Hélène Payette

Impact of a 12‐Month Exercise Program on the Physical and Psychological Health of Osteopenic Women

OBJECTIVE: To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women.

Predictors of dietary intake in a functionally dependent elderly population in the community.

OBJECTIVES The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

An approach to the management of unintentional weight loss in elderly people

UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population.

Risk factors for institutionalization of frail elderly have been studied but the role of nutritional status has not been addressed. A prospective cohort of 288 frail elderly (81 male; 207 female; mean age: 78.2 +/- 7.6 years) were recruited from the current list of those receiving home help services and followed for 3-5 years. At baseline, height, weight, and arm muscle circumference were measured. Self-reported weight loss prior to baseline, energy, and protein intake were recorded. Covariates included sociodemographic factors, social network variables, functional and health status. Coxs multivariate survival analysis was used to identify independent predictors of institutionalization. Over the period of observation, 46% of subjects were institutionalized. Univariate predictors included weight loss >/=5 kg, functional status, and not living alone. In multivariate analysis, weight loss significantly increased the likelihood of institutionalization [Hazard Ratio (HR) = 1.71 (95% CI: 1.08-2.73)] as did limited functional capacities [HR = 1.26 (95% CI: 1.02-1.55)]. Among the free-living frail elderly, weight loss >/=5 kg is an important predictor of early institutionalization after controlling for social network, health, and functional status.

Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force.

BACKGROUND In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. MATERIALS AND METHODS This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. RESULTS One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. CONCLUSION Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.

Muscle strength and functional mobility in relation to lean body mass in free-living frail elderly women

Objectives: (1) To describe body composition of the frail elderly, (2) To relate lean body mass to muscle strength and functional ability, and (3) To assess temporal stability of strength measures and index of functional ability.Design: Cross-sectional study.Setting: Community-dwelling.Subjects: Thirty frail elderly women (81.5±7 y) recruited from residences or out-patient facilities.Methods: Total body fat and fat-free mass (FFM) were determined using multi-frequency bioelectrical impedance analysis and predicted from anthropometry. Handgrip strength, biceps and quadriceps strength, functional capacities (Timed ‘Up & Go’) as well as self-perceived health and functional status were measured. Reliability was assessed using two separate observations made one week apart by the same examiner.Results: Mean height, weight and body mass index were 1.52±0.04 m, 60.4±10.7 kg and 26.0±4.8 kg/m2 respectively. FFM (34.1±4.6 kg) was lower than previous reports for autonomous elderly females and associated with all measures of muscle strength (Pearson’s r=0.42–0.62, P≤0.02), but not with performance on the Timed ‘Up & Go’ or self-perceived health and functional status. Strength measures correlated significantly with different subscales of self-perceived functional capacities and were significantly lower among women with a low %FFM (n=19) and those reporting pain (n=11) as compared to other women. Excellent temporal stability for muscle and functional measures was observed (ICC=0.80–0.90).Conclusions: Muscle strength was strongly related to FFM in free-living frail elderly women especially in the absence of pain.Sponsorship: Abbott Laboratories, Limited, Saint-Laurent (Québec) Canada.

A weight-bearing, water-based exercise program for osteopenic women: its impact on bone, functional fitness, and well-being.

OBJECTIVE To evaluate the effects of a weight-bearing, water-based, exercise program designed for women with low bone mass. DESIGN A test-retest cross-sectional, prospective study. SETTING Community-dwelling women from a Canadian city. PARTICIPANTS Seventy-seven postmenopausal women, 50 to 70 years of age, with spinal or femoral bone density below the fracture threshold. INTERVENTION Subjects exercised in a pool with waist-high water for 60 minutes, 3 days a week, over a 12-month period. Forty minutes of each session were devoted to successive jumps and muscular exercises designed to promote bone accretion, strength, and endurance. MAIN OUTCOME MEASURES Spinal and femoral bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, functional fitness (flexibility, coordination, agility, strength/endurance, and cardiorespiratory endurance) assessed with the American Alliance for Health, Physical Education, Recreation and Dance battery, and psychological states evaluated with Dupuys General Well-Being Schedule. RESULTS Spinal BMD decreased significantly (p < .001), whereas there was no change in femoral neck BMD (p = .90). Four of the parameters chosen to assess functional fitness, namely, flexibility, agility, strength/endurance, and cardiorespiratory endurance, were affected positively by the exercise program (all p values < .001). Psychological well-being also improved significantly after participation in the exercise program (p < .001). CONCLUSION The intervention was successful in improving the functional fitness and psychological well-being of the participants, despite a lack of effect on the skeletal system. Future studies are needed to identify water exercises that are safe yet exert enough stress on the bones to initiate a bone response.

