Institutionalized Individuals Research Articles

Comparing Homogenized Instantaneous Meals and Traditional Pureed Foods in Patients Affected by Dysphagia: A Pilot Study

Background: Institutionalized individuals with dysphagia are particularly at risk for malnutrition. This study investigated two texture-modified models for patients with dysphagia, as follows: (i) traditional homemade pureed food (PF) and (ii) homogenized meals obtained from dehydrated and rehydrated instantaneous preparations (IPs). Methods: A retrospective pilot study was performed. It included patients affected by medium-severity dysphagia admitted to the nursing home “Sacra Famiglia” Institute of Cocquio Trevisago, Varese. The patients were aged 41–81 years old and all had complex disabilities. They underwent anthropometric and biochemical parameter assessments at baseline, as well as at two months and four months follow-up. Results: The study involved 30 patients, 15 received the IP meal. The comparison between the baseline and the follow-up did not show significant anthropometric and biochemical parameter differences. Conversely, the IP group reported significantly higher levels of consumption and satisfaction, evaluated using a modified Chernoff scale based on three levels of smiles, than the PF group. Conclusions: The present findings provide promising indications to improve the diet of patients affected by dysphagia, since meal satisfaction is a relevant factor that has been shown to be associated with better patient mood, motivation to eat, and adherence to prescribed diet.

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study.

To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Predictive health monitoring: Leveraging artificial intelligence for early detection of infectious diseases in nursing home residents through discontinuous vital signs analysis

This research addresses the problem of detecting acute respiratory, urinary tract, and other infectious diseases in elderly nursing home residents using machine learning algorithms. The study analyzes data extracted from multiple vital signs and other contextual information for diagnostic purposes. The daily data collection process encounters sampling constraints due to weekends, holidays, shift changes, staff turnover, and equipment breakdowns, resulting in numerous nulls, repeated readings, outliers, and meaningless values. The short time series generated also pose a challenge to analysis, preventing the extraction of seasonal information or consistent trends. Blind data collection results in most of the data coming from periods when residents are healthy, resulting in excessively imbalanced data. This study proposes a data cleaning process and then builds a mechanism that reproduces the basal activity of the residents to improve the classification of the disease. The results show that the proposed basal module-assisted machine learning techniques allow anticipating diagnostics 2, 3 or 4 days before doctors decide to start treatment with antibiotics, achieving a performance measured by the area-under-the-curve metric of 0.857. The contributions of this work are: (1) a new data cleaning process; (2) the analysis of contextual information to improve data quality; (3) the generation of a baseline measure for relative comparison; and (4) the use of either binary (disease/no disease) or multiclass classification, differentiating among types of infections and showing the advantages of multiclass versus binary classification. From a medical point of view, the anticipated detection of infectious diseases in institutionalized individuals is brand new.

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

ObjectivesTo clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex). MethodsData from the nationally representative “Old Age in Germany (D80+)” were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire). ResultsHigher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex). ConclusionSeveral sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia".

There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80years and above (n=1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6years (SD: 4.3years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted. Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

Factors Leading to a Decrease in Grip Strength Among the Oldest Old: A Large, Representative, Longitudinal Survey

ObjectivesGrip strength is an indicator for physical performance and highly correlated with general health among older adults. To date, there is limited knowledge regarding the factors contributing to grip strength exclusively among the oldest old based on data from large representative samples and also including institutionalized individuals. Consequently, the purpose of our current study was to address this gap in knowledge. DesignA large representative, longitudinal study. Setting and ParticipantsSurvey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+), including individuals ≥80 years (residing in institutionalized settings and living in private households) in North Rhine-Westphalia (n = 1824, mean age was 86.7 years, 80 to 104 years). MethodsIn accordance with other large cohort studies, isometric grip strength was measured using a dynamometer (Smedley Dynamometer, 100 kg). ResultsLinear fixed effects regressions showed that decreases in grip strength were significantly associated with increases in age (β = −0.70, P < .001), decreases in social network size (β = 0.08, P < .05), and worsening self-rated health (β = 0.80, P < .01). In contrast, decreases in grip strength were not significantly associated with changes in marital status, changes in living situation, changes in the number of chronic conditions, changes in depressive symptoms, and changes in health literacy. Conclusions and ImplicationsIt has been shown that age, social network size, and self-rated health were associated with grip strength among the oldest old longitudinally. Our current study may assist in identifying individuals at risk for low grip strength. For example, efforts to maintain social contacts may be beneficial to maintain grip strength. This is relevant because low grip strength contributes to unfavorable outcomes such as poor quality of life, functional impairment, cognitive decline, and reduced longevity.

