Institutionalized Elderly Persons Research Articles

Effect of Covid-19 Educational Bag on Knowledge, Attitude and Precautionary Practices of Institutionalized Elderly Persons

Background: The COVID-19 pandemic is affecting the worldwide population drastically. Elderly people face significant risks of having severe illness if they are diseased because of their physiological changes associated with aging and the possible outcome of underlying health statuses. Public awareness about dealing with highly infectious respiratory diseases is extremely important and plays an imperative role in limiting and preventing the widespread of infection, especially in countries with low and middle-income. Aim: Assess the effect of Covid_19 Educational Bag on Knowledge, Attitude and precautionary Practices of institutionalized Elderly persons . Methods: A quasi-experimental study design was used. This study was carried out at El Amal elderly home, affiliated to Mansoura City and Dar El-Walaa affiliated to Meet khamr city-Dakahlia governorate- Egypt. The study involved a convenience sample of 72 elderly persons who are residence at El Amal and El Walaa elderly homes. Data collected over a period of 6 months from first of April 2020 till the end of September 2020.Tools: Four tools were used for data collection; Demographic and Clinical Data structured Interview Sheet, and Elder's Covid-19 Knowledge Questionnaire, Elder’s Attitude towards Covid-19 Questionnaire, and Covid-19 Precautionary Practices Checklists .Results: Two thirds of the studied elders were selected from dar El Walaa, nearly one half of the subjects were middle old with a mean of 66.57±4.08 yrs. More than one half of the sample were females. A statistically significant improvement of COVID-19 knowledge, attitude, and precautionary practices of the studied elders immediately after implementation of COVID-19 educational bag than before it, and the improvement still apparent across all the studied sample regardless of their demographic characteristics and clinical data. The studied elders COVID-19 knowledge levels were positively associated with their attitude and precautionary practice. While no proven relation was found between studied elders COVID-19 attitude and precautionary practices Conclusion: A significant improvement of the studied elders means of score of COVID-19 levels of knowledge, attitudes and precautionary practices immediately, and two months after implementation of COVID-19 educational bag regardless of their demographic characteristics and clinical data. Recommendation: Development of an educational programs targeting vulnerable elderly population institutionalized in elderly homes in various Egypt governorates, designing a long-term plan by healthcare authorities to improve access to education and health services.

Transdisciplinarity in Evaluating the Health Conditions of Institutionalized Elderly Persons in Bauru, São Paulo, Brazil

The main aim of the research developed and described here was to record and evaluate-in the light of the concept of transdisciplinarity-the conditions of health and functional capacity of institutionalized elderly persons in Bauru, a city with 400,000 inhabitants, situated close to the centre of the state of São Paulo, Brazil. A descriptive and exploratory field research was conducted with diverse objects of research and methodologies, considering the fields of Dentistry, Nursing, Physical Therapy, Biomedicine and Speech Therapy. The Government effort in Brazil must be placed on record to make it possible to understand therapid growth of its elderly population, its consequences and needs, with the aim of greatly enhancing attention to their quality of life, compatible with the expectations of the population and authorities in all fields of Brazilian health care.

Eye Movement Program Consisting of Saccadic Eye Movement and Pursuit Eye Movement Improved Visual Memory in Institutionalized Elderly Person: Randomized controlled pilot study

Background: Aging reduces cognitive abilities, including visual memory (VM) and visual discrimination (VD). Since common cortical networks subserve eye movement and attention, voluntary eye movement may improve visual attention. Visual selective attention was major role for memory, and visual memory and visual attention are intimately related. Objective: To identify the improvement in VD and VM, after implementing the eye movement program consisting of saccadic eye movement (SEM) and pursuit eye movement (PEM) in the institutionalized healthy elderly. Design: Randomized controlled trial. Methods: The study involved a sample of 36 participants, and the mean age was 79.03 years (range 76~84 years). They were randomly allocated to the experimental group (n=16) and control group (n=20). Participants in the experimental group performed SEM 5 times per week for 4 weeks: twice daily at the same time in the morning and afternoon. The program was carried out for 3 minutes, and it consisted of SEM and PEM. The target’s moving frequency was set at 0.5 Hz. VM and VD at the baseline and post-intervention were measured using Motor-Free Visual Perception test-4 (MFVPT-4). Results: VM significantly improved in the experimental group (p < .01), and significant differences were observed compared to the control group (p < .01). There was no significant change in VD. Conclusion: The eye movement program consisting of SEM and PEM increased VM more than VD. Therefore, eye movement program was feasible interventions for improving VM in institutionalized elderly persons.

