Merja Suominen

Nutritional Status, Energy, Protein, and Micronutrient Intake of Older Service House Residents

OBJECTIVESnTo examine the nutritional status and energy, protein, and micronutrient intake of aged residents living in service houses and to compare how they meet official recommendations.nnnDESIGNnCross-sectional study.nnnPARTICIPANTSnService house residents (n = 375) in the metropolitan region of Helsinki, Finland.nnnMEASUREMENTSnThe nutritional status of residents was assessed with the Mini Nutritional Assessment. Residents energy, protein, and nutrient intake were calculated from 1-day food diaries and compared with the nutrition recommendations.nnnRESULTSnThe mean age of participants was 83 years; 82% were females. According to the Mini Nutritional Assessment, 65% were at risk for malnutrition and 21% were malnourished. Energy, protein, and nutrient intake varied greatly among residents. Inadequate energy, protein, and micronutrient intake was common among the oldest residents. Of the whole group, 46% received less than 1570 kcal/d of energy and 47% received less than 60 g/d of protein. Their intake of fiber, vitamin E, vitamin D, and folic acid was especially low. The percentages of residents receiving less than the recommended intake of these nutrients were 98%, 98%, 38%, and 86%, respectively.nnnCONCLUSIONSnTaking into account the large number of aged residents suffering from malnutrition or being at risk for malnutrition, low energy, protein, and micronutrient intake was very common. Assessment-based nutritional care should be a significant part in supporting frail older people in service houses.

Use of laxatives among older nursing home residents in Helsinki, Finland.

Background and objectiveConstipation and, as a consequence, the use of laxatives are common among frail older people. The causes of and factors associated with laxative use, however, have undergone surprisingly little study. The objectives of our study were to (i) assess the prevalence of regularly administered laxatives, (ii) identify factors associated with regular use of laxatives, and (iii) determine which drug classes or medications are associated with regular laxative use in an older nursing home population in Helsinki.MethodsThis study was a cross-sectional assessment of all long-term nursing home residents aged ≥65 years in Helsinki, Finland. In February 2003, the health status of these residents was assessed and data on their demographic characteristics, health and medication use were collected from medical charts.ResultsOf all nursing home residents in Helsinki, 82% (n = 1987, mean age 83.7 years) participated in the study. Of all residents, 55.3% received laxatives regularly. Factors associated with regular laxative use in univariate analysis included age >80 years, stroke, Parkinson’s disease, inability to move independently, poor Mini Nutritional Assessment (MNA) score (<17), fluid intake less than five glasses per day, and chewing problems. Drugs associated with laxative use included opioids, antacids, diuretics, tricyclic antidepressants, lipid-lowering drugs other than HMG-CoA reductase inhibitors (statins), histamine H2 receptor antagonists, non-selective NSAIDs, anticholinergic drugs for urine incontinence, and calcium channel antagonists other than verapamil and nifedipine. In logistic regression analysis, age >80 years (odds ratio [OR] 1.29; 95% CI 1.03, 1.60), inability to move independently (OR 1.80; 95% CI 1.42, 2.28), poor MNA score (<17) [OR 1.51; 95% CI 1.19, 1.93], chewing problems (OR 1.27; CI 95% 1.00, 1.61), Parkinson’s disease (OR 1.63; 95% CI 1.01, 2.64), and concomitant use of a high number (>7) of drugs other than laxatives and constipation-inducing drugs found in univariate analysis (OR 1.06; 95% CI 1.03, 1.09) were associated with use of laxatives. Having snacks between meals (OR 0.74; 95% CI 0.60, 0.90) was associated with lower risk of laxative use.ConclusionsRegular laxative use in older nursing home residents in Helsinki is very common. Offering snacks between meals and regular evaluation of medication use may influence laxative use.

