An in-home nurse-administered geriatric assessment for hypoalbuminemic older persons: development and preliminary experience

How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime Outcomes in Long-Term Care

Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62-102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29-37) and MSPs were 26 kPa (95% CI 23-29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.

Dysphagia is associated with functional decline during acute-care hospitalization of older patients

AIM

Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute-care patients.

METHODS

A total of 103 older patients without present or prior history of diseases that could directly impair swallowing and cause dysphagia (45 men and 58 women; mean age 80.5 years) hospitalized in acute-care wards were included in the present study. Dysphagia or difficulty swallowing was assessed by using the 10-item Eating Assessment Tool. Functional and nutritional status, such as Barthel Index (BI), Mini-Nutritional Assessment short form, body mass index, calf circumference, handgrip strength and dysphagia, were analyzed to evaluate their relationships.

RESULTS

Dysphagia, as assessed using the 10-item Eating Assessment Tool, was noted in 26.2% of the participants. Multivariate analysis showed that dysphagia, handgrip strength and BI on admission were independently associated with poor BI gain during hospitalization after adjustment for age, sex, causative disease for admission, premorbid ADL, length of hospital stay, Mini-Nutritional Assessment short form, handgrip strength and BI.

CONCLUSIONS

Dysphagia, as assessed by the 10-item Eating Assessment Tool, was common in older patients. In addition, dysphagia was independently associated with poorer functional recovery during acute-care hospitalization of older patients. Geriatr Gerontol Int 2017; 17: 1610-1616.

[Factors associated with malnutrition in community-dwelling disabled elderly--the KANAGAWA-AICHI Disabled Elderly Cohort (KAIDEC) Study]

AIM

This study aimed to identify factors associated with malnutrition in community-dwelling disabled elderly.

METHODS

A cross-sectional study of baseline data for 1,142 community-dwelling elderly (81.2±8.7 years) from of the KANAGAWA-AICHI Disabled Elderly Cohort (KAIDEC) study was conducted. The data included the participants' demographic characteristics, nutritional status (Mini Nutritional Assessment short-form: MNA-SF), dysphagia status (Dysphagia Severity scale: DSS), comorbidity, basic activities of daily living (bADL), hospitalization with in the past three months and care level according to the Long-Term Care Insurance program. The participants were considered to be in malnutrition or at risk of malnutrition if their MNA-SF score was 0-7 or 8-11, respectively. The chi square test, analysis of variance, Jonckheere-Terpstra trend test and logistic regression analysis were used for the statistical analysis.

RESULTS

A total of 16.7% of the participants were classified as having malnutrition. In addition, a higher prevalence of malnutrition was associated with a higher care level in the long-term care insurance program, and malnutrition was associated with a lower bADL score, the presence of dysphagia and dementia and hospitalization with in the past three months.

CONCLUSIONS

The present study demonstrated that malnutrition in community-dwelling disabled elderly is associated with a lower bADL score, the presence of dysphagia and dementia and hospitalization with in the past three months.

Malnutrition and quality of life in older people: a systematic review and meta-analysis

Although the effects of malnutrition on morbidity and mortality of older people is well established, there has been little work done to investigate the relationship between malnutrition and quality of life (QoL) in this population. In order to facilitate further research and to aggregate existing evidence into a clear overview, a systematic review was conducted. The objective was to identify the literature on the topic, review the findings systematically, and assess the association between nutritional status and QoL. MEDLINE, EMBASE, CINAHL and Web of Science were searched for relevant studies published up to April 2011. References within identified studies also searched. The primary author extracted all data using a purpose-built form, and evaluated the quality of the studies using a published checklist. A second reviewer checked a random sample of articles independently. Evidence in the current review comes from both cohort studies and intervention trials. Results from the former suggested that individuals with malnutrition are more likely to experience poor QoL (OR: 2.85; 95% CI: 2.20-3.70, p<0.001). Consistent with this, interventions designed to improve nutritional status can also lead to significant improvements in QoL, both physical (standard mean difference 0.23, CI: 0.08-0.38, p=0.002) and mental aspects (standard mean difference 0.24, CI: 0.11-0.36, p<0.001). However, the results should be interpreted with caution in view of the poor quality of the included studies and the heterogeneity of methods employed in the assessment of both nutritional status and QoL. Future studies should carefully characterise their participants and use standardised parameters for nutritional and QoL assessments in order to achieve better evaluation and comparability of study results.

