Sachiko Izawa

Association between masticatory performance and anthropometric measurements and nutritional status in the elderly.

Aim:  The association between chewing ability and physical constitution and nutritional status remains uncertain in the elderly. We examined the relationships between chewing ability and anthropometric measurements or nutritional status in the elderly.

Impact of Caregiver Burden on Adverse Health Outcomes in Community-Dwelling Dependent Older Care Recipients

OBJECTIVE To determine whether caregiver burden is associated with subsequent all-cause mortality or hospitalization among dependent community-dwelling older care recipients. METHODS A prospective cohort study of 1,067 pairs of community-dwelling 65-year-old or older care recipients and their informal caregivers was conducted. The 1,067 pairs completed the baseline assessment including caregiver burden assessed by the Zarit Burden Interview and a 3-year follow-up for all-cause mortality and hospitalization. RESULTS During the 3-year follow-up, 268 recipients died and 455 were admitted to hospitals. The multivariate Cox proportional hazards model revealed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risks of all-cause mortality and hospitalization, respectively, in comparison with those with caregivers in the lowest quartile after adjustment for potential confounders. The highest quartile of caregiver burden was associated with all-cause mortality and hospitalization within nonusers of respite services including day-care services, home-help services, and nursing-home respite stay services. No apparent association was observed within the users of these services except for day-care services, for which users showed a statistically significant association between the highest quartile and the risk of hospitalization. CONCLUSIONS Heavy caregiver burden is associated with mortality and hospitalization among community-dwelling dependent older adults, even after adjusting for potential confounders. The reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.

Raised homocysteine and low folate and vitamin B-12 concentrations predict cognitive decline in community-dwelling older Japanese adults.

BACKGROUND & AIMS Recently, poor cognition and dementia have been associated with elevated homocysteine and low B vitamin concentrations. The aim of this study is to examine the association in community-dwelling older Japanese adults. METHODS Ninety-nine subjects (71 women and 28 men; mean age 75 years) were eligible for analysis after exclusion of subjects with high serum creatinine concentrations (1.3mg/dl and over) and those taking vitamin supplements. Fasting blood samples were analyzed for plasma total homocysteine, serum folate, and serum vitamin B-12. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE). RESULTS Multiple regression analysis revealed that homocysteine concentrations were predicted by concentrations of vitamin B-12 (p<0.001), folate (p<0.005), and creatinine (p<0.001) and age (p<0.005). Scores on the MMSE were associated with concentrations of homocysteine, vitamin B-12, and folate. The association between folate or vitamin B-12 concentrations and MMSE scores remained significant after adjusting for homocysteine concentrations. Folate concentrations, but neither homocysteine nor vitamin B-12 concentrations, were significantly associated with serum albumin concentrations. CONCLUSIONS Reduced folate and vitamin B-12 concentrations were independently associated with cognitive decline. The correlation between folate and albumin concentrations may imply that the reduction of folate in the Japanese older population is due to nutritional deficiency.

Accumulation of geriatric conditions is associated with poor nutritional status in dependent older people living in the community and in nursing homes.

To clarify the association between nutritional status and the prevalence of geriatric conditions in dependent older adults.

Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period

ObjectiveA number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period.MethodsParticipants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified.ResultsAt baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status.ConclusionsPoor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.

Day‐care service use is a risk factor for long‐term care placement in community‐dwelling dependent elderly

Aims:  To identify predictors of long‐term care placement and to examine the effect of day‐care service use on long‐term care placement over a 36‐month follow‐up period among community‐dwelling dependent elderly.

FACTORS ASSOCIATED WITH NONADHERENCE TO MEDICATION IN COMMUNITY‐DWELLING DISABLED OLDER ADULTS IN JAPAN

reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992;327:168–173. 7. Ray WA, Taylor JA, Meador KG et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med 1993;153:713–721. 8. Bates DW, Kuperman GJ, Wang S et al. Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003;10:523–530. 9. Kuperman GJ, Bobb A, Payne TH et al. Medication-related clinical decision support in computerized provider order entry systems: A review. J Am Med Inform Assoc 2007;14:29–40. 10. Gill SS, Bronskill SE, Normand S-LT et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med 2007;146:775–786.

Association between feeding via percutaneous endoscopic gastrostomy and low level of caregiver burden

with various findings in an animal model, yet our study does not show evidence of an association between CETP and CHD mortality in Caucasian men and women aged 55 and older. These findings combined suggest that the effect of the I405V CETP polymorphism may be relevant for CHD morbidity but that, by itself, its role is limited in terms of mortality. Further research aiming at the elucidation of the role of CETP in the metabolism of cholesterol and cellular functions will be pivotal for understanding CHD risk.