Analysis of risk factors for falls among institutionalized elderly persons

Abstract Objectives: to identify the demographic and clinical profile, context of risk and the occurrence of falls among institutionalized elderly persons; analyze the association between the classification of risk of falling using the Brazilian version of the Morse Fall Scale and the occurrence of falls in such individuals. Method: A cohort study was performed in two long-stay institutions in the city of Porto Alegre, Brazil. The sample consisted of 193 elderly persons. Descriptive and inferential statistics (Chi-squared and Fisher tests) were used for analysis. Results: The occurrence of falls was associated with hearing impairment, hand grip strength, Katz Index score, degree of dependence according to Collegial Board Resolution 283/2005 and risk of falls according to the MFS-B. Conclusion: Falls have multifactorial causes, which makes it important to identify the agents that contribute to their occurrence, as it is known that institutionalization significantly increases the risk of falling. Multidisciplinary actions are important for reducing the risk of falls, together with the use of instruments that can predict such risk among institutionalized elderly people.

The link between cognitive state and general self-esteem among institutionalized elderly persons: can health condition serve as a mediating factor?

Abstract Objective: to assess whether the health condition of an elderly person can serve as a mediating factor between the cognitive state and general self-esteem of the institutionalized elderly. Method: a quantitative, cross-sectional correlational study was performed, based on the path analysis technique.The following instruments were used for data collection: the Mini-Mental State Examination, the Tinetti Performance Oriented Mobility Assessment, the Mini Nutritional Evaluation and the Rosenberg Self-Esteem Scale. Results: the sample was composed of 312 elderly patients of both genders (112 men and 200 women), with an average age of 83.39 (+7.09) years. Most of the elderly persons were widowed, with a low educational level, and had been institutionalized in Residential Care Facilities for the Elderly for on average 54.6 (+51.69) months. The mediating factor of health condition renders the link between the cognitive state and self-esteem of the elderly null. However, the analysis of the decomposition of the effects showed a significant indirect effect between the cognitive state and health condition. The total effect of cognitive state on the health condition of the elderly is significant, positive and direct. Conclusion: based on the results of this study we maintain that cognitive changes can affect the nutritional state and physical balance of the institutionalized elderly.

The frailty syndrome in institutionalized elderly persons

Abstract Objective: to analyze the relationship between the level of frailty and sociodemographic and health characteristics among elderly residents of a long-term care facility (LTCF) in Ribeirão Preto, São Paulo, Brazil. Method: this descriptive and cross-sectional study included 56 elderly persons living in a LTCF. Data were collected from April to June 2016. A questionnaire addressing sociodemographic and health profiles was used together with the Mini-Mental State Examination, the Tilburg Frailty Indicator, the Barthel Index, and the Geriatric Depression Scale (GDS-15). Descriptive statistics were applied. The normality of the continuous variables was tested using the Shapiro-Wilk test. Spearman’s correlation was used for the continuous variables with frailty as the dependent variable. Result: Most elderly individuals were female (57.1%); the average age was 77.77; and 35.7% were widowed. In terms of health, 55.4% presented cognitive deficit; 62.5% had depression symptoms; 75.0% were considered frail; 42.9% had suffered falls in the last 12 months; and the individuals scored an average of 68.30 in the Barthel Index. A positive correlation between the frailty score and the GDS-15 (r=0.538; p=0.00) was observed, while a negative correlation was found between frailty and the Barthel Index (r=-0.302; p=0.02). Conclusion: increased frailty among institutionalized elderly persons is correlated with the presence of depressive symptoms and inferior performance of basic activities of daily living. The results of the present study can support the planning of care provided to elderly individuals living in LTCFs and encourage broader assessments of these individuals.

