Institutionalized Elderly Women Research Articles

Long-Term Effects of Inspiratory Muscle Training in Institutionalized Elderly Women: A Double-Blind Randomized Controlled Trial

Background: Inspiratory muscle training (IMT) has been applied to different populations, but evidence in elderly women and maintenance of improvements achieved during training is scarce. The objective of the study was to evaluate the effectiveness of IMT 6 months after finishing the training period in elderly women. Methods: A controlled, randomized, double-blind trial was conducted, with allocation concealment performed on 26 institutionalized elderly women distributed into 2 groups: high loads and low loads. Over an 8-week period, an IMT protocol was followed; later, elderly women continued for 6 months with their daily normal activities. Inspiratory strength, expiratory strength, and functional capacity were measured pre-IMT, post-IMT, and 6 months after intervention. Results: After an 8-week training, respiratory strength and functional capacity increased in both groups. Six months after finishing the intervention, these benefits were lost. Inspiratory strength decreased in the high-loads group but was 32% higher than initial values (p = 0.007); in the low-loads group, patients lost 41% (p = 0.015). Improvements were higher in the high-loads group after training (p = 0.000) and follow-up (p = 0.002). Functional capacity was similar to initial values in both groups. Conclusion: The improvements achieved with IMT in elderly women disappeared 6 months after the end of training. High loads were more effective to keep inspiratory strength than low loads.

Effect of Selective Behavioral Therapy on Stress Urinary Incontinence and Self-esteem among Institutionalized Elderly Women

Stress urinary incontinence is an ignored health problem among elderly women. Aim: Toevaluate the effect of selective behavioral therapy on stress urinary incontinence and self-esteem among institutionalized elderly women. A quasi-experimental research Design was utilized on a purposive Sample of 50 elderly women residing in three geriatric homes at Minia Governorate, Egypt. Tools: A Structured questionnaire sheet and three scales (Body Mass Index, Revised Urinary Incontinence,and Rosenberg Self-esteem Scales) were utilized. Results: The mean value of stress urinary incontinence severity declined to (4.30+3.38) after 12 weeks of behavioral training sessions compared with (8.20+5.21) before, besides, the mean score of self-esteem among the studied sample was elevated to (15.48±5.75) at posttest with highly statistically significant differences between pre and posttests (p=.000). A negative correlation was found between the severity of stress urinary incontinence and self-esteem. Conclusion: The application of selective behavioral therapy included (Kegel exercise and toilet training) was effective in reducing the severity of SUI and consequently, elevation of self-esteem among institutionalized elderly women. Recommendations: Behavioral training sessions are recommended to be offered regularly for geriatric residents to improve their self-esteem by controlling stress urinary incontinence.

Expressive arts therapy for subjective happiness and loneliness feelings in institutionalized elderly women: A pilot study

ABSTRACT The present study aimed to assess the effectiveness of Expressive Arts Therapy (EAT) in enhancing subjective happiness and reducing feelings of loneliness among institutionalized elderly women. The sample comprised of 5 women aged between 60-71 years. They were assessed on the Subjective Happiness Scale and UCLALoneliness scale. Pre and post-test analysis of Expressive Arts Therapy was done. The results showed improvement in the scores of subjective happiness and loneliness scales. It is concluded that EAT may produce positive effects on subjective happiness and loneliness feelings of institutionalized elderly women, however, a larger sample may draw a better conclusion.

Institutional routines and interpersonal conflicts among elderly in a Long-Term Care Facility.

To describe the influence of institutional routines on interpersonal conflicts among institutionalized elderly women. A qualitative study, with an ethnographic framework, performed with 17 elderly women in a Long-Term Care Facility. The field immersion occurred from August 2017 to May 2018. The data were produced by participant observation and fieldnotes and analyzed through the sociocultural perspective with theoretical tools related to the total institutions described by Erving Goffman. External bonds outside the institution and the routines were trigger factors of conflicts in the Long-Term Care Facility. The dissatisfaction with the lack of external bonds was noticed in the impossibility of leaving with family members, receiving visits, objects, money, foods, or attention. The standardization and collectivization of internal routines of basic activities generated dissatisfaction and challenged the elderly women's tolerance towards the norms. Such situations facilitated interpersonal conflicts in the institutional environment. The conflicts occurred among elderly women and professionals, and among them, from the insubordination of the elderly, based on the idea of reaffirming their individualities.