Nutritional guidelines for older people in Finland

BackgroundAgeing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people’s health, functional capacity and quality of life.ObjectiveTo identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland.DesignA review of the existing literature on older people’s nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland.ResultsThe heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4.The use of a vitamin D supplement (20 μg per day) recommended. 5.The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted.ConclusionsOwing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Nutritional treatment of aged individuals with Alzheimer disease living at home with their spouses: study protocol for a randomized controlled trial

BackgroundNutritional status often deteriorates in Alzheimer’s disease (AD). Less is known about whether nutritional care reverses malnutrition and its harmful consequences in AD. The aim of this study is to examine whether individualized nutritional care has an effect on weight, nutrition, health, physical functioning, and quality of life in older individuals with AD and their spouses living at home.MethodsAD patients and their spouses (aged >65u2009years) living at home (nu2009=u2009202, 102u2009AD patients) were recruited using central AD registers in Finland. The couples were randomized into intervention and control groups. A trained nutritionist visited intervention couples 4–8 times at their homes and the couples received tailored nutritional care. When necessary, the couples were given protein and nutrient-enriched complementary drinks. All intervention couples were advised to take vitamin D 20u2009μg/day. The intervention lasted for one year. The couples of the control group received a written guide on nutrition of older people. Participants in the intervention group were assessed every three months. The primary outcome measure is weight change. Secondary measures are the intake of energy, protein, and other nutrients, nutritional status, cognition, caregiver’s burden, depression, health related quality of life and grip strength.DiscussionThis study provides data on whether tailored nutritional care is beneficial to home-dwelling AD patients and their spouses.Trial registrationACTRN 12611000018910

MALNUTRITION ACCORDING TO THE MINI NUTRITIONAL ASSESSMENT IN OLDER ADULTS IN DIFFERENT SETTINGS

L. Lacavé, S. Maugat, H. Tronel, O. Hoff, F. Gimenez, L. Mouchot, P. Jarno, H. Sénéchal, G. Gourvellec, F. L’Hériteau, F. Daniel, M.H. Metzger, L. Voisin, C. Gautier, B. Amadéo). Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Lietard: analysis and interpretation of data, preparation of manuscript. Metzger: acquisition of data. Thiolet: concept and design, interpretation of data. Coignard: concept and design, preparation of manuscript. Lejeune: acquisition of data, preparation of manuscript. Sponsor’s Role: None.

Nutrition and psychological well-being among long-term care residents with dementia

ObjectivesTo examine the relationship between nutritional status of service housing and nursing home residents with dementia and their psychological well-being (PWB), and the associations of nutritional care and PWB.Design, participants and settingThis cross-sectional nutrition study was carried out in 2011. The study included all older long-term care residents (N=4966) living in nursing homes and service housing units (N=61) in Helsinki. The response rate of was 72%. Of the respondents, only persons who had a diagnosis of dementia were included in this analysis (N=2379).MeasurementsThe Mini Nutritional Assessment (MNA) tool and a structured questionnaire were used in assessing the residents. Six dimensions of PWB were included in the questionnaire. Information was also retrieved from medical records.ResultsOf residents 9% were wellnourished and 28% malnourished according to the MNA. PWB was good in 50% (score ≥ 0.80) and poor in 10% (score < 0.40) of the residents. Residents’ poor nutritional status, eating a little of the offered food, having meals alone and not having snacks were associated with poor PWB. Mild cognitive impairment was more often associated with poor PWB, whereas moderate or severe impairment was more often associated with good PWB.ConclusionNutritional status and nutritional care of residents with dementia were significantly associated with their psychological well-being. The residents suffering from malnutrition had the poorest psychological wellbeing.

