Kieran O'Connor

Composition, variability, and temporal stability of the intestinal microbiota of the elderly

Alterations in the human intestinal microbiota are linked to conditions including inflammatory bowel disease, irritable bowel syndrome, and obesity. The microbiota also undergoes substantial changes at the extremes of life, in infants and older people, the ramifications of which are still being explored. We applied pyrosequencing of over 40,000 16S rRNA gene V4 region amplicons per subject to characterize the fecal microbiota in 161 subjects aged 65 y and older and 9 younger control subjects. The microbiota of each individual subject constituted a unique profile that was separable from all others. In 68% of the individuals, the microbiota was dominated by phylum Bacteroides, with an average proportion of 57% across all 161 baseline samples. Phylum Firmicutes had an average proportion of 40%. The proportions of some phyla and genera associated with disease or health also varied dramatically, including Proteobacteria, Actinobacteria, and Faecalibacteria. The core microbiota of elderly subjects was distinct from that previously established for younger adults, with a greater proportion of Bacteroides spp. and distinct abundance patterns of Clostridium groups. Analyses of 26 fecal microbiota datasets from 3-month follow-up samples indicated that in 85% of the subjects, the microbiota composition was more like the corresponding time-0 sample than any other dataset. We conclude that the fecal microbiota of the elderly shows temporal stability over limited time in the majority of subjects but is characterized by unusual phylum proportions and extreme variability.

Prevalence of pressure ulcers in three university teaching hospitals in Ireland

AIM Pressure ulceration is a significant, but preventable, cause of morbidity and resource utilisation in hospital populations. Data on pressure ulcer prevalence in Ireland are limited. This study aims to determine (i) the point-prevalence of pressure ulcers in three teaching hospitals in Ireland and (ii) risk factors for their development. METHODS Eight teams of one doctor and one nurse visited 672 adult patients over a 2-day period in three teaching hospitals. Each patient was examined and pressure ulcers graded with the European Pressure Ulcer Advisory Panel system. Mental test score, Barthel index, type of support surface, length of stay, documentation of risk assessment and serum albumin were recorded. RESULTS Point-prevalence of pressure ulceration was 18.5%. Seventy-seven percent of pressure ulcers were hospital-acquired, 49% grade 1, 37% grade 2, 11% grade 3 and 3% grade 4. Reduced mobility, urinary incontinence, cognitive impairment, low serum albumin and length of stay were significantly associated with pressure ulcers. Multivariate logistic regression analysis found reduced mobility (odds ratio 8.84; 95% CI 5.04-15.48, p<0.0001) and length of stay (odds ratio 1.02; 95% CI 1.01-1.02, p<0.0001) to be predictive of the presence of pressure ulcers. Age, gender and risk assessment documentation were not associated with pressure ulcers. Sixty-five percent of patients with pressure ulcers were positioned on appropriate support surfaces. DISCUSSION Point-prevalence of pressure ulceration was 18.5%, similar to international data. Regular audit of prevalence, prevention and management strategies may raise awareness, influence resource allocation and ultimately improve patient care.

The functional decline of hospitalised older patients - are we doing enough?

A recently published paper found that higher levelsof physical activity (PA) and fitness were associatedwith better Health Related Quality of Life (HRQOL)in older people recently discharged from hospital [1].The authors recommend, “physical activity... whilein hospital... may be important in order to encour-age patients to actively preserve independence andHRQOL”, specifically “targeting those with lowerlevelsofphysicalactivity... .andmultiplecomorbidi-ties”. Studies have shown small positive benefits fromadditional exercise for older medical patients [2–4]and further meta-analysis suggested that targeting thefrailer might strengthen the effects seen [5].We conducted a small study in 2011 to measurethe effects of an augmented prescribed exercise pro-gram (APEP) for frail medical acute in-patients [6].We recruited 40 frail patients who were aged ≥65years, had an anticipated LOS >3 days, due for dis-charge home and needed a walking aid on admission.We allocated them to a usual care group (control) con-sisting of three physiotherapy sessions weekly or theAPEP group consisting of usual care augmented withtwo assisted exercise-sessions daily, Monday–Friday.The research physiotherapist delivered the exercise