutritional status of older people, and further research is needed to support healthy longevity. Geriatr Gerontol Int 2021; 21: 5-13.
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Affiliation(s)
- Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
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Flanders WD, Glymour MM, Goodman M. Estimating effects on changes in health outcomes using scores – An alternative visualization. GLOBAL EPIDEMIOLOGY 2020. [DOI: 10.1016/j.gloepi.2020.100022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Johnson J, Rodriguez MA, Al Snih S. Life-Space Mobility in the Elderly: Current Perspectives. Clin Interv Aging 2020; 15:1665-1674. [PMID: 32982200 PMCID: PMC7501960 DOI: 10.2147/cia.s196944] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.
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Affiliation(s)
- Jason Johnson
- Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Martin A Rodriguez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics/Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
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Stephan Y, Sutin AR, Terracciano A. Change in weight and personality in middle-aged and older adults. Psychol Health 2020; 35:872-886. [PMID: 31631712 PMCID: PMC9841264 DOI: 10.1080/08870446.2019.1679372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: Personality is associated with weight change and the development of obesity across adulthood. The present study examines whether significant weight change, including weight loss and weight gain, is related to personality change in a large longitudinal sample of middle-aged and older adults.Design: Participants were adults aged 50-92 years (N > 5000; 59% women, Mean age = 65.51, SD = 8.20) drawn from the Health and Retirement Study (HRS). Personality, demographic, health and staff assessed weight and height were obtained at baseline and 8 years later.Main Outcome Measures: Personality traits.Results: Both weight loss and weight gain greater than 10% of baseline weight were related to a steeper decline in extraversion, openness and conscientiousness. Weight loss was further associated with the maintenance of neuroticism and to a steeper decline in agreeableness. This overall pattern of personality change was also associated with both unhealthy and healthy weight change. The associations were not moderated by BMI and generally remained significant after accounting for disease burden.Conclusion: The present study provides new evidence that both weight loss and weight gain are related to change in personality.
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Manley NA, Bayen E, Braley TL, Merrilees J, Clark AM, Zylstra B, Schaffer M, Bayen AM, Possin KL, Miller BL, Schenk AK, Bonasera SJ. Long-term digital device-enabled monitoring of functional status: Implications for management of persons with Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12017. [PMID: 32548234 PMCID: PMC7293994 DOI: 10.1002/trc2.12017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Informal caregiving is an essential element of health-care delivery. Little data describes how caregivers structure care recipients' lives and impact their functional status. METHODS We performed observational studies of community dwelling persons with dementia (PWD) to measure functional status by simultaneous assessment of physical activity (PA) and lifespace (LS). We present data from two caregiver/care-recipient dyads representing higher and average degrees of caregiver involvement. RESULTS We acquired >42,800 (subject 1); >41,300 (subject 2) PA data points and >154,500 (subject 1); >119,700 (subject 2) LS data points over 15 months of near continuous observation. PA and LS patterns provided insights into the caregiver's role in structuring the PWD's day-to-day function and change in function over time. DISCUSSION We show that device-enabled functional monitoring (FM) can successfully gather and display data at resolutions required for dementia care studies. Objective quantification of individual caregiver/care-recipient dyads provides opportunities to implement patient-centered care.
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Affiliation(s)
- Natalie A. Manley
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Eléonore Bayen
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Tamara L. Braley
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jennifer Merrilees
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amy M. Clark
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Michael Schaffer
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Alexandre M. Bayen
- Department of Civil and Environmental EngineeringUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Katherine L. Possin
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Stephen J. Bonasera
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Association of peripheral artery disease with life-space mobility restriction and mortality in community-dwelling older adults. J Vasc Surg 2020; 71:2098-2106.e1. [PMID: 32081483 DOI: 10.1016/j.jvs.2019.08.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Symptomatic peripheral artery disease (PAD) impairs walking, but data on the impact of PAD on community mobility is limited. Life-space mobility measures the distance, frequency, and assistance needed as older adults move through geographic areas extending from their bedroom (life-space mobility score: 0) to beyond their town (life-space mobility score: 120). We evaluated the association of PAD with longitudinal life-space mobility trajectory. METHODS Participants were part of the University of Alabama at Birmingham Study of Aging, a longitudinal study of community-dwelling older adults who were observed from 2001 to 2009. We limited our analysis to those who survived at least 6 months (N = 981). PAD was based on self-report with verification by physician report and hospital records. Our primary outcome was life-space mobility score assessed every 6 months. A multilevel change model (mixed model) was used to determine the association between PAD and life-space mobility trajectory during a median 7.9 years of follow-up. RESULTS Participants had a mean age of 75.7 (standard deviation, 6.7) years; 50.5% were female, and 50.4% were African American. PAD prevalence was 10.1%, and 57.1% of participants with PAD died. In participants with both PAD and life-space restriction, defined as life-space mobility score <60, we observed the highest mortality (73.1%). In a multivariable adjusted mixed effects model, participants with PAD had a more rapid decline in life-space mobility by -1.1 (95% confidence interval [CI], -1.9 to -0.24) points per year compared with those without PAD. At 5-year follow-up, model-adjusted mean life-space mobility was 48.1 (95% CI, 43.5-52.7) and 52.4 (95% CI, 50.9-53.8) among those with and without PAD, respectively, corresponding to a restriction in independent life-space mobility at the level of one's neighborhood. CONCLUSIONS Life-space mobility is a novel patient-centered measure of community mobility, and PAD is associated with significant life-space mobility decline among community-dwelling older adults. Further study is needed to mechanistically confirm these findings and to determine whether better recognition and treatment of PAD alter the trajectory of life-space mobility.