Functionality of Elderly Persons: A Comparison Between Institutionalized and Non – Institutionalized Elderly Persons in Nairobi City County, in Kenya

This study compared the Functionality of Institutionalized elderly persons and that of the elderly persons living with their family and or community members using the Modified Barthel Index. Two hundred and seventy elderly men and women who met the inclusion criteria were sampled, 135 from 4 Institutions namely Mji wa Huruma, Nyumba ya Wazee Ruaraka, Kariobangi Cheshire home and Mother Teresa in Huruma and 135 from Gumba, Kariobangi, Huruma and Kawangware divisions. Data were coded and entered using EPI Info version 9 and were analyzed using SPSS version 17. There were more totally dependent elderly at Institutions (13.6%), compared to 3% who were Non-institutionalized. The majority of those who were able to independently go in and out of their house and in and out of bed or wheel chair were living in the Institutions of the elderly. There were no gender differences in performing ADLs. More men than women were found to have pressure sores and bed sores. The study will reference for similar studies in Kenya and other parts of the world and prompt tertiary institutions of learning to design new training programs and review existing programs to address the Functionality needs of the growing population of Elderly persons.

What is the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons?

Abstract Objective: To verify the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons in Natal, Rio Grande do Norte, Brazil. Method: 219 elderly persons (≥60 years) of both genders were recruited for the study. Two criteria were initially used to calculate the prevalence of sarcopenia: criterion A, based on the European Consensus, considering only elderly persons with good physical and cognitive conditions and criterion B, considering all elderly individuals, regardless of their physical and/or cognitive condition. The association between sarcopenia and gender, age and body mass index (BMI) in the two groups was investigated using the chi-square test and the Student's t-test, with a significance level of 5%. Result: the diagnosis of sarcopenia according to Criterion A revealed a prevalence of 32% (95% CI: 22.54-43.21), whereas Criterion B identified a prevalence of 63.2% (95% CI: 56; 45-69,13). Despite the difference in the prevalence of sarcopenia using the two criteria employed (p&lt;0.001), no differences were observed in terms of the association with gender (p=0.149, p=0.212), BMI (p&lt;0.001, p&lt;0.001), and age (p=0.904, p=353). Conclusion: including only elderly people with good physical and cognitive abilities to calculate sarcopenia, based on the European Consensus, underestimates the prevalence of this condition among institutionalized elderly. As elderly persons with physical or cognitive limitations are extremely typical in the population of care facilities and increased diagnostic calculation for sarcopenia did not interfere with the distribution of associated factors, it is recommended that these individuals are considered in the basis of calculation for future studies of the diagnosis and prevalence of sarcopenia.

Cognitive impairment and associated factors among institutionalized elderly persons in Natal, Rio Grande do Norte, Brazil

Abstract Objective: To identify the prevalence of cognitive impairment and associated factors among institutionalized elderly persons. Methods: A cross-sectional study was conducted from October to December 2013 in Long-Term Care Facilities for the elderly in Natal, Rio Grande do Norte, Brazil, featuring 326 elderly persons of both genders. The assessment of cognitive decline was classified using the Pfeiffer test. Information on sociodemographic conditions and health status was also recorded. Nutritional status was assessed by applying the Mini Nutritional Assessment tool and functional capacity with the Katz Index. To identify the factors associated with the presence of moderate or severe cognitive impairment multiple logistic regression analysis of variables with a p value &gt;0.20 was performed, using the Stepwise Forward method. Results: It was observed that 83.6% (95% CI: 78.9 to 87.3%) of the elderly persons had cognitive impairment. The final model, adjusted for type of LTCF, showed that being 83 years old or older was considered a risk factor for moderate or severe cognitive impairment. However, having systemic arterial hypertension (SAH) and having been institutionalized through their own choice were considered protective factors for moderate or severe cognitive impairment. Conclusion: the variables age, having SAH and having been institutionalized through their own choice are directly associated, as risk or protection factors, with the presence of severe or moderate cognitive impairment of the elderly population. The early diagnosis of these factors can lead to greater focus in setting goals for prevention and health care, thus improving the quality of life of these individuals.