Structural violence and institutionalized individuals: A paleopathological perspective on a continuing issue.

Past and present institutions (e.g., state and public hospitals, assisted living facilities, public nursing homes) have struggled with structural issues tied to patient care and neglect, which often manifests in the form of fracture trauma, and may explain why institutionalized individuals are at higher risk for this injury. Six hundred individuals from the Robert J. Terry Anatomical Collection born between 1822-1877 were examined to investigate hip fracture prevalence. Analysis of associated records and documentary data, including death, morgue, and census records, revealed that 36.3% (n = 218) of these individuals died in institutions such as the St. Louis State Hospital, City Infirmary, and Missouri State Hospital No. 4. Of the institutionalized individuals, 4.3% had evidence of hip fracture, significantly higher than the non-institutionalized (2.3%). Records revealed that many hip fractures were suffered around the time of death in state hospitals and were preventable, resulting from structural issues tied to understaffing and underfunding. Forensic and clinical literature, as well as current news media, indicate that structural violence in the forms of underfunding and understaffing continues to manifest as hip fractures harming institutionalized individuals today. This paper demonstrates how an anthropological perspective using paleopathological analysis sheds light on the chronicity and time depth of this issue, with the aim of driving public policy to entrench the equitable care of institutionalized people as a human right.

Diagnosis and Assessment of Oral Health Conditions Among Institutionalized and Non-institutionalized Elderly Individuals

Objective This study aimed to evaluate the perception of the quality of life of institutionalized elderly individuals (MB group) and non-institutionalized elderly individuals (CLIN group), and to compare these results with the results of dental indices. Study Design Elderly women and men aged 60 years or older were evaluated. Anthropometric and cardiac measurements were performed. A questionnaire related to geriatric oral health (GOHAI) and the SF-36, which addresses quality of life, were administered. Results The Mann-Whitney t test was used to perform the statistical analyses (α < 0.05). no statistically significant differences were found in the domains of the GOHAI. Despite the intensive care provided by the institution, self-perceived quality of life, in the physical aspect, was more pronounced in noninstitutionalized participants. Conclusions The participants presented similar overall oral health conditions. The institutionalized participants showed a higher salivary flow. Non-institutionalized participants showed higher salivary cortisol levels. Halitosis proved to be similar. The participants in both groups predominantly used total maxillary prostheses, but those in the non-institutionalized group used more partial mandibular prostheses. No differences were found in self-perceived health among the participants. The non-institutionalized participants presented better physical health; however, mental health was similar between the two groups. This study aimed to evaluate the perception of the quality of life of institutionalized elderly individuals (MB group) and non-institutionalized elderly individuals (CLIN group), and to compare these results with the results of dental indices. Elderly women and men aged 60 years or older were evaluated. Anthropometric and cardiac measurements were performed. A questionnaire related to geriatric oral health (GOHAI) and the SF-36, which addresses quality of life, were administered. The Mann-Whitney t test was used to perform the statistical analyses (α < 0.05). no statistically significant differences were found in the domains of the GOHAI. Despite the intensive care provided by the institution, self-perceived quality of life, in the physical aspect, was more pronounced in noninstitutionalized participants. The participants presented similar overall oral health conditions. The institutionalized participants showed a higher salivary flow. Non-institutionalized participants showed higher salivary cortisol levels. Halitosis proved to be similar. The participants in both groups predominantly used total maxillary prostheses, but those in the non-institutionalized group used more partial mandibular prostheses. No differences were found in self-perceived health among the participants. The non-institutionalized participants presented better physical health; however, mental health was similar between the two groups.

Enablers and Barriers to Utilisation of Available Formal Support by Institutionalised Individuals with Alzheimer’s Disease and Related Dementias in Rural South Western Uganda: A Qualitative Descriptive Study

Background: The world’s population is ageing resulting in a larger number of people living with dementia. Prevalence of dementia for persons aged above 60 years is expected to increase. There is paucity of information regarding formal support available for institutionalised individuals with AD/ADRD, enablers and barriers to its utilisation particularly South Western Uganda. Therefore, this study, filling this knowledge gap, sought to assess formal support available for individuals with AD/ADRD, enablers and barriers to its utilisation in rural communities in South Western Uganda. Methods: This study was conducted in two nongovernmental community-based facilities for the elderly in South Western Uganda employing a qualitative cross-sectional study design. Purposive sampling was used to recruit caretakers of individuals with Alzheimer’s disease and related dementias. A total of 28 in depth interviews and 6 key informant interviews were conducted. Results: Three arching themes emerged: 1) Formal support services available, 2) Enablers and 3) Barriers to the utilisation of the formal support services in institutionalised patients with AD/ADRD in rural communities in South Western Uganda. Conclusion: These findings highlight the importance of formal care in the long-term care of individuals with AD/ADRD. There is a dire need to equip caretakers involved in the care of patients with AD/ADRD with the required skill set and include formal support services in the mainstream primary health care to make the services accessible.