Comparison between Two Inspiratory Muscle Training Protocols, Low Loads versus High Loads, in Institutionalized Elderly Women: A Double-Blind Randomized Controlled Trial

Background: Aging results in a decline in the function of the respiratory muscles. Inspiratory muscle training is presented as a possible solution to attenuate the loss of respiratory function in the elderly. The objective of the study was to evaluate and compare the efficacy of 2 protocols with inspiratory muscle training (IMT), low loads and high loads, to improve respiratory strength, functional capacity and dyspnea in institutionalized elderly women, over 65 years. Methods: The study was a controlled, randomized, double-blind trial and with allocation concealment performed on 26 institutionalized elderly women distributed in 2 groups, the high-intensity group (HIG) and low-intensity group (LIG). Over an 8-week period an IMT protocol was followed 5 days/week, 15 min/day. The HIG trained with a load of 40% of the maximum inspiratory pressure (MIP) and the LIG with 20%. MIP, maximum expiratory pressure (MEP), functional capacity and dyspnea were evaluated. Results: After training, in the HIG MIP, MEP and functional capacity increased 52, 16 and 7%, respectively (p = 0.000, p = 0.001, p = 0.001) and in the LIG 30, 18 and 9%, respectively (p = 0.002, p = 0.014, p = 0.001). The improvement in MIP was significantly higher in the HIG than in the LIG (p = 0.042). Conclusion: IMT with low and high loads improves respiratory muscle strength and functional capacity in institutionalized elderly women. In addition, high loads were significantly more effective to improve MIP.

Neck circumference is associated with nutritional status in elderly nursing home residents.

Anthropometry is an easy and noninvasive method to evaluate nutritional status in institutionalized elderly people who are often bedridden. The aim of this study was to investigate the relationship between the neck circumference (NC) and nutritional status of elderly nursing home residents and to find cutoff points for NC size to identify individuals at risk of malnutrition. A cross-sectional study was developed with data collected from 352 elderly people living in five public nursing homes. Different anthropometric measures and the Mini Nutritional Assessment (MNA) were used to determine nutritional status. Receiver operating characteristic (ROC) curves were built for each anthropometric variable to determine their sensitivity and specificity for predicting the risk of malnutrition according to the MNA. The mean age of the participants (59% females) was 83 years old. In total, 48.3% of women and 45.5% of men were at risk of malnutrition according to their MNA scores. All anthropometric measurements were highly intercorrelated in both men and women, indicating a high degree of collinearity. Bootstrapped linear regression was used to assess the strength of the association between an individuals' nutritional status and their anthropometric parameters. Calf circumference and NC presented the best predictive value with the highest sensitivity for diagnosing the risk of malnutrition in both institutionalized elderly men and women. The best cutoff points of NC to identify elderly nursing home residents at risk of malnutrition were 35.2 cm for females and 37.8 cm for males. NC is associated with other classical anthropometric parameters and malnutrition status in elderly people living in nursing homes.

Conflicts among institutionalized elderly women: difficulties experienced by nursing professionals

Resumo Objetivo: O estudo objetivou identificar os conflitos interpessoais entre idosas institucionalizadas, na perspectiva da equipe de enfermagem e descrever as estrategias adotadas pela equipe de enfermagem nas situacoes de conflito. Metodos: Estudo qualitativo e descritivo, realizado nos meses de marco a julho de 2015, com 15 profissionais de enfermagem de uma Instituicao de Longa Permanencia, na regiao Sul do Brasil. Os dados foram coletados por meio de entrevista semiestruturada e submetidos a analise de conteudo tematica. Resultados: Identificou-se situacoes de conflitos entre as idosas em relacao a valorizacao do outro e disputas pelos objetos pessoais e espacos fisicos. As estrategias adotadas pela equipe de enfermagem dividiram-se em condutas regidas pelo dialogo ou embasadas na autoridade e carater punitivo. Conclusao: A compreensao da dinâmica e origens dos diferentes conflitos interpessoais entre idosas podera potencializar intervencoes da equipe de enfermagem, com esse publico pela reducao dos conflitos em numero e intensidade.

Physical And Functional Profile Of Institutionalized Elderly Women From A Brazilian Nursing Home

Physical And Functional Profile Of Institutionalized Elderly Women From A Brazilian Nursing Home

Sclerostin in institutionalized elderly women: associations with quantitative bone ultrasound, bone turnover, fractures, and mortality.