Prevalence of falls and evaluation of mobility among institutionalized elderly persons

Abstract Objective: The present study aimed to estimate the prevalence of falls among institutionalized elderly persons and identify associated factors. Method: A cross-sectional study of elderly residents of Care Facilities For the Elderly in Natal, Rio Grande do Norte, was carried out. The elderly persons could walk independently and did not have severe cognitive impairment. Data was obtained about the institution and socio-demographic and health information was collected. A physical examination was performed to evaluate frailty, mobility and balance (Timed up and go, Berg Balance Scale, Gait speed and Sitting-rising Test - SRT). Statistical analysis was performed using the Chi-squared Test for a 5% significance level. Results: Sixty-three elderly persons were within the search criteria. Of these 22.2% had fallen in the past year. Only the SRT was associated with these falls. Conclusion: It was concluded that the studied population has a low prevalence of falls, and the ability to perform less than 5 repetitions in the SRT was associated with episodes of falling.

Comparative Study of the Oral Health Profile of Institutionalized Elderly Persons in Brazil and Barcelona, Spain

Abstract Objective: To compare the oral health profile of institutionalized elderly persons in Brazil and in Barcelona, Spain, by gender and country of residence. Methods: A cross-sectional study was performed of individuals aged 65 years and above (n=1,440), resident in the health region of Barcelona and in Brazil. Two surveys and exams relating to the oral health status of institutionalized elderly persons in Brazil (in 2008) and in Barcelona, Spain (in 2009) were carried out. Periodontal disease, tooth loss and dental caries were analyzed, considering age and cognitive ability. The sample was stratified by gender and country. Bivariate and multivariate Robust Poisson Regression models were used to obtain adjusted Prevalence Ratios (aPR), and a 95% confidence interval (95%CI) was employed. Results: In Barcelona, men and women had a higher prevalence of periodontal illness: Men - calculus (aPR:1.5; CI:1.08-2.19) and pocket (aPR:2.05; CI:1.43-2.93) results. Women - calculus (aPR:2.4; CI:1.77-3.24) and pocket (aPR:3.2; CI:2.29-4.53) results. In Barcelona there was a lower prevalence of edentulism (aPR:0.49; CI:0.37-0.65) and functional edentulism (aPR:0.49; CI:0.40-0.60) among men. The same results were found among women with a lower prevalence of edentulism (aPR:0.49; CI: 0.41-0.58) and functional edentulism (aPR:0.42; CI: 0.30-0.49). Conclusions: A poor state of oral health of men and women was observed in both countries, with the elderly from Barcelona having worse periodontal health and the elderly from Brazil having greater tooth loss.

Palliative Care for Institutionalized Elderly Persons: Experience of Caregivers

Abstract The number of elderly persons institutionalized in residential facilities that provide various types of care is increasing all the time. Care is provided by caregivers who, often unknowingly, are delivering palliative care, and in doing so, are accompanying the elderly persons to their death. The aim of the present study was to investigate how terminal illness and death are experienced by caregivers. A qualitative explorative-descriptive study was carried out, featuring a phenomenological approach, in accordance with Giorgi. The sample was comprised of nine individuals who worked in residential facilities, with data collected through a semi-structured interview. Following data analysis, eight categories were defined: relationship with the elderly person; positive experiences, positive feelings, negative experiences, negative feelings, strategies, consequences and training. These categories were then divided into subcategories. It can be concluded that the caregivers experienced great difficulty when dealing with suffering at the end of life. This did not prevent them from enjoying their work, and a number of positive aspects of their relationships with the elderly were mentioned. The need to provide more support for these professionals, whether through further training or the level of psychological support provided, is also fundamental in this area of palliative care, as only in this way will individuals feel more able and confident about performing their tasks, brining greater benefit for the elderly persons.

