Roschelle Heuberger

The Frailty Syndrome: A Comprehensive Review

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.

Polypharmacy and Nutritional Status in Older Adults

AbstractBackground: Older adults have more chronic medical conditions, and the level of polypharmacy increases with advancing age. Malnutrition and drug nutrient interactions are of concern in this population. Objectives: The aims of this cross-sectional study were to examine nutritional status, the use of medications, and drug-nutrient interactions in older adults. Methods: Interviewer-administered surveys were conducted in 1100 community-dwelling older (age >65 years) adults. Information regarding demographics, nutritional status, medical history and medication usage was obtained. Self-reported data were verified by third parties when feasible. Informed consent and Human Subjects Committee approval were obtained. A pilot conducted prior to the onset of the study revealed high rates of inter-rater reliability. Data were recorded and entered into Excel spreadsheets for coding and cleaning and transferred to SPSS v. 17.0 for analyses. Results: The respondents’ mean age was 75.5 years. The top six most frequently used classes of medications were gastrointestinal agents, antihypertensives, diuretics, analgesics, β-adrenoceptor antagonists and antihyperlipidaemics. The prevalence of polypharmacy among the participants was 43.4%, with 51.1% of those participants using five or more medications. Most notable was the statistically significant inverse correlation between increasing number of medications and intake of fibre. Intake of cholesterol, glucose and sodium were positively associated with increasing medication use. A trend was also observed for increased phosphorus intake and increased number of medications used. Intake of fat-soluble vitamins, B vitamins, carotenoids and minerals was lower in those with increasing number of medications. Decrements in physical health were associated with decreasing intake of many fat-soluble and water-soluble vitamins, major minerals, trace minerals and electrolytes. Excessive macronutriture, specifically relating to the intake of saturated fats, refined carbohydrates and cholesterol, along with decreased intake of fibre and bioavailable protein sources, was also associated with poor physical health. Conclusions: The number of medications used by older adults in this convenience sample was associated with poorer nutritional status. Decrements in physical health have a statistically significant effect on nutrient intake. Further research into these issues is required.

Polypharmacy and Food–Drug Interactions Among Older Persons: A Review

Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.

Alcohol and the Older Adult: A Comprehensive Review

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of “boomers” who believe that alcohol intake improves health comes of age.

Effect of grape and other berries on cardiovascular health

Cardiovascular disease is a leading cause of death globally. Many cardiovascular risk factors can be modified through lifestyle modification, including dietary patterns that emphasize daily consumption of a variety of fruits and vegetables. Recent observational and clinical studies suggest that flavonoids, especially those abundant in grapes and other berries, may be associated with health benefits, particularly cardiovascular benefits. Human clinical data support cardioprotective benefits of grapes through inhibition of platelet aggregation, decreased low-density lipoprotein (LDL) oxidation, reduction in oxidative stress and improvements in endothelial function. Emerging evidence suggests that grapes may also have a favorable effect on blood lipids, decrease inflammation and reduce blood pressure in certain populations. Studies to date have shown that berries can have a beneficial effect on reducing LDL oxidation. Limited data suggest that berries may have a favorable effect on endothelial health and blood pressure. This review summarizes the current literature on human clinical studies examining the cardioprotective benefits of grapes and berries. Collectively, these data support the recommendation to incorporate products made with grapes and other berries into a heart-healthy diet.

Artificial Nutrition and Hydration at the End of Life

Considerable controversy surrounds the issue of care at the end of life (EOL) for older adults. Technological advances and the legal, ethical, clinical, religious, cultural, personal, and fiscal considerations in the provision of artificial hydration and nutrition support to older adults near death are presented in this comprehensive review.