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Kiesswetter E, Keijser BJF, Volkert D, Visser M. Association of oral health with body weight: a prospective study in community-dwelling older adults. Eur J Clin Nutr 2019; 74:961-969. [PMID: 31767989 DOI: 10.1038/s41430-019-0536-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To prevent involuntary weight loss in older people, the knowledge about factors affecting body weight (BW) is essential. Therefore, we aimed to investigate the longitudinal associations of multiple oral health aspects with BW in community-dwelling older adults. METHODS This analysis is based on prospective data with a 10-year follow-up of 657 Dutch community-dwelling older adults (age 66.4 ± 5.8 years, 54% female) from the Longitudinal Aging Study Amsterdam. Participants' characteristics, BW, and 12 oral health variables (teeth, dentures, nine oral problems, self-rated oral health) were assessed in 2005/07 and 2015/16. The association between oral health and BW was analyzed by mixed models and adjusted for demographic, socio-economic, smoking, health, and functional aspects considering data of both assessments. RESULTS Mean BW was 79.1 ± 13.3 kg at baseline (B) and 77.6 ± 13.8 kg at follow-up (FU). At baseline, 29.6% of the participants reported being edentulous (FU:34.4%) and 55.8% to wear dentures (FU:62.3%). Dental pain while chewing was the oral problem with the lowest (B:5.2%, FU:6.6%) and xerostomia with the highest prevalence at both examinations (B:24.3%, FU:30.0%). Most participants rated their oral status as healthy (B:65.2%, FU:66.9%). Neither edentulism and denture use nor oral problems showed a longitudinal association with BW. In contrast, self-rated oral health was associated with BW (b = 0.724, SE = 0.296, p = 0.015) after adjusting for multiple confounders. CONCLUSIONS In community-dwelling older adults self-rated oral health may indicate changes in body weight in the long term. Therefore, this simple measure could serve to identify a risk for weight loss and to initiate oral interventions in clinical practice.
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Affiliation(s)
- Eva Kiesswetter
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Bart J F Keijser
- Research Group Microbiology and Systems Biology, TNO, Utrechtseweg 48, 3704HE, Zeist, The Netherlands.,Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Kiesswetter E, Hengeveld LM, Keijser BJF, Volkert D, Visser M. Oral health determinants of incident malnutrition in community-dwelling older adults. J Dent 2019; 85:73-80. [DOI: 10.1016/j.jdent.2019.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 01/04/2023] Open
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Xu D, Kane R, Arling G. Relationship between nursing home quality indicators and potentially preventable hospitalisation. BMJ Qual Saf 2019; 28:524-533. [DOI: 10.1136/bmjqs-2018-008924] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/03/2022]
Abstract
BackgroundHospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.Methods23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.ResultsThe results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.ConclusionAlthough general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.
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Liu X, Yin X, Tan A, He M, Jiang D, Hou Y, Lu Y, Mao Z. Correlates of Mild Cognitive Impairment of Community-Dwelling Older Adults in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2705. [PMID: 30513638 PMCID: PMC6313802 DOI: 10.3390/ijerph15122705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 01/22/2023]
Abstract
Mild cognitive impairment (MCI) is an early stage of Alzheimer's disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess potential differences in the risk of MCI among different elderly groups in Wuhan, China, and to further identify the most vulnerable populations using logistic regression models. A total of 622 older adults participated in this study, and the prevalence of MCI was 34.1%. We found that individuals aged 80⁻84 (odds ratio, OR = 1.908, 95% confidence interval, 95% CI 1.026 to 3.549) or above (OR = 2.529, 95% CI 1.249 to 5.122), and those with two chronic diseases (OR = 1.982, 95% CI 1.153 to 3.407) or more (OR = 2.466, 95% CI 1.419 to 4.286) were more likely to be diagnosed with MCI. Those with high school degrees (OR = 0.451, 95% CI 0.230 to 0.883) or above (OR = 0.318, 95% CI 0.129 to 0.783) and those with a family per-capita monthly income of 3001⁻4500 yuan (OR = 0.320, 95% CI 0.137 to 0.750) or above (OR = 0.335, 95% CI 0.135 to 0.830) were less likely to experience MCI. The results also showed that those aged 80 or above were more likely to present with cognitive decline and/or reduced activities of daily living (ADL) function, with the odds ratios being 1.874 and 3.782, respectively. Individuals with two, or three or more chronic diseases were more likely to experience cognitive decline and/or reduced ADL function, with odds ratios of 2.423 and 2.631, respectively. Increased risk of suffering from either MCI and/or decline in ADL functioning is strongly positively associated with older age, lower educational levels, poorer family economic status, and multiple chronic diseases. Our findings highlight that the local, regional, and even national specific MCI-related health promotion measures and interventions must target these vulnerable populations.
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Affiliation(s)
- Xiaojun Liu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
| | - Xiao Yin
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- College of Public Administration, Huazhong University of Science and Technology, 1037# Luoyu Road, Wuhan 430074, China.
| | - Anran Tan
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Meikun He
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Dongdong Jiang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Yitan Hou
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Yuanan Lu
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
- Department of Public Health Sciences, University of Hawaii at Mānoa, 1960 East-West Road, Honolulu, HI 96822, USA.