To evaluate the association between levels of circulating sclerostin (an emerging biomarker and important regulator of bone formation) and laboratory parameters of bone and mineral metabolism, bone mineral density and quality measured using quantitative ultrasound (QUS), fracture risk, and mortality. Prospective cohort study. Austrian nursing homes (N = 95). Female nursing home residents aged 70 and older (mean 84 ± 6; N = 539). Serum sclerostin, bone turnover markers, and bone mineral density and quality were measured at baseline. Participants were followed for clinical fractures and all-cause mortality. Partial correlation analysis adjusted for age, weight, and renal function revealed a significant positive correlation between sclerostin levels and calcaneal stiffness and radial and phalangeal speed of sound (all P < .01) and a significant negative correlation between sclerostin levels and osteocalcin, serum C-terminal telopeptide of type I collagen, and parathyroid hormone (PTH; P < .05). After a mean follow-up of 27 ± 8 months, 139 participants (26%) had died and 64 had a hip or other nonvertebral fracture (12%). Sclerostin was not predictive of mortality. In women with a negative fracture history, it was significantly but not linearly associated with fracture risk. In institutionalized elderly women, there is a significant relationship between serum sclerostin levels and QUS indices, bone turnover, and PTH, but sclerostin was not strongly associated with important clinical outcomes. Thus, it remains unclear whether sclerostin is a clinically useful predictor of fractures or mortality, at least in this setting.

Re: Effects of Resistance Versus Multicomponent Training on Body Composition and Functional Fitness in Institutionalized Elderly Women

To the Editor: We read with great interest the study by Sousa and Mendes,1 who reported that 12 weeks of training protocol was not enough to induce changes in the body composition of institutionalized elderly women. The results of that study are particularly important because body composition changes with aging even in weight-stable elderly men and women.2 Beyond these, we would like to comment on some points. Body composition measurement in the study was made using bioelectrical impedance analysis (BIA). For body composition analysis in elderly adults, accuracy of BIA is under discussion.3 The theory of BIA measurement relies on the capacity of hydrated tissues to conduct electrical energy, which allows estimation of total body water (TBW). Calculation of lipid and fat-free mass with BIA was made using equations on TBW,4 so changes in TBW may easily affect BIA results, and pretest preparation is mandatory to minimize the effect of the confounders. The pretest protocol was not reported. Moreover, a recent study showed that a 12-week training program had a significant effect on changes in body fat, total lean mass, and total fat mass in an elderly population.5 In Sousa and Mendes's study, body composition was measured using dual-energy X-ray absorptiometry, which is the recommended alternative to criterion standard methods. We believe that these problems may have affected the results. 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: Umut Safer and Vildan Binay Safer discussed and prepared the manuscript. Sponsor's Role: None.

Effects of Resistance Versus Multicomponent Training on Body Composition and Functional Fitness in Institutionalized Elderly Women

Effects of Resistance Versus Multicomponent Training on Body Composition and Functional Fitness in Institutionalized Elderly Women

Consumption of Yogurts Fortified in Vitamin D and Calcium Reduces Serum Parathyroid Hormone and Markers of Bone Resorption: A Double-Blind Randomized Controlled Trial in Institutionalized Elderly Women

Nutritional prevention of bone deterioration with fortified foods seems particularly suitable in institutionalized elderly women at risk of vitamin D deficiency, secondary hyperparathyroidism, increased bone resorption, and osteoporotic fracture. The objective was to evaluate whether fortification of yogurts with vitamin D and calcium exerts an additional lowering effect on serum PTH and bone resorption markers as compared with isocaloric and isoprotein dairy products in elderly women. A randomized double-blind controlled-trial, 56-day intervention was conducted in institutionalized women (mean age 85.5 years) consuming 2 125-g servings of either vitamin D- and calcium-fortified yogurt (FY) at supplemental levels of 10 μg/d vitamin D₃ and 800 mg/d calcium or nonfortified control yogurt (CY) providing 280 mg/d calcium. The endpoints were serum changes from baseline (day 0) to day 28 and day 56 in 25-hydroxyvitamin-D (25OHD), PTH, and bone resorption markers tartrate-resistant acid phosphatase isoform-5b (TRAP5b), the primary outcome, and carboxyl-terminal cross-linked telopeptide of type I collagen (CTX). At day 56, serum 25OHD increased (mean ± SEM) by 25.3 ± 1.8 vs 5.2 ± 2.5 nmol/L in FY (n = 29) and CY (n = 27), respectively (P < .0001). The corresponding changes in PTH were -28.6% ± 7.2% vs -8.0% ± 4.3% (P = .0003); in TRAP5b, -21.9% ± 4.3% vs 3.0% ± 3.2% (P < .0001); and in CTX, -11.0% ± 9.7% vs -3.0% ± 4.1% (P = .0146), in FY and CY, respectively. At day 28, these differences were less pronounced but already significant for 25OHD, PTH, and TRAP5b. This study in institutionalized elderly at high risk for osteoporotic fracture suggests that fortification of dairy products with vitamin D₃ and calcium provides a greater prevention of accelerated bone resorption as compared with nonfortified equivalent foods.

