Sexually dimorphic patterns of nutritional intake and eating behaviors in community-dwelling older adults with normal and slow gait speed

OBJECTIVES

Assess sex-specific nutritional intake and dietary habits of independently living older adults with normal and slow gait speeds.

DESIGN

New Mexico Aging Process Study, cross-sectional, secondary data analysis.

SETTING

Albuquerque, New Mexico USA.

PARTICIPANTS

Three-hundred fifteen adults 60 years and older (194 women and 121 men).

MEASUREMENTS

Gait speed test, 3-day diet records, Mini-Mental State Examination, and body mass index.

RESULTS

Slow gait speed was associated with lower total calories (-154 kcal/day) and zinc (1 mg/day) (.05 < p < .1). Slower men consumed less protein (-4.1 g/day), calcium (-140 mg), fiber (-2.8 g/day) and iron (-2.5 mg/day) (p≤.05). Slower women consumed less, protein (-5.5 g/day), carbohydrate (-19.1 g/day), fiber (-2.7 gm/day), vitamin C (-18.4 mg/day) and higher fat intake (p=0.03). Slower women snacked less, had trouble chewing/biting, and lived alone (p= .04). Slower men were less likely to snack.

CONCLUSIONS

We found sex-specific nutritional differences associated with gait speed. Those presenting with slow gait speed may need encouragement to increase meat and whole grain breads/cereal. Those with trouble eating should be advised on adapting diet to maintain adequate nutrition and encouraged on regular snacking to achieve higher nutrient intake. Prospective and randomized controlled studies are needed to confirm these findings and provide further evidence for putting these suggestions into practice.

The New Mexico aging process study (1979-2003). A longitudinal study of nutrition, health and aging

In 1979, Dr. James S. Goodwin, M.D., assisted by Philip J. Garry, Ph.D., submitted a grant proposal to the United States Public Health Service/ National Institute on Aging (NIA) entitled, "A prospective study of nutrition in the elderly". This study was approved and funded by the NIA beginning in 1979. Initially, approximately 300 men and women over 65 years of age with no known medical illnesses and no prescription medications were selected for this study. The primary purpose of this multi disciplinary study, known in the literature as the New Mexico Aging Process Study (NMAPS), was to examine the role of nutrition and resultant changes in body composition and organ function in relation to the aging process and health status of the elderly. This was accomplished by following prospectively healthy elderly volunteers, obtaining in-depth information about dietary habits, lifestyle, body composition, organ function, cognitive status, vitamin metabolism, genetic markers, and biochemical measures of nutritional status and then examining these data in relationship to age and health status and changes in health status. Some of the specific aims of the study were modified over the course of this longitudinal study because of availability of University of New Mexico School of Medicine faculty with expertise in different areas of aging research. In 1988, Dr. Bruno Vellas from the University Hospital in Toulouse, France became an on-going visiting professor at the University of New Mexico School of Medicine. From 1988, until the study was terminated in 2003, Dr. Vellas has collaborated with the faculty involved in the NMAPS on a number of research projects. In this article, we provide information about the studies overall design and briefly describe some of the major finding of the NMAPS.

Behaviors underlying the use of nonvitamin nonmineral dietary supplements in a healthy elderly cohort

OBJECTIVE

The purpose of the study was to examine factors underlying the decision to use nonvitamin, nonmineral (NVNM) dietary supplements in a healthy elderly cohort.

DESIGN

Questionnaires were administered to probe for perceived health status, health insurance coverage, income level, monthly expenditure for supplements, duration of supplement use, information source, disclosure of supplement taking to physician, reasons for NVNM supplements use and perceived benefits, use of supplements to replace or complement a medication, and usual purchasing place.

SETTING/PARTICIPANTS

Between 1999- 2001, 418 elderly males (34.7%) and females (65.3%) ages 60-96 years were surveyed.

RESULTS

Nonvitamin nonmineral supplement "consumers" and "non-consumers" were not significantly different for sex, age, ethnicity, perceived health status, income level, and health insurance access. The average consumer took three NVNM supplements and spent significantly more money on supplements than non-consumers (p < 0.001). Over 44% of consumer's responses indicated that they had been using NVNM supplements for over 2 years. Literature/media were predominately the source of information with mail order being the most frequent method of purchase. Over 39% of consumer's responses showed that supplement use was revealed to a physician. Arthritis, memory improvement, and general health and well-being were the main reasons to use NVNM supplements. Less joint pain/improved mobility was the main perceived improvement from taking NVNM supplements. Overall, over 53% of consumer's responses showed that no change was noticed from taking NVNM supplements.

