Elderly Institutionalized Population Research Articles

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study.

Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.

The Relationship between Religion/Spirituality and the General Psychological Well-Being of the Elderly Institutionalised Population in the Eastern Cape, South Africa

Psychological well-being has a number of known benefits and is important for the quality of life of the elderly in particular. South Africa can be considered a religious country, with the majority of citizens identifying with some religious orientation. The elderly are considered to be a particularly religious segment of the population. This article reports on a quantitative exploratory study undertaken to ascertain whether a correlation exists between psychological well-being and religiosity/spirituality in the elderly institutionalised population of South Africa. The General Psychological Well-Being Scale and ASPIRES were administered to a convenience sample of 336 elderly in the Eastern Cape Province. A significant but weak positive correlation was found between the variables of psychological well-being and religiosity, which supports the findings of a body of studies undertaken from the positive psychology perspective.

An explosive outbreak of Streptococcus pneumoniae serotype-8 infection in a highly vaccinated residential care home, England, summer 2012.

In August 2012, an explosive outbreak of severe lower respiratory tract infection (LRTI) due to Streptococcus pneumoniae serotype-8 occurred in a highly vaccinated elderly institutionalized population in England. Fifteen of 23 residents developed LRTI over 4 days (attack rate 65%); 11 had confirmed S. pneumoniae serotype-8 disease, and two died. Following amoxicillin chemoprophylaxis and pneumococcal polysaccharide vaccine (PPV) re-vaccination no further cases occurred in the following 2 months. No association was found between being an outbreak-associated case and age (P = 0.36), underlying comorbidities [relative risk (RR) 0.84 95% confidence interval (CI) 0.34-2.09], or prior receipt of PPV (RR 1.4, 95% CI 0.60-3.33). However, the median number of years since PPV was significantly higher for cases (n = 15, 10.2 years, range 7.3-17.9 years) than non-cases (n = 8, 7.2 years, range 6.8-12.8 years) (P = 0.045), provided evidence of waning immunity. Alternative vaccination strategies should be considered to prevent future S. pneumoniae outbreaks in institutionalized elderly populations.

Factors associated with missing teeth in the Brazilian elderly institutionalised population

Identify factors associated with missing teeth in the elderly institutionalised population in Brazil. Cross-sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fisher's exact test, chi-squared test and multiple logistic regression. Mean age was 76.3 (± 9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (± 4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (± 6.8) with a mean of 4 (± 6.6) teeth present and 2.4 (± 4.5) caries-free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self-assessment of oral health, access to health services, type of institution and area of the country. High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.

P.3.d.017 Psychotropic medication use profile and adequacy in elderly institutionalised population

P.3.d.017 Psychotropic medication use profile and adequacy in elderly institutionalised population

Cessation of Exercise in the Institutionalized Elderly: Effects on Physical Function

The objectives of this study were (1) to examine the effects of a 12-week exercise cessation period separating two 12-week exercise sessions on physical variables in an elderly institutionalized population and (2) to explore overall programme effectiveness. The functional mobility of 25 elderly institutionalized adults participating in an existing exercise programme was examined using a one-group, interrupted time-series design. Functional mobility was evaluated at four time points during two cycles of a 12-week exercise programme, alternating with a 12-week period of no formal exercise. The primary outcome was the change in functional mobility scores, assessed at baseline, 12, 24 and 36 weeks. In both the higher-functioning (HF) group and the lower-functioning (LF) group, the cessation of exercise was associated with deterioration in physical function. The overall non-continuous nature of the programming under study also seemed to be detrimental to the physical function of the LF group. Findings of this small-sample study support the need to modify common practices in exercise programming for older, institutionalized people.

Effect of Multivitamin and Mineral Supplementation on Episodes of Infection in Nursing Home Residents: A Randomized, Placebo‐Controlled Study