Equation to estimate body weight in elderly Mexican women using anthropometric measurements.

Body weight is useful for many medical and nutritional procedures. When it is difficult or impossible to measure body weight in hospitalized/institutionalized elderly, it can be estimated through equations based on anthropometry generated in other countries, although their validity in other contexts has been poorly studied. To create and validate an equation for estimating body weight for both, hospitalized and nursing home residents Mexican elderly women (institutionalized) using anthropometric measurements. A validation study was carried out in elderly women (> or = 60 years old), admitted to the Geriatrics Service of the Hospital Civil de Guadalajara "Fray Antonio Alcalde" during February-April 19th (n = 43) and April 20th-June 2005 (n = 29), and elderly women residing in three nursing homes in the Metropolitan Area of Guadalajara evaluated during June 2003-June 2004 (n = 23). Subjects were weighed using a scale which was adapted to their clinical situation and were anthropometrically assessed. In the first sample, we generated a new equation using multiple regression analyses. Then, the equation was validated in the other two samples. We also estimated weight using Chumlea's equations: in all samples, estimated and actual weights were compared between each other through a paired t-test. A p < 0.05 was considered as significant. Mean ages in each sample were: 84.3 +/- 7.3, 84.4 +/- 9.1, and 84.2 +/- 8.5 years, respectively. Mean actual weights were: 48.2 +/- 13.5, 48.1 +/- 10.1, and 55.0 +/- 12.3 kg, respectively. The resulting equation was: estimated weight = (1.599* knee height) +(1.135* mid arm circumference) + (0.735*calf circumference) + (0.621* tricipital skinfold thickness)-83.123 (R2 = 0.896, p < 0.001). In hospitalized women, there were no significant differences between estimated and actual weight (sample 1:D-0.02 +/- 4.3 kg, p = 0.976; sample 2: D-0.7 +/- 4.2 kg, p = 0.352). In female nursing homes residents (institutionalized women) weight was significantly overestimated (1.9 +/- 3.2 kg p < 0.01), but the mean difference was smaller than the ones found using Chumlea's equations. The developed equation predicted accurately hospitalized elderly women's body weight in our context. In institutionalized elderly women, weight was significantly overestimated. It would be useful to derive equations for different settings.uals who present normal body weight.

Comment on: Urinary tract infection in hospitalized elderly patients in the United Kingdom: the importance of making an accurate diagnosis in the post broad-spectrum antibiotic era

Sir, The paper by Gopal Rao and Patel 1 is an important addition to the best management of urinary tract infections (UTIs) in hospitalized elderly patients, and the authors should be congratulated for highlighting the importance of a more focused antibiotic approach. As a practicing clinician, however, I believe that their paper does not emphasize sufficiently what to do in the presence of microbiologically positive urine without accompanying clinical features (asymptomatic bacteriuria), a condition whose prevalence increases with advancing age in both sexes, up to 40% and 50%, respectively, among asymptomatic institutionalized elderly men and women. 2 While it is a fact that the cardinal features of a UTI (fever, abdominal and/or back pain, frequent and painful urination) may sometimes be difficult to elicit in older people, bacteriuria is too often invoked as a spurious explanation for many non-specific symptoms in this population. 3

Effects of Aroma Hand Massage On Sleep, Depression and Quality of Life in the Institutionalized Elderly Women

Purpose: The purpose of this study was to examine the effects of aroma hand massage on Sleep, depression and quality of life in the institutionalized elderly women. Methods: This study was a nonequivalent control group pretest-posttest design. The data was collected from June 23 to August 10 of 2009. Fifty - Six elderly women were divided into two groups, 27 institutionalized elderly women for the experimental group and 29 institutionalized elderly women for the control group. As for experimental treatment, the experimental group went through aroma hand massage with blended oil-a mixture of Lavender, Bergamot, Chamomile Roman in the ratio of 1 : 1 : 1, which was diluted 2.0% with jojoba carrier oil 20mL-on each hand for 5 minutes, three times a week during two weeks. Control group went non-treatment. Results: The aroma hand massage experimental group showed more significant differences in the charge of sleep score (t=3.83, p=.00) and depression (t=-3.54, p=.00). Conclusion: Aroma hand massage had a positive effect on sleep and depression in Institutionalized elderly women.