Use of Anticholinergic Drugs and Cholinesterase Inhibitors and Their Association with Psychological Well-Being Among Frail Older Adults in Residential Care Facilities

Background Drugs with anticholinergic properties have harmful effects among frail older people and they may antagonize the effects of cholinesterase inhibitors (ChEIs). However, their association with psychological well-being has not been studied. Objective: To determine (1) the prevalence of the use of anticholinergic drugs, ChEIs, or their combination among older adults in residential care facilities and their association with psychological well-being, and (2) the association of anticholinergic drugs with an individuals psychological well-being. Methods: In 2007, all older adults (N = 1475) living in residential care facilities in the cities of Helsinki and Espoo, Finland, were assessed in a cross-sectional study. A trained nurse retrieved data on demographic factors, regularly administered medications, and diagnoses from medical charts. Psychological well-being was assessed using 6 questions concerning life satisfaction, zest for life, plans for the future, feeling needed, and feeling depressed or lonely, and a psychological well-being score was created (range 0-1). Results: Residents taking anticholinergic drugs (n = 613) were significantly younger, used more drugs, and were more often on ChEIs compared with nonusers (n = 862). There was no significant difference in Charlson comorbidity index, stage of cognition, or dependence on activities of daily living between the users or nonusers of anticholinergic drugs. The anticholinergic drug users had significantly lower psychological well-being scores compared with the nonusers. Of the participants, 10.7% used ChEIs and anticholinergic drugs concomitantly. In logistic regression analysis where age, sex, comorbidities, and use of ChEIs were used as covariates, lower psychological well-being was associated with the use of anticholinergic drugs (OR 1.40; 95% CI 1.00 to 1.94; p = 0.048). Conclusions: Concomitant use of anticholinergic drugs and ChEIs is common among older adults. The use of anticholinergic drugs is associated with poor psychological well-being.

Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities

OBJECTIVEnThe aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living.nnnDESIGNnA cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality.nnnSETTINGnAssisted living facilities in the Helsinki metropolitan area, Finland.nnnPARTICIPANTSnAll residents (N=1466) in assisted living facilities.nnnMEASUREMENTSnPersonal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers.nnnRESULTSnSWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinsons disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p < .001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p < .001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p < .010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p< .001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 -2.12).nnnCONCLUSIONSnSWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.

Porvoo sarcopenia and nutrition trial: effects of protein supplementation on functional performance in home-dwelling sarcopenic older people - study protocol for a randomized controlled trial.

BackgroundAge-related muscle loss (that is, sarcopenia) is a common health problem among older people. Physical exercise and dietary protein have been emphasized in prevention and treatment of sarcopenia. Rigorous trials investigating the effects of protein supplementation on physical performance in sarcopenic populations are still scarce. The aim of this study is to investigate the effects of protein supplementation along with simple home-based exercises on physical performance among home-dwelling sarcopenic older people.Methods/DesignDuring 2012 the entire 75 and older population (Nu2009=u20093,275) living in Porvoo, Finland was contacted via a postal questionnaire. Persons at risk of sarcopenia are screened with hand grip strength and gait speed. Poorly performing persons are further examined by segmental bioimpendance spectroscopy to determine their skeletal muscle index. Sarcopenic patients (target Nu2009=u2009250) will be enrolled in a 12-month randomized controlled trial with three arms: 1) no supplementation, 2) protein supplementation (20 grams twice a day), and 3) isocaloric placebo. All the participants will receive instructions on simple home-based exercises, dietary protein, and vitamin D supplementation (20xa0μg/d). The recruitment of patients will be completed during 2013. The primary endpoint of the trial is the change in short physical performance battery score and percentage of patients maintaining or improving their physical performance. Secondary endpoints will be, among other things, changes in muscle functions, nutritional status, body composition, cognition, quality of life, use of health care services, falls, and mortality. The assessment times will be 0, 6, 12 and 24xa0months.DiscussionTo our knowledge, this is the first large scale randomized controlled trial among community dwelling older people with sarcopenia that focuses on the effects of protein supplementation on physical performance.Trial registrationACTRN12612001253897, date of registration 28 October 2012, first patient was randomized 11 April 2012.

Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial

BackgroundAfter diagnosis of a dementing illness, patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine, in an objective-oriented group intervention, the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers.MethodsDuring the years 2011 to 12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients’ HRQoL (15D) and spousal caregivers’ HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers’ psychological well-being (GHQ-12) and coping resources, patients’ depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up.DiscussionThis is a ‘proof-of-concept’ study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.Trial registrationACTRN12611001173987