To evaluate the effect of vitamin and mineral supplementation on infections in an elderly institutionalized population. Eighteen-month, randomized, placebo-controlled trial. Twenty-one long-term care facilities. Seven hundred sixty-three subjects from 21 long-term care facilities. Participants were randomized to receive one multivitamin and mineral supplementation daily or placebo. The primary outcome was number of infections per subject. Secondary outcomes were antibiotic use and hospitalization rates. Infection control surveillance was conducted over 18 months using standardized criteria. Outcome data from 748 subjects, mean age 85, were included in the intention-to-treat analysis. Using univariate analyses, there was no difference in infectious episodes between the supplemented and placebo groups (3.5 infections per 1,000 resident-days vs 3.8 infections per 1,000 resident-days, odds ratio (OR)=0.92, 95% confidence interval (CI)=0.82-1.03, P=.12). There was a reduction in antibiotic usage in the supplementation group, but this was not significant in the multivariate model. There was no difference in the number of hospital visits. In the multivariate analysis, the effect of multivitamin use on total number of infections was not significant (OR=0.77, 95% CI=0.54-1.1). Subjects without dementia had a greater rate of infections than those with dementia (OR=1.44, 95% CI=1.19-1.76). In post hoc subgroup analysis, subjects without dementia who received supplementation had a significantly lower rate of infections than those who received placebo (relative risk=0.81, 95% CI=0.66-0.99). Overall, multivitamin and mineral supplementation does not have a significant effect on the incidence of infections in institutionalized seniors, although the subgroup of residents in long-term care without dementia may benefit from supplementation. Further research is needed to determine its effect in high-risk subgroups within the nursing home population.

Distinguishing syncopal from non-syncopal causes of fall in older people

Syncope is the mechanism by which cardiovascular abnor-malities may cause falls in older people. Syncope is a symp-tom, defined as a transient, self-limited loss ofconsciousness, usually leading to falling. The onset of syn-cope is relatively rapid, and the subsequent recovery isspontaneous, complete and usually prompt. The underlyingmechanism is a transient global cerebral hypoperfusion [1,2]. Syncopal loss of consciousness invariably determinesloss of postural tone and, if it occurs in the upright position,falling. Irrespective of the precise underlying cause of syn-cope, a sudden cessation of cerebral blood flow for 6–8 sand/or a decrease in systolic blood pressure to 60 mm Hghas been shown to be sufficient to cause complete loss ofconsciousness. Further, it has been estimated that as little asa 20% drop in cerebral oxygen delivery is sufficient to causeloss of consciousness.Syncope is common amongst older people. In theFramingham study [3], the 10-year cumulative incidence ofsyncope was 6%. The incidence was not, however, con-stant but increased more rapidly from the age of 70 yearsupwards. The 10-year cumulative incidence of syncopewas 11% for both men and women aged 70–79 and 17%and 19% for men and women, respectively, aged 80 orover. The incidence of syncope in an elderly institutional-ised population was 6% per year, with a 10-year prevalenceof 23% and a recurrence rate of 30% [4]. Age-associatedphysiological changes in heart rate, blood pressure, cere-bral blood flow, baroreflex sensitivity and intravascularvolume regulation, combined with comorbid conditionsand concurrent medications, may all contribute to thehigher incidence of syncope in the older population [5].In terms of the immediate injurious consequences ofsyncope, major morbidity such as fractures and motor vehi-cle accidents has been reported in 6% of patients and minorinjury such as laceration and bruises in 29%. Recurrent syn-cope is associated with fractures and soft-tissue injury in12% of patients [6].

Prevalence of Visual Handicap in the Elderly Institutionalised Population in the Geneva Area

The aim of this study was to establish the prevalence of visual impairment in the elderly population in geriatric homes in an urban area. A sample of 96 patients from 8 geriatric homes ["Etablissements Médico-Sociaux" (EMS)] in the Geneva area were examined. The NEI-VFQ-25 modified questionnaire was used. Visual acuity examination (far and near), contrast visual acuity measurement and enlargement need were administered by low vision trainers. Of the 96 patients 42 % were partially sighted and 3 % blind. Self assessment of visual performance disclosed that 31 % of the patients complained about bad vision but only 12 % were worried about their vision. Cataract, age-related macular degeneration, glaucoma and diabetes were the most frequent diagnosis associated to visual disability. The prevalence of the visual handicap in the elderly geriatric population is very high, but most of the patients are neither aware, nor worried about their handicap. This maybe related to associated general health disabling diseases.

Folate and cobalamin synergistically decrease the risk of high plasma homocysteine in a nonsupplemented elderly institutionalized population

Objective Total plasma homocysteine (tHcy) has been associated with an increased risk of cardiovascular disease in the general population and elderly subjects are at high risk of elevated homocysteine because of an impaired vitamin status. The aim of the present study was to determine the independent and interactive association of adequate folate and cobalamin (intake and serum levels) with tHcy in elderly subjects who were not taking vitamin supplementation. Design and methods Cross-sectional analysis of a sample of 140 elderly recruited from seven nursing homes in Asturias (Northern Spain). Dietary intake was assessed by a food frequency questionnaire, and serum folate, cobalamin, and tHcy were determined in fasting blood samples. Results Mean tHcy concentration was 13.3 μmol/L (upper quartile of tHcy >16.0 μmol/L) and was inversely correlated with serum folate. Subjects with an adequate intake or serum levels of both folate and B 12 were at a reduced risk of being in the highest quartile of tHcy. In both cases, the reduction of high tHcy (upper quartile) risk was found to be greater than expected when subjects with high levels of both vitamins were considered together. Conclusions Adequate folate and cobalamin (both intake and serum levels) act synergistically to decrease the risk of high total plasma homocysteine levels in this elderly population.