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
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Tsuji T, Rantakokko M, Portegijs E, Viljanen A, Rantanen T. The effect of body mass index, lower extremity performance, and use of a private car on incident life-space restriction: a two-year follow-up study. BMC Geriatr 2018; 18:271. [PMID: 30409120 PMCID: PMC6225643 DOI: 10.1186/s12877-018-0956-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/18/2018] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of the study was to explore the single and combined contributions of body mass index (BMI) and lower extremity performance as modifiable physical factors, and the influence of use of a private car as an environmental factor on prevalent and incident life-space restriction in community-dwelling older people. Methods Community-dwelling people aged 75–90 years (n = 823) participated in the Life-Space Mobility in Old Age (LISPE) two-year follow-up study. Participants who reported that the largest life-space area they had attained, without aid from any device or another person, was the neighborhood or less were considered to have life-space restriction. Incident life-space restriction was the endpoint of Cox’s proportional hazard model. BMI, lower extremity performance (Short Physical Performance Battery, SPPB), and use of a private car were predictors. Results At baseline, people who had both obesity (BMI ≥30.0) and impaired lower extremity performance (SPPB 0–9) had a higher prevalence of life-space restriction (prevalence ratio 3.6, 95% confidence interval, CI, 2.0–6.3) compared to those with normal weight (BMI 23.0–24.9) and intact physical performance (SPPB 10–12). The 581 people without life-space restriction at the baseline contributed 1033 person-years during the two-year follow-up. Incident life-space restrictions were reported by 28.3% participants. A higher hazard ratio (HR) for incident life-space restriction was observed in subjects having both obesity and impaired lower extremity performance (HR 3.6, 95% CI, 1.7–7.4), impaired lower extremity performance only (HR 1.9, 95% CI 0.9–4.1), and obesity only (HR 1.8, 95% CI, 0.9–3.5) compared to those with normal weight and intact performance. Private car passengers (HR 2.0, 95% CI, 1.3–3.0) compared to car drivers had a higher risk of life-space restriction. All models were adjusted for age, sex, chronic diseases, and education. Conclusions Older people with impaired lower extremity performance have an increased risk of incident life-space restriction especially if combined with obesity. Also, not driving a car renders older people vulnerable to life-space restriction.
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Affiliation(s)
- Taishi Tsuji
- Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba City, Chiba, 260-8670, Japan.
| | - Merja Rantakokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
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Iyer AS, Wells JM, Bhatt SP, Kirkpatrick DP, Sawyer P, Brown CJ, Allman RM, Bakitas MA, Dransfield MT. Life-Space mobility and clinical outcomes in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2731-2738. [PMID: 30233163 PMCID: PMC6130264 DOI: 10.2147/copd.s170887] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Social isolation is a common experience in patients with COPD but is not captured by existing patient-reported outcomes, and its association with clinical outcomes is unknown. Methods We prospectively enrolled adults with stable COPD who completed the University of Alabama at Birmingham Life Space Assessment (LSA) (range: 0–120, restricted Life-Space mobility: ≤60 and a marker of social isolation in older adults); six-minute walk test (6MWT), and the University of California at San Diego Shortness of Breath Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale. The occurrence of severe exacerbations (emergency room visit or hospitalization) was recorded by review of the electronic record up to 1 year after enrollment. We determined associations between Life-Space mobility and clinical outcomes using regression analyses. Results Fifty subjects had a mean ± SD %-predicted FEV1 of 42.9±15.5, and 23 (46%) had restricted Life-Space mobility. After adjusting for age, gender, %-predicted FEV1, comorbidity count, inhaled corticosteroid/long-acting beta2-agonist use, and prior cardiopulmonary rehabilitation, subjects with restricted Life-Space had an increased risk for severe exacerbations (adjusted incidence rate ratio 4.65, 95% CI 1.19–18.23, P=0.03). LSA scores were associated with 6MWD (R=0.50, P<0.001), dyspnea (R=−0.58, P<0.001), quality of life (R=−0.34, P=0.02), and depressive symptoms (R=−0.39, P=0.005). Conclusion Restricted Life-Space mobility predicts severe exacerbations and is associated with reduced exercise tolerance, more severe dyspnea, reduced quality of life, and greater depressive symptoms.
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Affiliation(s)
- Anand S Iyer
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - James M Wells
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, .,Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - deNay P Kirkpatrick
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - Patricia Sawyer
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia J Brown
- Veterans Affairs Medical Center, Birmingham, AL, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard M Allman
- Department of Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Marie A Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Center for Palliative and Supportive Care, Division of Geriatrics, Gerontology, and Palliative Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, .,Veterans Affairs Medical Center, Birmingham, AL, USA
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LeBlanc ES, Rizzo JH, Pedula KL, Yaffe K, Ensrud KE, Cauley JA, Cawthon PM, Cummings SR, Hillier TA. Long-Term Weight Trajectory and Risk of Hip Fracture, Falls, Impaired Physical Function, and Death. J Am Geriatr Soc 2018; 66:1972-1979. [PMID: 30151825 DOI: 10.1111/jgs.15532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the association between weight trajectory, health status, and mortality in older women. DESIGN Cohort study. SETTING Study of Osteoporotic Fractures. PARTICIPANTS Older community-dwelling women (age: baseline (1986-88), mean 68, range 65-81; Year 20 (2006-08), mean 88, range 83-102 (N = 1,323)). MEASUREMENTS Body weight measured repeatedly over 20 years (mean 8 times). Logistic and Cox proportional hazard models were used to evaluate whether 20-year weight trajectory measures were associated with hip fracture, falls, physical performance, and mortality. RESULTS In models adjusted for age, clinic, calcium use, Year 20 weight, walking speed, comorbidity score, smoking, self-reported health, and walking for exercise, women with moderate weight loss (>9.0 kg) over 20 years had a 74% greater risk of death (hazard ratio (HR) = 1.74, 95% confidence interval (CI) = 1.37-2.20) in the 5 years after the Year 20 visit than those with no weight loss and more than twice the risk of hip fracture (HR = 2.56, 95% CI = 1.39-4.70). They were 3.6 times (odds ratio (OR) = 3.60, 95% CI = 1.86-6.95) as likely to have poor physical function at the Year 20 visit as women with no weight loss but no greater risk of 2 or more falls in the 1.5 years after the Year 20 visit. Weight variability and abrupt weight decline were not associated with adverse health oucomes (falls, fractures, mortality), but those in the highest quartile of variability were 2.3 times (OR = 2.26, 95% CI = 1.34-3.80) as likely to have poor physical function scores. CONCLUSION In women surviving past 80 years of age, moderate weight loss over 20 years was associated with greater risk of hip fracture, poor physical function, and mortality but not of falls. Future work should separate voluntary from involuntary weight loss.
