Irma Nykänen

Association between Frailty and Dementia: A Population-Based Study

Background: Frailty is commonly considered as a syndrome with several symptoms, including weight loss, exhaustion, weakness, slow walking speed and physical inactivity. It has been suggested that cognitive impairment should be included in the frailty index, however the association between frailty and cognition has not yet been fully established. Objective: To investigate cross-sectionally whether frailty is associated with cognitive impairment or clinically diagnosed dementia in older people. Methods: The study included a total of 654 persons aged 76-100 years (mean 82 ± 4.6). Frailty status of the participants was assessed using the Cardiovascular Health Study criteria. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Clinically diagnosed dementia was assessed by specialists using diagnostic criteria. The associations between frailty and cognition were investigated using logistic regression. Results: A total of 93 (14%) participants were classified as frail. Cognitive impairment (MMSE score <25) was observed among 171 (26%) persons and 134 (21%) persons had clinically diagnosed dementia. 97 (15%) persons had Alzheimers disease, 19 (3%) had vascular dementia, 12 (2%) had dementia with Lewy bodies and 8 persons (1%) had some other type of dementia. Multivariate logistic regression models showed that frail persons were almost 8 times more likely to have cognitive impairment (OR 7.8, 95% CI 4.0-15.0), 8 times more likely to have some kind of dementia (OR 8.0, 95% CI 4.0-15.9), almost 6 times more likely to have vascular dementia (OR 5.6, 95% CI 1.2-25.8) and over 4 times more likely to have Alzheimers disease (OR 4.5, 95% CI 2.1-9.6) than persons who were robust. Conclusion: Frailty is strongly associated with cognitive impairment and clinically diagnosed dementia among persons aged 76 and older. It is possible that cognitive impairment is a clinical feature of frailty and therefore should be included in the frailty definition.

Nutritional screening in a population-based cohort of community-dwelling older people

BACKGROUND The risk of malnutrition is widely recognized in institutional settings but few studies have been conducted among community-dwelling older people. The objective of this study was to describe the nutritional status and factors associated with possible malnutrition among community-dwelling older people. METHODS A randomly selected sample (n = 696) of persons aged ≥ 75 years were included in the study. Baseline information was obtained for nutritional status (mini nutritional assessment short-form MNA-SF), depressive symptoms (15-item geriatric depression scale), cognitive status (mini-mental state examination MMSE) and daily activities (Barthel ADL index and Lawton and Brody IADL scale), self-reported health, oral health and medication use. Univariate and multivariate regression analyses were conducted to identify demographical, clinical and functional factors associated with possible malnutrition. RESULTS Of the 696 participants, 15% had possible malnutrition. In the univariate analysis, low MNA-SF scores were associated with advanced age, poor self-rated health, dry mouth/chewing problems, depressive symptoms and an increasing number of drugs in regular use. Higher albumin level, ADL, IADL and MMSE scores, and the ability to walk 400 m independently were inversely associated with possible malnutrition. In the multivariate analysis, dry mouth/chewing problems (OR 2.01, 95% CI: 1.14-3.54), IADL (OR 0.85, 95% CI: 0.75-0.96) and MMSE scores (OR 0.90, 95% 0.85-0.96) were independently associated with possible malnutrition. CONCLUSION Being at risk of malnutrition was common among community-dwelling older people. Problems with mouth, IADL and cognitive impairments were linked to possible nutritional risks.

Frailty as a predictor of all-cause mortality in older men and women

To investigate the modifying effect of sex on the association between frailty and all‐cause mortality, and to determine the effects of changes in frailty status on mortality.

Effects of individual dietary counseling as part of a Comprehensive Geriatric Assessment (CGA) on nutritional status: A population-based intervention study

BackgroundNutritional risk is relatively common in community-dwelling older people.ObjectiveTo objective of this study was to evaluate the effects of individual dietary counseling as part of a Comprehensive Geriatric Assessment on nutritional status among community-dwelling people aged 75 years or older.MethodsData were obtained from a subpopulation of participants in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) intervention study in 2004 to 2007. In the present study, the population consist 173 persons at risk of malnutrition in the year 2005 in an intervention (n=84) and control group (n=89). Nutritional status, body weight, body mass index, serum albumin were performed at the beginning of the study and at a two-year follow-up. The nutritional screening was performed using the Mini Nutritional Assessment (MNA) test.ResultsA increase in MNA scores (1.8 95% confidence interval [CI]: 0.7 to 2.0) and in serum albumin (0.8 g/L, 95% CI: 0.2 to 0.9 g/L) were a significant difference between the groups.ConclusionsNutritional intervention, even dietary counseling without nutritional supplements, may improve nutritional status.

Effects of comprehensive geriatric assessment-based individually targeted interventions on mobility of pre-frail and frail community-dwelling older people.

To assess the effects of comprehensive geriatric assessment (CGA)‐based individually targeted interventions on the ability to walk 400 m in pre‐frail or frail and non‐frail community‐dwelling older people.

Salivary flow rate and risk of malnutrition – a study among dentate, community-dwelling older people

OBJECTIVE To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home-dwelling elderly people. BACKGROUND Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. MATERIALS AND METHODS The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short-Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). RESULTS Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5-3.9, OR: 1.5, CI: 0.5-4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. CONCLUSION Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community-dwelling elders.

Xerostomia among older home care clients

OBJECTIVES The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older. METHODS The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care nurses, nutritionists, dental hygienists and pharmacists. The collected data contained information on sociodemographic factors, health and oral health status, drug use, depressive symptoms (GDS-15), cognitive functioning (MMSE), functional ability (Barthel Index, IADL) and nutrition (MNA). The primary outcome was xerostomia status (never, occasionally or continuously). RESULTS Among the home care clients, 56% (n = 150) suffered from xerostomia. Persons with continuous xerostomia used more drugs and had more depressive symptoms and a higher number of comorbidities than other home care clients. In multivariate analyses, excessive polypharmacy (OR = 1.83, 95% Cl 1.08-3.10) and depressive symptoms (OR = 1.12, 95% Cl 1.03-1.22) were associated with xerostomia. CONCLUSIONS Xerostomia is a common problem among old home care clients. Excessive polypharmacy, use of particular drug groups and depressive symptoms were associated with xerostomia. The findings support the importance of a multidisciplinary approach in the care of older home care clients.

Discrepancies between in-home interviews and electronic medical records on regularly used drugs among home care clients.

To compare discrepancies between in‐home interviews and electronic medical records (EMRs) on regularly used prescription drugs among older home care clients.

Orthostatic Hypotension and Associated Factors Among Home Care Clients Aged 75 Years or Older - A Population-Based Study

ObjectivesThe aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older.DesignNon-randomised controlled study.Setting and participantsThe study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland.MeasurementsNurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records.ResultsThe prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014–1.283) appeared to be independently connected to a risk of OH.ConclusionOne-third of the home clients had OH and it was associated with lower MNA scores.

Preventive oral health intervention among old home care clients

Background poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. Aim to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over. Patients and methods the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months. Results the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene. Conclusions the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.