Use of antidepressants in Parkinson's disease: A Swedish register-based study of over 1.5 million older people

IntroductionIt has been suggested that depression in Parkinson's Disease (PD) is often unrecognized and undertreated. However, few previous studies have studied the use of antidepressants in a large sample of both home-dwelling and institutionalized elderly persons with PD. We aimed to study the use of antidepressants in older persons using anti-parkinson drugs (APD, used as a proxy for PD), stratified by residential setting. MethodsWe analyzed individual data on age, sex, residential setting and drug use in over 1.5 million older persons in the Swedish Prescribed Drug Register on 31th of December 2013. ResultsTwenty-two percent of the home-dwellers and 50% of the institutionalized elderly persons with APD used antidepressants. Persons with APD had a higher probability of use of any antidepressant compared to persons without APD. A selective serotonin reuptake inhibitor (SSRI) was the most commonly used antidepressants in both settings followed by mirtazapin. ConclusionsThe high use of antidepressants among older persons with APD warrants further studies on the quality of treatment of depression in PD.

Prevalence of dizziness and associated factors in institutionalized elderly persons

Dizziness is a common symptom among the elderly, and is more prevalent among institutionalized elderly persons, due to their immobility and fragility. Objective : The aim of the present study was to ascertain the prevalence of dizziness and associated factors in institutionalized elderly persons. Methods : A cross-sectional study was performed in 12 Nursing Homes in Natal, Brazil. Elderly persons who possessed a cognitive level that allowed them to answer questions consciously, and were able to walk, were selected, resulting in a total sample of 115 individuals. They were asked whether they had experienced dizziness in the past year. Variables relating to the characteristics of the nursing homes, the dizziness, the life habits and the health of the elderly were evaluated. The Chi-square test for a significance level of 5% was used for statistical analysis, and the prevalence ratio (PR) calculated. For multivariate analysis, logistic regression was performed. Results : The prevalence of dizziness was 44.34%. Most elderly persons were female, long-lived, resided in non-profit facilities where they had lived for less than four years, had less than three diseases, used between 0 and 5 types of medication, did not smoke or drink, did not partake in physical inactivity, had rapid, imbalance type dizziness without neurovegetative symptoms and/or associated neurotological symptoms. Dizziness was associated with a large number of illnesses, the presence of cardiovascular disease, arterial hypertension, osteoarthritis and the use of gastro-protective medication. Conclusion : There was a high prevalence of dizziness among institutionalized elderly persons and was associated with cronic disease.

Risk Factors of Dizziness among Institutionalized Elderly Persons: A Case Control Study

Introduction: Institutionalized elderly people suffer from balance disorders, such as dizziness, that may result in falls and health debilitation. The aims of this study were to describe the institutionalized elderly population with dizziness and to determine the risk factors for dizziness related to the institution, lifestyle and health status of the elderly. Method: A case control study was performed in 12 Nursing Homes regulated by the Health Surveillance department. A hundred and twenty-three elderly persons who possessed a satisfactory cognitive level measured by the Pfeiffer test and the ability to walk were eligible. Of these, 102 elderly persons were selected half of whom (n=51) had suffered dizziness in the previous year. The other half (n = 51) were used as controls, and the two groups were matched for sex and age. Variables relating to the characteristics of the facility, lifestyle and health status of the elderly were analyzed. The Chi-squared and Fisher’s Exact tests were used for statistical analysis, with a significance level set at 5%, and multivariate model by logistic regression, with magnitude of the association calculum between variables measured by Odds Ratio. Results: The risk factors for dizziness were the presence of three or more pathologies per elderly person and the use of a gastro-protective drug, as a proxy of polypharmacy adjusted by systemic arterial hypertension and smoking. Conclusion: Risk factors associated with dizziness were the number of comorbidities higher than three and a gastro-protective drug adjusted in the multivariate model by hypertension and smoking