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Affiliation(s)
- Erin S LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Joanne H Rizzo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Kathryn L Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Kristine Yaffe
- Departments of Psychiatry.,Neurology.,Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Kristine E Ensrud
- Department of Medicine, School of Medicine.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.,Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii
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- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 630] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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So ES. The Impacts of Weight Change and Weight Change Intention on Health-Related Quality of Life in the Korean Elderly. J Aging Health 2018; 31:1106-1120. [PMID: 29504447 DOI: 10.1177/0898264318761908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: This study aimed to identify the impacts of weight change and weight change intention on health-related quality of life (HRQL) among community-dwelling Korean elderly individuals. Method: Data on those aged 75 years and above from the Korean National Health and Nutrition Examination Survey were analyzed using multiple regression analysis. Results: Compared with no weight change, unintentional weight loss was associated with significantly lower adjusted overall HRQL and lower scores in the subdimensions of mobility, pain/discomfort, usual activities, and self-care (in order), whereas intentional weight loss was associated with significantly poorer scores for anxiety/depression. Weight gain showed no statistically significant differences in comparison with no weight change. Discussion: These findings suggest that weight maintenance or weight gain should be recommended rather than weight loss, whether unintentional or intentional, regardless of weight status, to improve HRQL among the elderly.
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Affiliation(s)
- Eun Sun So
- 1 Chonbuk National University, Jeonju-si, Republic of Korea
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Kim M, Kim J, Won CW. Association between involuntary weight loss with low muscle mass and health-related quality of life in community-dwelling older adults: Nationwide surveys (KNHANES 2008-2011). Exp Gerontol 2018; 106:39-45. [PMID: 29499371 DOI: 10.1016/j.exger.2018.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 11/17/2017] [Accepted: 02/25/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the relationship between involuntary weight loss with low muscle mass and health-related quality of life in a large representative sample of older adults. METHODS A nationwide cross-sectional study based on data from the Korea National Health and Nutritional Examination Survey, 2008 to 2011. Study participants included 2249 individuals aged ≥70 years. The participants reported an unintentional weight loss >3 kg in the past year. Appendicular lean mass was measured using dual-energy X-ray absorptiometry and calculated with the appendicular lean mass index. Health-related quality of life was measured using the EuroQol-5 dimension (EQ-5D) instrument. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for the lowest quintile of the EQ-5D index. RESULTS In total, 39.1% of participants were male and 60.9% were female. The weighted mean age was 75.6 years (95% CI; 75.3-75.9). Clinically significant weight loss is typically 5% of one's body weight; average, 2.8 kg (3.1 kg for men; 2.7 kg, women) for our participants. Compared with the normal reference group and after adjusting for potential confounders, the ORs for the lowest quintile of the EQ-5D indices were 1.39 (95% CI, 0.92-2.10), 2.56 (95% CI, 1.56-4.18), and 3.40 (95% CI, 2.05 to 5.63) for the low muscle mass, involuntary weight loss, involuntary weight loss with low muscle mass groups, respectively. CONCLUSION Involuntary weight loss combined with low muscle mass was more closely associated with poor quality of life than involuntary weight loss alone in community-dwelling older adults.
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Affiliation(s)
- Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea
| | - Junghoon Kim
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Sampaio LS, Carneiro JAO, Coqueiro RDS, Fernandes MH. [Anthropometric indicators as predictors in determining frailty in elderly people]. CIENCIA & SAUDE COLETIVA 2017; 22:4115-4124. [PMID: 29267728 DOI: 10.1590/1413-812320172212.05522016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/06/2016] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to analyze anthropometric indicators as predictors in determining frailty in elderly people. This is a cross-sectional, family-based and analytical study. The survey was composed of 316 elderly subjects. The association between the anthropometric markers and frailty was tested using the Logistic Regression technique. However, the power of frailty diagnosis using anthropometric markers and the identification of the best cutoff points were evaluated using the parameters provided by the Receiver Operating Characteristic (ROC) curve. The anthropometric indicators of nutritional status: calf circumference, body mass index and corrected arm-muscle area are inversely associated with frailty. Thus, an increase in the values of these indicators is a protective factor against this syndrome. Analyzing body mass index and calf circumference simultaneously in order to perform a simpler screening for frail elderly people is recommended, as these indicators show good sensitivity and are easier to measure.
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Affiliation(s)
- Lucas Silveira Sampaio
- Universidade Estadual do Sudoeste da Bahia. R. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil,
| | | | - Raildo da Silva Coqueiro
- Universidade Estadual do Sudoeste da Bahia. R. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil,
| | - Marcos Henrique Fernandes
- Universidade Estadual do Sudoeste da Bahia. R. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil,
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Kabayama M, Mikami H, Kamide K. Multidimensional factors associated with the loss of independence: A population-based longitudinal study. Geriatr Gerontol Int 2017; 18:448-455. [PMID: 29235230 DOI: 10.1111/ggi.13209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Abstract
AIM To clarify the factors associated with loss of independence multidimensionally over a 3-year period among community-dwelling older adults. METHODS The survey was exclusively carried out by the local government for people aged >65 years who were independent at baseline living in H-City, a mid-sized urban city in Japan. The participants completed a self-administered postal questionnaire, and we obtained data regarding their loss of independence from administrative records 3 years later. RESULTS A total of 22 328 participants completed the follow up (baseline mean age 71.6 years). At follow up, 998 (4.3%) participants were categorized as dependent, with 606 requiring partial support in toileting, bathing and so on (mild loss of independence), and 392 requiring complete support (severe loss). Factors independently associated with mild loss of independence after 3 years for both men and women were advanced age, low physical function, low nutritional status, low cognitive function and high depression risk. In contrast, factors independently associated with severe loss of independence were advanced age, low physical function and high depression risk in men, and advanced age, and low physical and cognitive function in women. CONCLUSIONS We clarified the variety of factors associated with loss of independence according to its severity, and the strength of those independent associations was different in the whole city longitudinal study. The present study's findings have important clinical implications for the development of better preventive medicine to establish a society of healthy longevity. Geriatr Gerontol Int 2018; 18: 448-455.