Vitamin D status and supplementation in pediatric gastrointestinal disease

PURPOSE To evaluate vitamin D status and supplementation in the pediatric population with common gastrointestinal diseases. The literature was searched for studies on vitamin D status in children with inflammatory bowel disease (IBD), celiac disease, and liver disease. Vitamin D supplementation in healthy children was also reviewed. CONCLUSIONS Those with gastrointestinal diseases are more likely to have vitamin D deficiency as a result of malabsorption. Current recommendations for supplementation may be too low to achieve optimal levels. PRACTICE IMPLICATIONS It is important to monitor vitamin D levels in pediatric populations with gastrointestinal diseases and appropriately treat levels that are insufficient.

The association between depression and widowhood and nutritional status in older adults

This study aimed to investigate the association of depression and widowhood on the nutritional status of older adults. A cross-sectional study of community-dwelling older adults in the rural United States was conducted. Dietary intake was measured via questionnaires. Depression status was classified by asking participants if they have ever been diagnosed with the condition, or by review of medical records. The final sample consisted of 1065 participants with 141 (13.2%) depressed, 384 (36.1%) widowed, and 67 (6.3%) both depressed and widowed. Mean caloric intake for total study population was low; widows and widowers had the lowest energy consumption among all groups. Greater intake of several nutrients was observed in depressed and/or widowed subjects. Nutritional services, such as congregate and home delivered meal programs, were not identified as significant contributors to the nutritional intake in older adults who were depressed, widowed, or both. Health care professionals may contribute to meal-based nutrition programs by offering their assistance in aspects of nutritional education and counseling for the promotion of healthy aging.

Effect of Vitamin D 3 on Lifespan in Caenorhabditis elegans

Vitamin D is an essential micronutrient, necessary for human health. To determine if Caenorhabditis elegans (C. elegans) could function as an effective model to study the mechanisms of action of vitamin D, we asked if vitamin D3 affects C. elegans lifespan. Multiple factors positively impact lifespan in this system including dietary restriction and vitamin E. In addition, the C. elegans DAF-12 nuclear hormone receptor is homologous to the vitamin D receptor in humans and is therefore a candidate for a functional vitamin D receptor. It was hypothesized that vitamin D3 supplementation would increase the lifespan of C. elegans in a DAF-12-dependent manner. Dose-response curves were completed, and results indicate that exposure to 1,000 µg/ml vitamin D3 significantly increased the lifespan of wild-type worms by up to 39% (p<0.001). The daf-12 mutants exposed to 1,000 µg/ml vitamin D3 lived significantly longer than daf-12 controls exposed to 0 µg/ml (p<0.001), but among worms exposed to 1,000 µg/ml vitamin D3, wild type lived significantly longer than daf-12 (p<0.01). The data suggest that vitamin D3 can interact with multiple receptors, possibly implicating the NHR family of nuclear hormone receptors related to DAF-12. This research is the first to our knowledge to utilize C. elegans as a model to study the impact of vitamin D3 on longevity and supports the use of this model system to increase our understanding of vitamin D function at the cellular level, its role in cellular health, and its potential medicinal utility in humans.

Associations between alcohol use, polypharmacy and falls in older adults

AIMS To describe the prevalence of alcohol intake, medication use and falls, evaluate the association between alcohol intake and medication use, and assess the effects of use of alcohol, medication and/or both on the occurrence of falls. METHOD Trained interviewers collected information on self-reported frequency of alcohol consumption, medication use and falls in a cross-sectional sample of 2,444 community-dwelling older adults in rural US. Polypharmacy was defined as taking five or more medications. RESULTS Of the sample, 38% consumed alcohol, 83% used medication and 19% had fallen. The ingestion of alcohol was inversely associated with the likelihood of taking medication, but had no statistically significant association with incidence of falls. Analyses with logistic regression indicated that alcohol intake was not a significant predictor of falls. Medication was positively related to, and a significant predictor of, falls. CONCLUSION Nurses working with older people should be aware of medications that increase the risk of falls. Potentially deleterious falls may be prevented through ongoing risk-benefit assessment of prescribed medicines and, when feasible, use of non-pharmacological interventions.