CONCLUSIONS

Although the most commonly reported responses by those noticing change from NVNM supplement use were improved mobility and less joint pain, over half of the responses indicated that they did not feel any benefit from taking supplements, yet continued to purchase and take them. Communication of NVNM supplement use to their physician was low. More studies are needed to investigate what influences the decision to continue supplement use regardless of the lack of efficacy, considerable cost, and potential risks.

An examination of the mediating role of psychological empowerment on the relations between the job, interpersonal relationships, and work outcomes

A field investigation of 337 employees and their immediate superiors tested the mediating role of empowerment in relations between job characteristics, leader-member exchange (LMX), team-member exchange (TMX), and work outcomes. The meaning and competence dimensions of empowerment mediated the relation between job characteristics and work satisfaction. The meaning dimension also mediated the relation between job characteristics and organizational commitment. Contrary to prediction, empowerment did not mediate relations between LMX, TMX, and the outcome variables. Rather, LMX and TMX were directly related to organizational commitment. In addition, TMX was directly related to job performance. These findings suggest that work satisfaction is explained largely by job characteristics (through empowerment) but that LMX and TMX combine with job characteristics and empowerment to explain variation in organizational commitment and job performance.

One-leg balance is an important predictor of injurious falls in older persons

OBJECTIVE

To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls.

DESIGN

Analysis of data from a longitudinal cohort study.

SUBJECTS

Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years).

MAIN OUTCOME MEASURES

Falls and injurious falls detected via reports every other month.

INDEPENDENT VARIABLES

Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg).

RESULTS

At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03).

CONCLUSION

One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

Fear of falling and restriction of mobility in elderly fallers

OBJECTIVES

To identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time.

DESIGN

A prospective study of falls over a 2-year period (1991-92). Falls were ascertained using bimonthly postcards plus telephone interview with a standardized (World Health Organisation) questionnaire for circumstances, fear of falling and consequences of each reported fall. Each participant underwent a physical exam and subjective health assessment each year form 1990 to 1993.

SETTING

New-Mexico Aging Process Study, USA.

SUBJECTS

487 elderly subjects (> 60 years) living independently in the community.

MAIN OUTCOME MEASURES

Fear of falling after experiencing a fall.

RESULTS

70 (32%) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling. Women were more likely than men to report fear of falling (74% vs 26%). Fallers who were afraid of falling again had significantly ore balance (31.9% vs 12.8%) and gait disorders (31.9% vs 7.4%) at entry in the study in 1990. Among sex, age, mental status, balance and gait abnormalities, economic resource and physical health, logistic regression analysis show gait abnormalities and poor self-perception of physical health, cognitive status and economic resources to be significantly associated with fear of falling. Subjects who reported a fear of falling experienced a greater increase in balance (P = 0.08), gait (P < 0.01) and cognitive disorders (P = 0.09) over time, resulting in a decrease in mobility level.

CONCLUSION

The study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme.

Nutritional status and cognitive functioning in a normally aging sample: a 6-y reassessment

Associations between nutritional status and cognitive performance were examined in 137 elderly (aged 66-90 y) community residents. Participants were well-educated, adequately nourished, and free of significant cognitive impairment. Performance on cognitive tests in 1986 was related to both past (1980) and concurrent (1986) nutritional status. Several significant associations (P < 0.05) were observed between cognition and concurrent vitamin status, including better abstraction performance with higher biochemical status and dietary intake of thiamine, riboflavin, niacin, and folate (rs = 0.19-0.29) and better visuospatial performance with higher plasma ascorbate (r = 0.22). Concurrent dietary protein in 1986 correlated significantly (rs = 0.25-0.26) with memory scores, and serum albumin or transferrin with memory, visuospatial, or abstraction scores (rs = 0.18-0.22). Higher past intake of vitamins E, A, B-6, and B-12 was related to better performance on visuospatial recall and/or abstraction tests (rs = 0.19-0.28). Use of self-selected vitamin supplements was associated with better performance on a difficult visuospatial test and an abstraction test. Although associations were relatively weak in this well-nourished and cognitively intact sample, the pattern of outcomes suggests some direction for further research on cognition-nutrition associations in aging.