Dental status, xerostomia and the oral health-related quality of life of an elderly institutionalized population.

The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OHIP-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.

Prevalencia de hipovitaminosis D en una población anciana institucionalizada. Valoración del tratamiento sustitutivo

Osteoporosis in the elderly is a common and severe disease, vitamin D deficiency being an important causative factor. Hypovitaminosis D is frequent in old people, particularly those living in nursing homes. We performed a cross-sectional study of 100 randomly recruited elderly institutionalized subjects. The prevalence of hypovitaminosis D and its possible repercussion on the phosphocalcium metabolism were assessed. The degree of sun exposure and the existence of co-morbidity were also recorded. Individuals with hypovitaminosis D were included in a longitudinal study (6 months' duration) aimed at assess the efficacy of treatment with calcium and two different therapeutic regimens with calcidiol (16,000 IU/week or 16,000 IU every 3 weeks). 87% of individuals had hypovitaminosis D; 21.8% of them had secondary hyperparathyroidism. The study population had a low degree of sun exposure and a high level of co-morbidity. The two doses of calcidiol led to a normalization of 25-OHD3 levels, increased calciuria and compensated secondary hyperparathyroidism, yet higher 25-OHD3 levels were achieved with the weekly therapeutic scheme. Hypovitaminosis D prevalence appears to be very high In the elderly institutionalized population. Calcium and calcidiol supplementation normalized 25-OHD3, improved calcium absorption and compensated secondary hyperparathyroidism. Calcium and vitamin D supplementation should be employed routinely in the elderly institutionalized population.

Retrospective Study Of The Effects Of Zinc Supplementation In An Elderly Institutionalized Population With Decubitus Ulcers

The present pilot study was a retrospective analysis of 70 institutionalized elderly (37F 33 M, mean age 81.7 + 8.3 years) with documented decubitus ulcers (stage II-IV). The study compared 26 patients who received 440 mg zinc sulfate/day (100 mg elemental zinc/day) for 30 days with 44 patients not receiving zinc sulfate. There were no significant differences between groups in age, sex, % ideal body weight, mobility, continence, or glucocorticoid use. Food intake was <30 kcal/kg in 68% of the non-supplemented, and 69% of zinc supplemented subjects. The effects of the zinc sulfate on outcome measures of healing were inconclusive. There was a statistically greater decrease in surface area of the ulcers related to zinc supplementation when stage of the ulcer was considered. Days to heal were not affected by zinc supplementation. Adverse affects were observed related to the zinc supplementation. Patients receiving the large doses of zinc sulfate had 12.5 times greater odds of experiencing nausea/vomiting, and 7.8 times greater odds of an infection requiring antibiotic use compared to patients not receiving the zinc supplementation (p<0.05). Sufficient statistical power was demonstrated (l−β=0.71, nausea/vomiting; and 0.76, infection rate) and the effect size for infection rate was moderate (w2=0.32). Some of the effects of the zinc sulfate supplement appeared to be modulated by multi-vitamin/mineral supplementation at RDA levels. CONCLUSIONS: This preliminary study suggests several adverse effects related to zinc sulfate supplementation in excess (6 times) of the RDA. Further study is needed to substantiate these Findings. The maximal safe dose of zinc supplementation is not known. Findings from the present study emphasize the importance of carefully evaluating zinc supplementation practices.

Use of Folic Acid-Fortified Milk in the Elderly Population

Folic acid deficiency is common in the elderly population, resulting in anaemia, dementia, many neurological sequelae and an indirect role in atheromatous disease. An increase in natural food folate is relatively ineffective at increasing folate status and the use of folate fortification of foodstuffs is recommended. The aim of our study was to assess the benefits of folic acid-fortified milk to the folate status of an elderly institutionalised population. 49 subjects received fortified milk as part of their daily diet for at least 6 months (active group) and 40 subjects received unfortified milk (control group). Our results showed a mean serum folate level in the active group of 5.81 (1.1–17.6) µg/l compared to the control group mean of 2.16 (0.5–9.4) µg/l (p < 0.001; normal range for serum folate 2.7–20 µg/l). Similarly the mean red cell folate level in the active group of 316.5 (130–905) µg/l was significantly higher than the control group mean of 196.1 (95–490) µg/l (p < 0.001; normal range for red cell folate 150–1,000 µg/l). Our results suggest that folic acid-fortified milk is an efficacious and acceptable method of administration of folic acid in the elderly population and we recommend the use of folic acid-fortified milk in the regular daily diet of the elderly population.