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Affiliation(s)
- Mai Kabayama
- Department of Health Promotion Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Mikami
- Osaka Pharmacology Clinical Research Hospital, Osaka, Japan
| | - Kei Kamide
- Department of Health Promotion Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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van der Pols-Vijlbrief R, Wijnhoven HA, Bosmans JE, Twisk JW, Visser M. Targeting the underlying causes of undernutrition. Cost-effectiveness of a multifactorial personalized intervention in community-dwelling older adults: A randomized controlled trial. Clin Nutr 2017; 36:1498-1508. [DOI: 10.1016/j.clnu.2016.09.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 09/01/2016] [Accepted: 09/30/2016] [Indexed: 11/29/2022]
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Windham BG, Griswold ME, Wang W, Kucharska-Newton A, Demerath EW, Gabriel KP, Pompeii LA, Butler K, Wagenknecht L, Kritchevsky S, Mosley TH. The Importance of Mid-to-Late-Life Body Mass Index Trajectories on Late-Life Gait Speed. J Gerontol A Biol Sci Med Sci 2017; 72:1130-1136. [PMID: 27811156 DOI: 10.1093/gerona/glw200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background Prior studies suggest being overweight may be protective against poor functional outcomes in older adults. Methods Body mass index (BMI, kg/m2) was measured over 25 years across five visits (1987-2011) among Atherosclerosis Risk in Communities Study participants (baseline Visit 1 n = 15,720, aged 45-64 years). Gait speed was measured at Visit 5 ("late-life", aged ≥65 years, n = 6,229). BMI trajectories were examined using clinical cutpoints and continuous mixed models to estimate effects of patterns of BMI change on gait speed, adjusting for demographics and comorbidities. Results Mid-life BMI (baseline visit; 55% women; 27% black) was associated with late-life gait speed 25 years later; gait speeds were 94.3, 89.6, and 82.1 cm/s for participants with baseline normal BMI (<25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) (p < .001). In longitudinal analyses, late-life gait speeds were 96.9, 88.8, and 81.3 cm/s for participants who maintained normal, overweight, and obese weight status, respectively, across 25 years (p < .01). Increasing BMI over 25 years was associated with poorer late-life gait speeds; a 1%/year BMI increase for a participant with a baseline BMI of 22.5 (final BMI 28.5) was associated with a 4.6-cm/s (95% confidence interval: -7.0, -1.8) slower late-life gait speed than a participant who maintained a baseline BMI of 22.5. Conclusion Being overweight in older age was not protective of mobility function. Maintaining a normal BMI in mid- and late-life may help preserve late-life mobility.
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Affiliation(s)
| | - Michael E Griswold
- Department of Data Science, University of Mississippi Medical Center, Jackson
| | - Wanmei Wang
- Department of Data Science, University of Mississippi Medical Center, Jackson
| | | | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Kelley Pettee Gabriel
- University of Texas School of Public Health in Austin, Department of Epidemiology, Human Genetics, and Environmental Sciences
| | - Lisa A Pompeii
- University of Texas School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences
| | | | - Lynne Wagenknecht
- Center on Diabetes, Obesity, and Metabolism; Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Kritchevsky
- Sticht Center on Aging; Wake Forest School of Medicine, Winston-Salem, North Carolina
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Xiao Q, Berrigan D, Keadle SK, Matthews CE. Neighborhood Socioeconomic Deprivation and Weight Change in a Large U.S. Cohort. Am J Prev Med 2017; 52:e173-e181. [PMID: 28314557 PMCID: PMC5438759 DOI: 10.1016/j.amepre.2017.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Both excessive weight gain and weight loss are important risk factors in the older population. Neighborhood environment may play an important role in weight change, but neighborhood effects on weight gain and weight loss have not been studied separately. This study examined the associations between neighborhood socioeconomic deprivation and excessive weight gain and weight loss. METHODS This analysis included 153,690 men and 105,179 women (aged 51-70 years). Baseline addresses were geocoded into geographic coordinates and linked to the 2000 U.S. Census at the Census tract level. Census variables were used to generate a socioeconomic deprivation index by principle component analysis. Excessive weight gain and loss were defined as gaining or losing >10% of baseline (1995-1996) body weight at follow-up (2004-2006). The analysis was performed in 2015. RESULTS More severe neighborhood socioeconomic deprivation was associated with higher risks of both excessive weight gain and weight loss after adjusting for individual indicators of SES, disease conditions, and lifestyle factors (Quintile 5 vs Quintile 1: weight gain, OR=1.36, 95% CI=1.28, 1.45 for men and OR=1.20, 95% CI=1.13, 1.27 for women; weight loss, OR=1.09, 95%% CI=1.02, 1.17 for men and OR=1.23, 95% CI=1.14, 1.32 for women). The findings were fairly consistent across subpopulations with different demographics and lifestyle factors. CONCLUSIONS Neighborhood socioeconomic deprivation predicts higher risk of excessive weight gain and weight loss.
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Affiliation(s)
- Qian Xiao
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa.