Rapidly exchangeable pool study of zinc in free-living or institutionalized elderly women

Objective We evaluated the effect of age and institutionalization on zinc metabolism by using a stable isotope technique. Methods This was a randomized case-control study. Three groups were recruited: nine young women (group 1, ages 36 ± 1 y) as controls, nine free-living elderly women (group 2, ages 72 ± 2 y), and nine institutionalized women (group 3, ages 73 ± 2 y). Only women were recruited to obtain homogeneous groups. The study was set in a Valence hospital (France) in the geriatric department (headed by Dr. Ferry). The experimental design of the study was reviewed and approved by the local ethical committee, and all participants signed a consent form. No subject dropped out of the study. A zinc stable isotope label (0.73 mg of 70Zn) was injected intravenously into patients and measured by inductively coupled plasma mass spectrometry. Results Decay curves of the plasma 70Zn followed a one-compartment kinetic leading to the determination of one pool. The size of this pool suggested that it corresponded to the liver compartment. The size of this pool was significantly smaller in elderly people. 70Zn plasma resident time was significantly longer in elderly individuals, and shorter in institutionalized than in free-living elderly subjects. Conclusion These data suggest that the zinc metabolism of elderly women is related to lifestyle or its consequences and to age. Moreover, we have demonstrated that kinetic studies using stable isotopes of zinc can provide novel information on exchangeable zinc pools in clinical situations.

Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System).

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.

Mental Status and Functional Abilities: Change in Institutionalized Elderly Women

A study of 40 institutionalized elderly women was undertaken to determine if changes occurred in mental status and functional abilities over the course of 1 year. Although a number of studies examine factors that impact on successful adaptation in persons admitted to long-term care facilities, the longitudinal changes on functional abilities and mental status have not been addressed. These variables were examined in relation to the concept of self-care, which has been applied to the elderly only recently. Findings indicate a decline in mental status and an increase in functional dependency. Nursing implications and questions that merit further study in the area of self-care are presented.

Prospective Randomized Comparison of Therapy and No Therapy for Asymptomatic Bacteriuria in Institutionalized Elderly Women

Fifty elderly (mean age, 83.4 +/- 8.8 years) institutionalized women with asymptomatic bacteriuria were randomly assigned either to receive therapy for treatment of all episodes of bacteriuria identified on monthly culture or to receive no therapy unless symptoms developed. Subjects were followed for one year. The therapy group had a mean monthly prevalence of bacteriuria 31 +/- 15 percent lower than those in the no-therapy group, but periods free of bacteriuria lasting six months or longer were documented for only five (24 percent) subjects. For residents receiving no therapy, 71 percent showed persistent infection with the same organism(s). Antimicrobial therapy was associated with an increased incidence of reinfection (1.67 versus 0.87 per patient-year) and adverse antimicrobial drug effects (0.51 versus 0.046 per patient-year) as well as isolation of increasingly resistant organisms in recurrent infection when compared with no therapy. No differences in genitourinary morbidity or mortality were observed between the groups. Thus, despite a lowered prevalence of bacteriuria, no short-term benefits were identified and some harmful effects were observed with treatment of asymptomatic bacteriuria. These data support current recommendations of no therapy for asymptomatic bacteriuria in this population.

Thyrotoxicosis in Institutionalized Elderly Patients With Atrial Fibrillation

We hypothesized that hyperthyroidism would be an infrequent cause of atrial fibrillation in older persons because atherosclerotic, hypertensive, and degenerative heart disorders are more prevalent with aging. We determined the cardiac rhythm and thyroid status of 316 patients older than 65 years of age residing in a nursing home. One (11%) of the nine elderly men and five (31%) of the 16 women with atrial fibrillation had laboratory evidence or a history of hyperthyroidism. The elderly patients with cardiac rhythms other than atrial fibrillation (n = 291) had only a 1.7% prevalence of hyperthyroidism. The analysis for elderly women demonstrated a statistically significant association between atrial fibrillation and hyperthyroidism, but the association was not statistically significant for men. These findings indicate that hyperthyroidism is common in institutionalized elderly women with atrial fibrillation.