Dietary Intake of Elderly Living in Toronto Long-Term Care Facilities: Comparison to the Dietary Reference Intake

OBJECTIVE

To compare the dietary intake of elderly living in 11 long-term care facilities (LTCFs) to the Estimated Average Requirement set as part of the Dietary Reference Intake for older adults.

DESIGN

A cross-sectional assessment of dietary intake using a 3 days food record among 407 elderly with mean age of 85.2 +/- 7.7 years and BMI of 23.8 +/- 5.7 kg/m(2). This population sample was similar to the one living in LTCFs in the province of Ontario.

RESULTS

The daily energy intake was 1513 +/- 363 kcal (6330.4 +/- 1518.8 kJ). Percentage of energy from fat, saturated fat, polyunsaturated fat, protein, and carbohydrate were 30%, 11%, 5.2%, 15%, and 56%, respectively. Although these values were close to the recommendations, 29.5% had protein intake below the recommended 0.8 g/kg; and 38.3% of subjects had cholesterol intake more than the recommended 300 mg/d. More than 50% of the subjects had suboptimal intake of calcium, magnesium, zinc and vitamins E, B(6), and folate. In addition, greater than 15% had suboptimal intakes of other micronutrients such as vitamins A, C, niacin, and copper.

CONCLUSIONS

Elderly subjects living in LTCFs in Toronto despite having a normal body mass index (BMI), do not meet the recommended levels of intake for protein and many of the micronutrients. LTCFs staff should monitor dietary intake. Menu modification and micronutrient supplementation may be required in order to meet the daily requirements of these elderly.

[Anthropometric measurements as a predictor of mortality of community-dwelling Japanese elderly: the Nagoya Longitudinal Study of Frail Elderly (NLS-FE)]

AIM

This study aimed to evaluate the relationship between anthropometric measurements and mortality among community-dwelling frail elderly.

METHODS

This study was a prospective cohort analysis of 520 community-dwelling elderly registered in the Nagoya Longitudinal Study for Frail Elderly (NLS-FE). Data included the participants' demographic characteristics, body mass index (BMI), mid-arm circumference (MAC), triceps skinfold (TSF), and arm muscle area (AMA), basic activities of daily living, comorbidity. BMI and TSF values were categorized into three groups, respectively, according to above the 75th percentile, the 25-75th percentile, and below the 25th percentile of Japanese Anthropometric Reference Data (JARD 2001). Survival analysis of 21-month mortality was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models.

RESULTS

BMI and TSF were independent risk factors for 21-month mortality in the study participants. Significant higher risk of 21-month mortality was observed in participants below the 75th percentile of BMI or below the 25th percentile of TSF set in JARD 2001. A striking increase in the risk of 21-month mortality, adjusting for potential confounding factors, was observed in the below 75th percentile of the BMI group with a below 25th percentile TSF of JARD 2001, compared with the 75th or above percentile BMI group with the 25th or above percentile TSF.

CONCLUSION

The combination of BMI and TSF is a predictor of 21-month mortality among older people with ADL dysfunction.

Patient-centred outcomes in dietary research

INTRODUCTION

Current health policy stresses the need to take patients' views into account in the provision of health care, including involvement in the process of care and determining the outcome(s) of treatment. It is unclear whether patients undergoing dietary treatment have been consulted on their views.

METHODS

A literature review, searching electronic databases and hand searching dietetic journals, of dietary intervention research was carried out to identify if patients' views were sought in determining outcomes.

RESULTS

Searching uncovered a total of 28 papers reporting the results of studies of dietary interventions where patients views were sought in the measurement of outcome, however little detail was given about patient(s) involvement and whether the use of the measures influenced future care.

FUTURE WORK

Should address the issue of patient involvement in the determination of outcome and how this then influences future care.

Diagnosing malnutrition in the elderly

Numerous research studies have documented the inability of many health care providers to identify nutritional deficit vulnerability and early and advanced malnutrition states in the elderly. This article provides a clinical evaluation guide for identifying risks and diagnosing incipient and advanced malnutrition. Diagnosis and intervention can prevent loss of function and independence and decrease morbidity and mortality in the elderly.