Hydration patterns and beverage consumption among a sample of institutionalized senior adults in Portugal

Water plays an important role in different body functions, being fundamental for cells, tissues, and organs. It is also directly related to various processes, from maintaining body temperature to eliminating compounds. With age the feeling of thirst decreases, which can lead to inadequate consumption of water causing dehydration in the senior population. This dehydration can have consequences on the clinical status of this population, enhancing its clinical decline. The primary objective of the present study was to evaluate the daily consumption of liquid from beverages in institutionalized individuals in a senior adult residence in the Lisbon area. A cross-sectional observational quantitative study views. An adapted version of a specific fluid-validated questionnaire was used to assess the consumption of different beverages and total daily fluid intake. It was observed that institutionalized individuals did not consume enough total fluid intake to meet the European recommendations appropriate for their sex and age group. Nevertheless, individuals receiving artificial nutrition achieve a daily consumption of 1.5 liters of water.

Liver abscess rupture into the chest wall with multi-localized pleural effusion

ABSTRACT Amoebic liver abscess (ALA) is a serious but readily treatable form of hepatic infection. It is a tropical disease with a wide spectrum of clinical manifestations. Although most amoebiasis cases are asymptomatic, dysentery and invasive extraintestinal diseases can occur. ALA is the most common manifestation of invasive amoebiasis; however, other organs can also be involved, including the pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. In developed countries, amoebiasis primarily affects those who have traveled to or migrated from endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals. Here, we report a case of a patient with extraintestinal amoebic lesions complicated by chest rupture. A 22yearold male from India presented to the emergency department with a cough, fever, weight loss, hemoptysis, chest pain, and diarrhea. He was diagnosed with a liver abscess that ruptured into the chest with multiloculated pleural effusion.

The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort.

Mobility disability is predictive of further functional decline and can itself compromise older people's capacity (and preference) to live independently. The world's population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants' self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p < 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p < 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p < 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services.

Long-term benefits of heart rate variability biofeedback training in older adults with different levels of social interaction: a pilot study

To test whether heart rate variability (HRV) biofeedback training benefits older adults with different social interaction levels. Methods. 32 older adults (16 were institutionalized and 16 were not). Both groups received 14 sessions, 15 min, 3 times a week, with half of the individuals receiving HRV biofeedback training and the other half receiving control training. The following parameters were assessed immediately before and after training, and 4.5 weeks after the last session (follow-up period): aerobic conditioning, anthropometric data, emotional scores, and HRV components. Results. Before the training, the institutionalized individuals had higher scores of loneliness (p < 0.01) and depression (p < 0.0001) and lower social touches (p < 0.0001), body mass (p = 0.04), and body fat percentage (p = 0.002) than the non-institutionalized individuals. HRV biofeedback improved symptoms of depression in both groups. HRV improved only in the non-institutionalized group, and loneliness only in the institutionalized group. Lastly, all changes persisted after the follow-up period. Conclusions. HRV biofeedback training was effective in improving symptoms of depression in older adults. Improvement of HRV and loneliness was dependent on the level of social interaction.

Horizontal Modes of Transmission of Hepatitis B Virus (HBV): A Systematic Review and Meta-Analysis.

Horizontal transmission of hepatitis B virus (HBV) is a significant transmission route in households, among contact sport athletes and institutionalized individuals. Children often are infected by non-sexual close contacts with an increased tendency to become chronic carriers. Hence, the awareness about various high-risk behaviours leading to horizontal transmission in the community is essential. A systematic review and meta-analysis was carried out to assess quantitatively the pooled prevalence of horizontally transmitted HBV infection globally. The study was started after ruling out registered or ongoing systematic reviews related to this topic in the PROSPERO database. The study protocol was documented in PROSPERO with a registration number CRD42021235165. We searched electronic databases for published articles in English between 1981 and April 2021 reporting horizontal modes of hepatitis B transmission among unvaccinated contacts. Meta-analysis was carried out in STATA version 13.0 (College Station, Texas 77,845 USA). The forest plots were constructed using metaprop package in STATA. Forty-one studies were systematically reviewed and 15 studies were qualified for the meta-analysis, including 1619 hepatitis B cases and 4869 contacts. The overall pooled prevalence of horizontally transmitted HBV infection among the contacts was 38% (95% CI 30%-46%). The pooled prevalence among 3,912 household contacts from nine qualified studies was estimated as 44% (95% CI 35%-54%). The pooled prevalence rates among institutionalized individuals and contact sport athletes were 30% (95% CI 23%-37%) and 18% (95% CI 5%-32%), respectively. The likelihood of horizontal transmission of HBV is greater among household contacts of chronic carriers of HBV and institutionalized individuals.