Prevalência de vestibulopatia em idosos institucionalizados de Natal - RN - Brasil

Resumo: OBJETIVO: aferir a prevalência de vestibulopatia e seus fatores associadosem idosos institucionalizados por meio do exame clínico de cabeceira. MÉTODOS: trata-se de um estudo transversal realizado nas 12 Instituições de longa permanência para idosos de Natal-Brasil, regulamentadas pela Vigilância Sanitária. Foram eleitos os idosos com bom nível cognitivo e capazes de deambular, totalizando 115 indivíduos. Os idosos foram questionados sobre a presença de tontura no último ano, e quando a resposta era positiva, eram submetidos a questionário e exame físico específico para diagnóstico de vestibulopatia, segundo o protocolo de Johnson e Lalwani (2004). Para a análise estatística, utilizou-se o teste do Qui-quadrado ou exato de Fisher para um nível de significância de 5% e cálculo da razão de prevalência. RESULTADOS: a prevalência de vestibulopatia foi de 10,56%e foram associados a osteoartrose e o etilismo. CONCLUSÃO: a vestibulopatia apresenta baixa prevalência nos idosos institucionalizados de Natal-Brasil.

Measurement Properties of the Groningen Frailty Indicator in Home-Dwelling and Institutionalized Elderly People

To enable prevention of poor outcome in elderly people, a valid instrument is required to detect individuals at high risk. The concept of frailty is a better predictor than age alone. The Groningen Frailty Indicator (GFI) has been developed to identify frailty. We assessed feasibility, reliability, and construct validity of the self-assessment version of the GFI. Cross-sectional. Community-based. Home-dwelling and institutionalized elderly persons were included in the study (n = 353) who met the following inclusion criteria: persons 65 years and older who were able to fill out questionnaires. The feasibility of the GFI was assessed by determining the proportion of missing values per item. The internal consistency reliability of the GFI was established by calculating the KR-20. Mann-Whitney and Kruskal-Wallis tests were applied to assess discrimination between specific subgroups (known group validity). Convergent and discriminant validity was assessed using Spearman Rank correlations between GFI and diseases and disorders, case complexity, and health care needs (INTERMED), life satisfaction (Cantril Ladder of Life), activities of daily living (Katz), quality of life (EQ-5D), and mental health (SF-36). Finally, we used multivariate regression analyses to evaluate the cutoff score of the GFI (<4 versus ≥4). A total of 296 (84%) of the participants completed all items of the GFI; the internal consistency was 0.68. The GFI yielded statistically significant GFI scores for subgroups (known group validity). The correlations for the convergent (range 0.45 to 0.61) and discriminant validity (range 0.08 to 0.50) were also as hypothesized. In contrast with nonfrail participants, frail older persons had higher levels of case complexity, disability, and lower quality of life and life satisfaction. This study supports the feasibility, reliability, and validity of the self-assessment version of the GFI in home-dwelling and institutionalized elderly people.

Characterization of presbyequilibrium among institutionalized elderly persons

The aim was to characterize dizziness, vertigo, poor maintenance of posture, and sudden instabilities (called presbyequilibrium) among institutionalized elderly to model and identify possible treatable causes. A questionnaire based study focusing on symptoms among 72 elderly persons from a single residential facility and followed them for 3 years. Dizziness, vertigo, poor maintenance of posture, and black-outs were reported by 68% of the 72 elderly and make them at risk for falls, and reduced quality of life. The most common complaint was postural instability, with a tendency to fall. "Spinning" vertigo and "floating" sensation had a strong inter-correlation and correlated with habitual falls. The various dizziness symptoms often occurred in combinations. Attacks of self-experienced syncope never occurred alone but always in combination with "spinning vertigo" or "tendency to fall". In factorial analysis, presbyequilibrium could be divided into six categories. Two of these categories correlated with falls. Among elderly, presbyequilibrium is commonly characterized by a combination of phenomena involving perceptual, orientation, postural, and autonomic manifestations. It is often difficult to obtain an accurate history from the elderly and the presence of vestibular symptoms is frequently overlooked. Taking a careful history and utilizing the classification of symptoms that emerged from the factorial analysis may give a deeper understanding of the etiology of presbyequilibrium, thereby facilitating appropriate rehabilitation.