Longitudinal evidence on the association between interleukin-6 and C-reactive protein with the loss of total appendicular skeletal muscle in free-living older men and women

BACKGROUND there is no longitudinal evidence about the association between the loss of total appendicular skeletal muscle (TASM) and cytokines. OBJECTIVE to investigate whether high levels of the inflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the loss of TASM in free-living non-sarcopenic older people. DESIGN five-year prospective cohort study. SUBJECTS one hundred and fifteen free-living non-sarcopenic older men and women aged 60-84 years at baseline and 5-year follow-up were included. METHODS TASM was measured by dual-energy X-ray absorptiometry, and the relative change in TASM was calculated. The response variable was the loss of TASM defined as the lowest sex-specific 15th percentile of the cohort distribution of percentage of change in TASM. The exposure variables were the baseline serum IL-6 and CRP levels measured by ELISA. RESULTS sixteen subjects were below the sex-specific 15th percentile of the cohort. The mean absolute loss of TASM in these men and women subjects was 1.9 and 1.3 kg, respectively. The risk of loss TASM was 1.29 times higher (95% confidence interval [CI], 1.01-1.64) (P = 0.03) per unit of increase in IL-6 (pg/ml) and 1.28 times higher (95% CI, 1.04-1.58) (P = 0.01) per unit of increase in CRP (mg/l). As a categorical variable, the risk of loss TASM was 4.85 times higher (95% CI, 1.24-18.97) among subjects with serum IL-6 >2.71 pg/ml and 3.97 times higher (CI 95%, 1.09-14.39) among subjects with serum CRP >3.74 mg/l. These findings remained after adjusting for age, sex and 5-year weight change. CONCLUSIONS inflammation is associated with the loss of TASM in free-living non-sarcopenic older men and women.

Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial

Background: National guidelines for managing diabetes set standards for care. We sought to determine whether a 1-year intensive multitherapy program resulted in greater goal attainment than usual care among patients with poorly controlled type 2 diabetes mellitus. Methods: We identified patients with poorly controlled type 2 diabetes receiving outpatient care in the community or at our hospital. Patients 30–70 years of age with a hemoglobin A1c concentration of 8% or greater were randomly assigned to receive intensive multitherapy (n = 36) or usual care (n = 36). Results: The average hemoglobin A1c concentration at entry was 9.1% (standard deviation [SD] 1%) in the intensive therapy group and 9.3% (SD 1%) in the usual therapy group. By 12 months, a higher proportion of patients in the intensive therapy group than in the control group had achieved Canadian Diabetes Association (CDA) goals for hemoglobin A1c concentrations (goal ≤ 7.0%: 35% v. 8%), diastolic blood pressure (goal < 80 mm Hg: 64% v. 37%), low-density lipoprotein cholesterol (LDL-C) levels (goal < 2.5 mmol/L: 53% v. 20%) and triglyceride levels (goal < 1.5 mmol/L: 44% v. 14%). There were no significant differences between the 2 groups in attaining the targets for fasting plasma glucose levels, systolic blood pressure or total cholesterol:high-density lipoprotein cholesterol ratio. None of the patients reached all CDA treatment goals. By 18 months, differences in goal attainment were no longer evident between the 2 groups, except for LDL-C levels. Quality of life, as measured by a specific questionnaire, increased in both groups, with a greater increase in the intensive therapy group (13% [SD 10%] v. 6% [SD 13%], p < 0.003). Interpretation: Intensive multitherapy for patients with poorly controlled type 2 diabetes is successful in helping patients meet most of the goals set by a national diabetes association. However, 6 months after intensive therapy stopped and patients returned to usual care, the benefits had vanished.

Trajectories of Physical Function Decline and Psychological Functioning: The Québec Longitudinal Study on Nutrition and Successful Aging (NuAge)

BACKGROUND Decline of physical function with age is associated with substantial health consequences. Physical and psychological functioning is linked, but the temporal nature of this association remains unclear. METHODS Three-year follow-up data from men and women (n = 1,741), aged 68-82 years, in the longitudinal study on nutrition and successful aging (NuAge; Québec, Canada) were used. Growth curve modeling was performed to examine trajectories of a global physical performance score across time as conditioned by cognition and depression. RESULTS Significant decline in physical function was observed (p < .0001). Rate of decline in physical performance score was accelerated in the older participants (>77 years; age(2): p < .01) but not affected by slight decline in cognition or depression. Yet, people with lower cognition level and more depressive symptoms show lower physical capacity throughout the entire follow-up period (p < .0001). CONCLUSIONS Physical function significantly declined over 3 years, in particular in the oldest group. A subtle decline in psychological health paralleled decline in physical function but did not accelerate it.