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Sarah K Keadle
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Visser M, Volkert D, Corish C, Geisler C, de Groot LC, Cruz-Jentoft AJ, Lohrmann C, O'Connor EM, Schindler K, de van der Schueren MA. Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub. NUTR BULL 2017. [DOI: 10.1111/nbu.12268] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Visser
- VU University Medical Center; Amsterdam The Netherlands
- Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - D. Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen-Nürnberg Germany
| | - C. Corish
- University College Dublin; Dublin Ireland
| | - C. Geisler
- Christian-Albrechts-Universität; Kiel Germany
| | | | | | | | | | | | - M. A. de van der Schueren
- VU University Medical Center; Amsterdam The Netherlands
- HAN University of Applied Sciences; Nijmegen The Netherlands
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Zhi T, Wang Q, Liu Z, Zhu Y, Wang Y, Shi R, Wang Z, Chu X, Wang X, Jiang X. Body mass index, waist circumference and waist-hip ratio are associated with depressive symptoms in older Chinese women: results from the Rugao Longevity and Ageing Study (RuLAS). Aging Ment Health 2017; 21:518-523. [PMID: 26689763 DOI: 10.1080/13607863.2015.1124837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective was to determine whether obesity is associated with depressive symptoms among older Chinese. METHODS Data from the cross-sectional Rugao Longevity and Ageing Study were used including anthropometric measurements (body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)), socio-demographic characteristics, living habits, physical health and cognitive impairment. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15). Chi-square tests and multivariate logistic regression analyses were performed to investigate the association between obesity and depressive symptoms. RESULTS Among 1732 elderly Chinese aged 70-84 years, the prevalence of depressive symptoms was 6.7% (5.0%-8.5%) in men and 12.5% (10.4%-14.6%) in women. A negative linear trend was found between depressive symptoms and BMI in women (Pfor trend < 0.05). Women with BMI ≥ 28.0 kg/m2 had lower chances (OR = 0.41 (0.20-0.84), p = 0.01) to have elevated depressive symptoms compared with their normal weight counterparts. Furthermore, consistent trends were observed with lower depression prevalence rates in higher WC and WHR categories in women. However, no such associations were apparent in men. CONCLUSION Higher BMI, WC and WHR categories were all associated with a lower risk of depressive symptoms in older women.
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Affiliation(s)
- Tingfan Zhi
- a Key Laboratory of Arrhythmias of the Ministry of Education of China , Tongji University School of Medicine , Shanghai , China.,b Department of Pathology and Pathophysiology , Tongji University School of Medicine , Shanghai , China
| | - Qunshan Wang
- c Department of Cardiology, Xinhua Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Zuyun Liu
- d Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology , School of Life Sciences and Institutes of Biomedical Sciences, Fudan University , Shanghai , China
| | - Yinsheng Zhu
- e Rugao People's Hospital , Rugao , Jiangsu , China
| | - Yong Wang
- e Rugao People's Hospital , Rugao , Jiangsu , China
| | - Rui Shi
- f Department of Gynaecology and Obstetrics, East Hospital , Tongji University School of Medicine , Shanghai , China
| | | | - Xuefeng Chu
- e Rugao People's Hospital , Rugao , Jiangsu , China
| | - Xiaofeng Wang
- d Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology , School of Life Sciences and Institutes of Biomedical Sciences, Fudan University , Shanghai , China
| | - Xiaoyan Jiang
- a Key Laboratory of Arrhythmias of the Ministry of Education of China , Tongji University School of Medicine , Shanghai , China.,b Department of Pathology and Pathophysiology , Tongji University School of Medicine , Shanghai , China
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Hu Y, Malyutina S, Pikhart H, Peasey A, Holmes MV, Hubacek J, Denisova D, Nikitin Y, Bobak M. The Relationship between Body Mass Index and 10-Year Trajectories of Physical Functioning in Middle-Aged and Older Russians: Prospective Results of the Russian HAPIEE Study. J Nutr Health Aging 2017; 21:381-388. [PMID: 28346564 DOI: 10.1007/s12603-016-0769-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the associations of overweight and obesity with longitudinal decline in physical functioning (PF) among middle-aged and older Russians. DESIGN Prospective cohort study. SETTING Four rounds of data collection in the Russian Health, Alcohol and Psychosocial factors In Eastern Europe study with up to 10 years of follow-up. PARTICIPANTS 9,222 men and women aged 45-69 years randomly selected from the population of two districts of Novosibirsk, Russia. MEASUREMENTS PF score (range 0-100) was measured by the Physical Functioning Subscale (PF-10) of the 36-item Short Form Health Survey (SF-36) at baseline and three subsequent occasions. Body mass index (BMI), derived from objectively measured body height and weight at baseline, was classified into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity class II+ (BMI≥35.0). RESULTS The mean annual decline in the PF score during the follow-up was -1.92 (95% confidence interval -2.17; -1.68) in men and -1.91 (-2.13; -1.68) in women. At baseline, compared with normal weight, obesity classes I and II+ (but not overweight) were associated with significantly lower PF in both sexes. In prospective analyses, the decline in PF was faster in overweight men (difference from normal weight subjects -0.38 [-0.63; -0.14]), class I obese men and women (-0.49 [-0.82; -0.17] and -0.44 [-0.73; -0.15] respectively) and class II+ obese men and women (-1.13 [-1.73; -0.53] and -0.43 [-0.77; -0.09] respectively). Adjustment for physical activity and other covariates did not materially change the results. CONCLUSIONS PF decreased more rapidly in obese men and women than among those with normal weight. The adverse effect of high BMI on PF trajectories appeared to be more pronounced in men than in women, making more extremely obese Russian men an important target population to prevent/slow down the process of decline in PF.
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Affiliation(s)
- Y Hu
- Yaoyue Hu, Research Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK, , Tel: +44 (0)20 7679 1680, Fax: +44 (0)203 108 3354
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Danon-Hersch N, Fustinoni S, Bovet P, Spagnoli J, Santos-Eggimann B. Association between Adiposity and disability in the Lc65+ Cohort. J Nutr Health Aging 2017; 21:799-810. [PMID: 28717810 DOI: 10.1007/s12603-016-0813-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort. DESIGN Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up. SETTING City of Lausanne, Switzerland. PARTICIPANTS 1,293 individuals aged 65 to 70 at baseline (58% women). MEASUREMENTS BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference. RESULTS 130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]). CONCLUSION Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life.