Effects of Exercise Programs to Prevent Decline in Health-Related Quality of Life in Highly Deconditioned Institutionalized Elderly Persons

Our objective was to assess the effects of targeted exercise programs on health-related quality of life compared with usual care based on the ability to perform activities of daily living (ADL) and the Neuropsychiatric Inventory scores in geriatric institutionalized persons. A randomized controlled trial of 2 exercise programs vs usual care was conducted in 160 institutionalized persons 65 years or older who were able to understand basic motor commands and to move from one position to another. Interventions were performed over 6 months and were either an adapted tai chi program (4 times 30 min/wk) or a cognition-action program (2 times 30-45 min/wk) that focused primarily on an adapted guidance of patient-centered communication skills. The control group received usual care. The study was conducted at 4 settings. The main outcomes were changes in health-related quality of life based on ADL and Neuropsychiatric Inventory scores after 12 months. The control group experienced a decline in ADL over the 12-month period compared with the adapted tai chi and cognition-action groups, but the differences were not significant (P = .24 and P = .15, respectively). Also, the components of ADL, eg, ability to walk, continence, and nutrition, were maintained better in the intervention groups than in the control group. The total Neuropsychiatric Inventory score also worsened significantly in the control group, while it was unchanged or improved in the intervention groups. The differences between the cognition-action group and the control group were significant (P > .001). Neuropsychiatric diagnosis subgroups (such as dementia and psychosis) did not show a specific response from any intervention. Adapted exercise programs can slow down the decline in health-related quality of life among heterogeneous, institutionalized elderly persons. clinicaltrials.gov Identifier: NCT00623532.

Severe vitamin D deficiency in the institutionalized elderly

Severe vitamin D deficiency has been found to be prevalent in institutionalized elderly persons in several countries. The aim of the present work was to assess the vitamin D status of institutionalized elderly and compare it to that of community-living independent elderly in southern Greece during summer. Serum 25-hydroxyvitamin D [25(OH)D] and plasma PTH were measured in 58 (aged 68-103 yr, median 83.5) elderly inmates of a nursing home (IE) in the town of Kalamata (latitude N 37 degrees ) and in 48 (aged 60-89 yr, median 72) community-dwelling elderly (CDE) in Athens (latitude N 38 degrees ). The CDE had mean serum 25(OH)D 67.6 nmol/l [95% confidence interval (CI) 57.4 to 79.5], not far from the value of 80 nmol/l which is generally considered to be the lower limit of vitamin D sufficiency. The IE had significantly lower mean 25(OH)D 19.0 nmol/l (17.1 to 21.1); values of 25(OH)D below 20 nmol/l characterize severe vitamin D deficiency and may cause osteomalacia. The group of CDE had significantly lower mean plasma PTH 1.5 pmol/l (1.0 to 1.8) compared to 4.5 (3.9 to 5.3) of IE. Ninety percent of CDE had normal plasma PTH whereas 60% of IE had secondary hyperparathyroidism (PTH values >4.0 pmol/l). In conclusion, the majority of institutionalized elderly in southern Greece had severe vitamin D deficiency and secondary hyperparathyroidism in contrast to the fairly good vitamin D status and lack of hyperparathyroidism in the community-living elderly during summer. These findings indicate the need for vitamin D and calcium supplementation of the institutionalized elderly throughout the year.