Commitment and employee behavior: comparison of affective commitment and continuance commitment with perceived organizational support

The social exchange view of commitment (R. Eisenberger, R. Huntington, S. Hutchison, & D. Sowa, 1986) suggests that employees' perceptions of the organization's commitment to them (perceived organizational support, or POS) creates feelings of obligation to the employer, which enhances employees' work behavior. The authors addressed the question of whether POS or the more traditional commitment concepts of affective commitment (AC) and continuance commitment (CC) were better predictors of employee behavior (organizational citizenship and impression management). Participants were 383 employees and their managers. Although results showed that both AC and POS were positively related to organizational citizenship and that CC was negatively related to organizational citizenship, POS was the best predictor. These findings support the social exchange view that POS creates feelings of obligation that contribute to citizenship behaviors. In addition, CC was unrelated, whereas AC and POS were positively correlated, with some impression management behaviors.

Prediction of iron absorption based on iron status of female blood donors

Iron stores were assessed in 27 postmenopausal healthy women who donated five units of blood (approximately 485 mL/unit) over approximately 1 y. The mean (+/- SD) age was 67.7 +/- 4.0 y and the average time between successive blood donations was approximately 10 wk (range 8-30 wk). Steady-state iron stores at entrance were 10.59 +/- 3.88 mg/kg body wt (mean +/- SD) and declined to 1.03 +/- 3.20 mg/kg by the fifth donation. Determination of iron stores was based on biochemical measures of iron status at each donation. Iron intakes were 23.3 +/- 10.1 mg/d. From these data we developed equations that can be used to predict the frequency at which healthy postmenopausal women can donate blood without becoming iron deficient. The ability of elderly women to become successful blood donors depends primarily on initial iron stores, iron intake, and frequency of donation. Women with low steady-state iron stores may be able to donate only two times per year without becoming iron deficient.

Relationship between malnutrition and falls in the elderly

Due to the multifactorial nature of falls in the elderly population, it is difficult to determine causal relationships for risk factors for falls. In some cases, other risk factors may play a role. For example, the association between poor nutrition status and falls has not been studied extensively. The association of commonly demonstrated nutritional deficiencies in the elderly with factors such as balance, gait, and mobility may lead to new insights into causes of falls in the elderly not previously established. In this article, we review how malnutrition can be a risk factor for falls, how falls can induce malnutrition, and the possible relationship between mobility and nutrition in the elderly.

Longitudinal prescribing patterns in a nursing home population

OBJECTIVE

This study documents the patients characteristics associated with prescribed medications on entry to a nursing home and the change in prescribing patterns after 3 months.

DESIGN

One-year admission cohort.

SETTING

Three university-affiliated community nursing homes in Albuquerque, NM.

PATIENTS

All new admissions (n = 81) to a University geriatrics team, covering intermediate and skilled levels of care during 1 year (July 1, 1988-July 1, 1989).

METHODS

Outcome measures were scheduled and as-needed (PRN) medications prescribed at entry and 3 months. Data collected at entry included patient demographics, activities of daily living index, mental status score, and medical diagnoses.

RESULTS

Older persons were prescribed fewer scheduled medications than younger ones, and women fewer than men. There was a positive association between the number of diagnoses and the number of scheduled medications (r = 0.25, P = 0.02). No associations were found between medications prescribed and mental status or functional level. There were no associations between as-needed (PRN) medications and any of the variables studied. Overall, there was a significant increase in the average total number of medications prescribed between admission (4.7) and 3 months (6.2). This was due to an increase in the number of PRN medications from 1.3 at admission to 3.0 at 3 months (P less than 0.001).

CONCLUSIONS

Measuring medications at consistent points in a person's nursing home stay may be more informative than using cross-sectional sampling. Future studies on medications in nursing home populations should distinguish between PRN and scheduled medications because medication prescribing patterns may be different in these categories.