Prevalence of Associated Diseases in Different Types of Dementia Among Elderly Institutionalized Patients: Analysis of 3447 Records

To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type. Retrospective analysis of a database of diagnostic codes. All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989. All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia). The study involved 3447 patients aged 81.0 +/- 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 +/- 2.10 in the Alzheimer dementia group, 4.73 +/- 2.38 in the vascular dementia group, and 3.96 +/- 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01). Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co-existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.

Prevalence of predisposing factors for endocarditis among an elderly institutionalized population

The charts of 100 nursing home patients in a Veterans Affairs skilled nursing facility were reviewed to identify the need for endocarditis prevention prior to dental procedures. Forty-two (42%) had identifiable needs. Systolic murmurs, documented in 38% of the residents, were the most prevalent abnormality. Five patients had other indications for antibiotic coverage (history of rheumatic heart disease, previous endocarditis, artificial heart valve), which added four unique patients (those not already identified by murmurs) to the total. The dental implications of these findings are discussed.

The Risk of Falling in the Elderly

Accidental injury resulting from falling is the leading cause of death in the elderly population. In fact, 11% of the nation's annual injury deaths occur in this age group. A significant number of accidental deaths occur in resident institutions. A short-term risk index was constructed and validated for the purpose of predicting the risk of a fall in an elderly institutionalized population. The risk index was developed from expert insights, using Bayesian inference. A group of experts identified major risk factors that influence the chance of a fall and provided estimates of the impacts of the identified risk factors. Identification of risk factors, elicitation of experts' insights, construction of the subjective risk index, and validation of the index are discussed.

The Effect of VIT D Fortified Milk on Hypovitaminosis D in an Elderly Institutionalised Population

Journal Article The Effect of VIT D Fortified Milk on Hypovitaminosis D in an Elderly Institutionalised Population Get access E. M. Keane, E. M. Keane Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar A. Rochfort, A. Rochfort Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar D. MC. Govern, D. MC. Govern Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar J. P. Cox, J. P. Cox Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar D. Coakley, D. Coakley Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar J. B. Walsh J. B. Walsh Mercer's Institute for Research in AgeingSt. James's Hospital, Dublin B, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar Age and Ageing, Volume 19, Issue suppl_2, 1990, Pages P9-a–P9, https://doi.org/10.1093/ageing/19.suppl_2.P9-a Published: 01 September 1990

Oral Soft Tissue Status in an Elderly Institutionalized Population1

A total of 1,037 oral soft tissue lesions (3.98 lesions per patient) was found in 260 elderly people of American/European and of Asian/African extraction residing in a home for senior citizens in Jerusalem. There was a strong association between wearing of dentures or usage of bare mucosa for masticatory purposes and the presence of specific lesions at typical locations. A significant difference was found between the two ethnic groups with respect both to pattern of tooth loss and utilization of rehabilitative means. The distribution of the oral soft tissue lesions among the participants in the study seemed to be linked to their cultural background.

Fatty acid composition of serum lipids and its relation to diet in an elderly institutionalized population

This study was conducted to determine the nutritional status with respect to fatty acids of 53 institutionalized elderly subjects (group A). Seven-day food records and biochemical determinations were used. The same protocol was applied to 25 healthy young adults (group B). The 1981 French Recommended Dietary Allowances were used to assess adequacy of intake. Total fat intake was found to be too high in both groups. Higher intakes of animal fats and saturated fatty acids and lower intakes of polyunsaturated fatty acids and linoleic acid were documented in group A than in group B. Elderly subjects exhibited decreased 18:2 omega 6 and 20:4 omega 6 in serum phospholipids and triglycerides. Other indicators of essential fatty acid status in group A differed from group B in the direction of deficiency (double-bond index [DBI], 0.93 +/- 0.01 vs 1.13 +/- 0.04, p less than 0.001; total omega 6, 25.07 +/- 0.46% vs 32.49 +/- 0.89%, p less than 0.001). These findings indicate that institutionalized elderly people are deficient in circulating essential fatty acids, which appears to be caused by both diet and metabolism.