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Affiliation(s)
- N Danon-Hersch
- Nadia Danon-Hersch, Institute of Social and Preventive Medicine (IUMSP), University and University Hospital Center, Biopole 2, Route de la Corniche 10, 1010 Lausanne, Switzerland, Tel : +41 21 314 91 09; Fax: +41 21 314 97 67; ;
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van der Pols-Vijlbrief R, Wijnhoven HAH, Visser M. Perspectives on the Causes of Undernutrition of Community-Dwelling Older Adults: A Qualitative Study. J Nutr Health Aging 2017; 21:1200-1209. [PMID: 29188880 DOI: 10.1007/s12603-017-0872-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults. DESIGN Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed. SETTING Community-dwelling. PARTICIPANTS Older adults. MEASUREMENTS A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition. RESULTS 33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food and appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization. CONCLUSIONS This study provides guidance to better understand the underlying causes of undernutrition from an older adult's perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.
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Affiliation(s)
- R van der Pols-Vijlbrief
- Rachel van der Pols-Vijlbrief, Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands, E-mail address: ; Telephone number: +31 (0)20 59 83 701; Fax number: +31 (0)20 59 86 940
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Westergren A, Edfors E, Norberg E, Stubbendorff A, Hedin G, Wetterstrand M, Hagell P. Short-term effects of a computer-based nutritional nursing training program for inpatient hospital care. J Eval Clin Pract 2016; 22:799-807. [PMID: 27133949 DOI: 10.1111/jep.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 12/19/2022]
Abstract
RATIONALE This study aimed to explore whether a computer-based training in eating and nutrition for hospital nursing staff can influence the precision in nutritional treatment and care. METHOD A pre-intervention and post-intervention study was conducted with a cross-sectional design at each time point. The settings were one intervention (IH) and two control hospitals (CH1 and CH2). Hospital inpatients >18 years old at baseline (2012; n = 409) and follow-up (2014; n = 456) were included. The computer-based training was implemented during a period of 3 months in the IH with 297 (84%) participating registered nurses and nurse assistants. Nutritional risk was screened for using the Minimal Eating Observation and Nutrition Form. Nutritional treatment and care was recorded using a standardized protocol RESULTS In the IH, there was an increase in the share of patients at UN risk that received energy-dense food (+16.7%) and dietician consultations (+17.3%) between baseline and follow-up, while fewer received feeding assistance (-16.2%). There was an increase in the share of patients at UN risk that received energy-dense food (+19.5%), a decrease in oral nutritional supplements (-30.5%) and food-registrations (-30.6%) in CH1, whereas there were no changes in CH2. 'Overtreatment' (providing nutritional treatment to those not at UN risk) was significantly higher in CH2 (52.7%) than in CH1 (14.3%) and in the IH (25.2%) at follow-up. CONCLUSION The computer-based training seemed to increase the probability for patients at UN risk in the IH to receive nutritional treatment without increasing overtreatment.
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Affiliation(s)
- Albert Westergren
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden.
| | - Ellinor Edfors
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
| | | | | | - Gita Hedin
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
| | | | - Peter Hagell
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Batsis JA, Gill LE, Masutani RK, Adachi-Mejia AM, Blunt HB, Bagley PJ, Lopez-Jimenez F, Bartels SJ. Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. J Am Geriatr Soc 2016; 65:257-268. [PMID: 27641543 DOI: 10.1111/jgs.14514] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify geriatric obesity interventions that can guide clinical recommendations. DESIGN Systematic review using Medline (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, EMBASE (Ovid), and PsycINFO (Proquest) from January 1, 2005, to October 12, 2015, to identify English-language randomized controlled trials. PARTICIPANTS Individuals aged 60 and older (mean age ≥65) and classified as having obesity (body mass index ≥30 kg/m2 ). INTERVENTIONS Behavioral weight loss interventions not involving pharmacological or procedural therapies lasting 6 months or longer. MEASUREMENTS Two investigators performed the systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and achieved a high concordance rate (97.3%) in summarizing the primary outcomes. The three primary outcomes were weight loss, physical performance, and quality of life. RESULTS Of 5,741 citations, 19 were included. (Six studies were unique, and the remaining 13 were based on the same study population.) Duration ranged from 6 to 18 months (n = 405 participants, age range 66.7-71.1). Weight loss in the intervention groups ranged from 0.5 to 10.7 kg (0.1-9.3%). Five studies had a resistance exercise program accompanying a dietary component. Greater weight loss was observed in groups with a dietary component than those with exercise alone. Exercise alone led to better physical function but no significant weight loss. Combined dietary and exercise components led to the greatest improvement in physical performance measures and quality of life and mitigated reductions in muscle and bone mass observed in diet-only study arms. Heterogeneous outcomes were observed, which limited the ability to synthesize the data quantitatively. CONCLUSIONS The evidence supporting geriatric obesity interventions to improve physical function and quality of life is of low to moderate quality. Well-designed trials are needed in this population.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Weight & Wellness Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Lydia E Gill
- Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Rebecca K Masutani
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire
| | - Anna M Adachi-Mejia
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Pamela J Bagley
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
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46
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The impact of weight loss and low BMI on mortality of nursing home residents – Results from the nutritionDay in nursing homes. Clin Nutr 2016; 35:900-6. [DOI: 10.1016/j.clnu.2015.06.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/01/2015] [Accepted: 06/13/2015] [Indexed: 01/01/2023]
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Tsai LT, Rantakokko M, Rantanen T, Viljanen A, Kauppinen M, Portegijs E. Objectively Measured Physical Activity and Changes in Life-Space Mobility Among Older People. J Gerontol A Biol Sci Med Sci 2016; 71:1466-1471. [PMID: 26975981 DOI: 10.1093/gerona/glw042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 02/19/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our aim was to study the relationship between objectively measured physical activity and subsequent changes in life-space mobility over 2 years among older people. Life-space mobility refers to the area a person moves through in daily life, taking into account frequency, and need of assistance. Life-space mobility and physical activity correlate, but whether different intensities of objectively assessed physical activity predicts decline in life-space mobility is not known. METHODS Prospective cohort study of the "Life-space Mobility in Old Age" (LISPE) project accelerometer substudy. Participants were community-dwelling older people aged 75-90 (n = 164). Life-space mobility was measured with the Life-Space Assessment at baseline face-to-face home interview and telephone follow-up interviews 1 and 2 years after baseline. Physical activity (step count and time spent in moderate activity, low activity, and sedentary behavior) was measured by a tri-axial accelerometer (Hookie "AM20 Activity Meter") for 7 days at baseline. Generalized estimating equations (GEE models) were used to compare changes in life-space mobility between participants categorized according to the baseline physical activity measures. RESULTS Median age of the participants was 79.5 (IQR 6.7) and 64% were women. Over the 2 years, life-space mobility declined significantly among those with lower step counts and less time spent in moderate activity measured at baseline. Time spent in low activity and sedentary behavior did not predict changes in life-space mobility. CONCLUSIONS In old age, more time spent walking outdoors and accumulation of moderate-intensity physical activity may help to maintain higher life-space mobility, a correlate of good quality of life.