Characteristics of elderly blood donors

The aging of our society will result in an increased demand for blood components, but it also has the potential to produce a large group of blood donors, the elderly. To study the effects of regular donation by older persons, a randomized, controlled trial is being conducted among 244 healthy, elderly volunteers. This report focuses on the efficacy of the recruiting efforts for that study and describes the resultant population in terms of their demographics, medical status, and donation safety. Of 325 potential subjects, 18 percent were disqualified and 7 percent refused entry into the study. After medical evaluation, only 2 persons were disqualified for conditions not detected by the usual blood services screening protocols. The resultant elderly donor population (n = 244) was well-educated, middle-income, and, for the most part, married. The group reported more past and present medical conditions, past surgical procedures, and current medications than would be expected in a younger donor group. Reactions to donation were infrequent and mild. With current screening and donation procedures, blood donation by the elderly appears to be safe and practical.

A prospective study of blood donations in healthy elderly persons

Iron stores were observed in 57 healthy elderly volunteers, between 63 and 77 years of age, who donated 5 units of blood over approximately 1 year. An equal number of nondonors who contributed approximately 7 mL of blood at each visit for iron status measurements only were seen at the same frequency as the donor population. At entrance to the study, iron stores in women and men averaged 724 and 875 mg, respectively. After five donations, mean iron stores dropped to 67 mg in women (n = 27) and 362 mg in men (n = 30); four women (15%) became iron deficient, while two (7%) developed iron deficiency anemia. Three men (10%) developed iron deficiency, but none were found to be anemic. Mean intakes of iron were 23.3 and 22.5 mg per day, respectively, for women and men. Iron intakes were adequate to meet iron requirements of nondonors, but they were not sufficient to halt the steady decrease in iron stores among the donor population, in whom iron absorption increased from approximately 5 percent at entrance to 14 percent at the time of the fifth donation. In summary, healthy elderly persons may contribute to the national blood resource; however, donations should probably be limited to less than five per year or donors should regularly take an iron supplement to preserve reasonable amounts of iron reserves.

Sampling issues in nursing home research

It has been suggested that two common methods of sampling nursing home populations, cross-sectional sampling and discharge sampling, result in samples with different characteristics and lengths of stay. Comparison of these samples to a sample of nursing home admissions has not been studied. This study compares characteristics and lengths of stay among cross-sectional, discharge, and admission samples. All current residents of three nursing homes in February 1987 made up the cross-sectional sample, all admissions in the following year made up the admission sample, and all discharges in the same year made up the discharge sample. The results of comparing these three sampling techniques show that the most striking differences occur between the cross-sectional sample and the admission sample. Persons in the cross-sectional sample tended to have longer nursing home stays as well as less social support and more behavioral and functional problems than persons in the admission sample, who tended to have shorter stays and more acute medical problems. The discharge sample was more similar to the admission sample than it was to the cross-sectional sample; however, some differences were found between the discharge and admission samples. Based on the differences found among the three samples, appropriate uses for each sample are discussed.

Cell-mediated immunity as a predictor of morbidity and mortality in subjects over 60

Previous studies have suggested an association between depressed cell-mediated immunity and increased mortality in elderly persons. However, the effects of age and existing disease on this association have not been adequately addressed. We studied the association between cell-mediated immunity and subsequent morbidity and mortality in 273 initially healthy persons 60 years of age and older. In 1979, two tests of cell-mediated immunity were conducted--mitogen stimulation with phytohaemagglutinin, and delayed hypersensitivity skin testing. The study group was followed annually for development of pneumonia, cancer, and death. Anergy was associated with all-cause mortality (hazard ratio of 2.16; 95% confidence interval [1.10,4.28]). When the results were adjusted for age, the resulting hazard ratio was 1.89;[0.94,3.79]. A relationship was also suggested between anergy and cancer mortality although this association was not statistically significant. Response to phytohaemagglutinin was a poorer predictor of mortality than was response to delayed hypersensitivity skin testing. The results show that anergy may be a good indicator of subsequent all-cause mortality, and perhaps cancer mortality, in elderly who lack other indicators of poor health.

A modification of the tuck position for lumbar spine surgery. A 15-year follow-up study

The tuck position used in conjunction with the tuck seat continues to satisfy the important requirements of lumbar spine surgery: satisfactory respiratory exchange, diminished venous oozing, and ample exposure. In 253 operations performed since 1971, minimal postoperative morbidity, including deep vein thrombosis, was experienced. The tuck seat is simple to use and, when recommended principles are followed, safe.