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Affiliation(s)
- Li-Tang Tsai
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
| | - Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
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Factors associated with (risk of) undernutrition in
community-dwelling older adults receiving home care: a cross-sectional study in
the Netherlands. Public Health Nutr 2016; 19:2278-89. [DOI: 10.1017/s1368980016000288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjectiveIt is generally thought that causes of undernutrition are multifactorial, but
there are limited quantitative studies performed. We therefore examined a
wide range of potential factors associated with undernutrition in
community-dwelling older adults.DesignCross-sectional study.SettingCommunity-dwelling older adults (≥65 years) receiving home care in the
Netherlands.SubjectsData on potential factors associated with (risk of) undernutrition were
collected among 300 older adults. Nutritional status was assessed by the
SNAQ65+ instrument. Undernutrition was defined as
mid-upper arm circumference <25 cm or unintentional weight loss of
≥4 kg in 6 months. Being at risk of undernutrition was defined as
having poor appetite and inability to walk up and down stairs of fifteen
steps, without resting.ResultsOf all participants, ninety-two (31·7 %) were undernourished
and twenty-four (8·0 %) were at risk of undernutrition. Based
on multivariate logistic regression analyses, the statistically significant
factors associated with (risk of) undernutrition
(P<0·05) were: unable to go outside
(OR=5·39), intestinal problems (OR=2·88),
smoking (OR=2·56), osteoporosis (OR=2·46),
eating fewer than three snacks daily (OR=2·61), dependency in
activities of daily living (OR=1·21), physical inactivity
(OR=2·01), nausea (OR=2·50) and cancer
(OR=2·84); a borderline significant factor was depression
symptoms (OR=1·83,
P=0·053).ConclusionsThe study suggests that (risk of) undernutrition is a multifactorial problem
and that associated factors can be found in several domains. These findings
may support the development of intervention trials for the prevention and
treatment of undernutrition in community-dwelling older adults.
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Getty MD, Mueller M, Amella EJ, Fraser AM. Differences in Medical and Life-style Risk Factors for Malnutrition in Limited-Resource Older Adults in a Rural U.S. State: A Descriptive Study. J Nutr Health Aging 2016; 20:121-7. [PMID: 26812507 DOI: 10.1007/s12603-015-0561-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Medical and life-style factors are associated with malnutrition in older adults. This study assessed the presence of these risk factors in limited-resource, community-dwelling older adults to inform the development of a nutrition education interventions. DESIGN Quantitative descriptive study. SETTING A total of 24 randomly selected congregate nutrition sites (where limited-resource older adults can receive one hot meal/day, five days/week) in the rural state of South Carolina, USA. PARTICIPANTS Data were collected from 477 older adults (of the 407 who reported race, 219 were African American and 171 were White). MEASUREMENTS Extension Educators who work for the Cooperative Extension Service (a formalized educational outreach system associated with some U.S. universities) read aloud a 27-item instrument designed to assess risk factors for malnutrition. Response frequencies were tabulated and chi-square tests were performed using SAS 9.3. RESULTS More African Americans reported having a chronic illness or condition (81.2 vs. 68.3%; p=0.003), eating alone (66.2 vs. 53.6%; p=0.012), having a refrigerator that sometimes did not keep food cold (31.8 vs. 8.4%; p<0.0001), and sometimes not having enough money to buy food (38.9 vs. 18.5%; p<0.0001) compared to White older adults. CONCLUSION Rural older adults who attend congregate nutrition sites, especially African Americans, could be at risk for malnutrition due to health status and food preparation-related factors. Evidence-based, tailored programs are needed to minimize malnutrition among limited-resource older adults living in rural areas in the U.S.
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Affiliation(s)
- M D Getty
- Angela M. Fraser, 223 Poole Agricultural Center, Clemson, South Carolina 29634, USA,
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50
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Visnjevac O, Davari-Farid S, Lee J, Pourafkari L, Arora P, Dosluoglu HH, Nader ND. The Effect of Adding Functional Classification to ASA Status for Predicting 30-Day Mortality. Anesth Analg 2015; 121:110-116. [DOI: 10.1213/ane.0000000000000740] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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