It’s Dopamine and Schizophrenia All Over Again

Dopamine (DA) has been hovering over schizophrenia for 70 years, with the earliest clues of a connection between the two coming from clinical reports that psychotic symptoms tended to diminish in chronically institutionalized individuals with schizophrenia who developed Parkinson’s disease. It became the “dopamine hypothesis” based on 3 seminal observations: 1) that dopamimetic drugs like amphetamine can induce paranoid states; 2) that, as shown by Nobel Laureate Arvid Carlsson, antipsychotic drugs influence DA metabolism; and 3) that, as shown by Lasker Awardee Sol Snyder, the clinical potency of antipsychotic drugs is remarkably correlated with their in vitro affinity for DA receptors.

Frequency and correlates of driving status among the oldest old: results from a large, representative sample

Background/aimsIn the light of the restricted knowledge, our aim was to explore the frequency and correlates of driving status among the oldest old.MethodsData came from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80 +)” consisting of community-dwelling and institutionalized individuals ≥ 80 years residing in the most populous German state (North Rhine-Westphalia; n = 1,832 in the analytical sample, mean age: 86.5 years). The present driving status (no; yes, I drive myself; yes, as a passenger; yes, as driver and passenger) served as outcome measure.ResultsOverall, 43.62% (95% CI 40.98–46.29%) of the individuals did not drive, whereas 30.12% (95% CI 27.75–32.59%) of the individuals drove by themselves, 20.97% (95% CI 18.91–23.20%) of the individuals drove as a passenger, and 5.29% of the individuals drove both (by themselves and as a passenger) (95% CI 4.16–6.71%). Multinomial logistic regressions showed, e.g., that being male (RRR: 0.13, 95% CI 0.09–0.18), younger age (RRR: 0.88, 95% CI 0.84–0.91), being married and living together with spouse (RRR: 1.48, 95% CI 1.08–2.02), living in a private household (RRR: 0.04, 95% CI 0.01–0.35), better self-rated health (RRR: 1.26, 95% CI 1.02–1.56), and lower functional impairment (RRR: 19.82, 95% CI 12.83–30.62) were positively associated with ‘Yes, I drive myself’ (compared to not driving a car).Discussion/conclusionsA sizable proportion of the individuals aged 80 years and above still drove by themselves. Less than half of the oldest old individuals did not drive. Moreover, our current study identified some correlates of driving status among individuals in latest life.

Frequency and correlates of mild cognitive impairment and dementia among the oldest old – Evidence from the representative “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)”

ObjectivesSince there is limited knowledge with regard to the frequency and correlates of mild cognitive impairment and dementia among the oldest old based on large representative data (including institutionalized individuals), our objective was to fill this research gap. MethodsFor our study, data came from the representative “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)”. This study included community-dwelling and institutionalized individuals aged 80 years and over (n = 1,173, mean age: 86 years) residing in the most populous state of Germany (North Rhine-Westphalia). The DemTect was used to quantify cognitive impairment (i.e., probable mild cognitive impairment and probable dementia). ResultsOverall, 73.1% of the individuals were not cognitively impaired, 17.0% of the individuals had probable mild cognitive impairment and 9.9% of the individuals had probable dementia. Compared to individuals without cognitive impairment, individuals with probable mild cognitive impairment were more likely to be male, live in an institutionalized setting, have a lower educational level, have a smaller network size, and have lower functional abilities. Moreover, compared to individuals without cognitive impairment, individuals with probable dementia were more likely to be older, live in an institutionalized setting, have a lower educational level, have a smaller network size, not be multimorbid, and have lower functional abilities. ConclusionsOur study identified several sociodemographic and health-related factors which are associated with probable mild cognitive impairment and probable dementia among the oldest old. This knowledge may help to address individuals at risk for mild cognitive impairment and dementia.

Respiratory Function Correlates with Fat Mass Index and Blood Triglycerides in Institutionalized Older Individuals.

We investigated the relationship between respiratory function measured by spirometry analysis and anthropometric variables (skeletal and fat mass) and nutritional status in the institutionalized elderly, particularly at high-risk for adverse outcomes after respiratory infections and malnutrition. This is a multicenter cross-sectional study with a quantitative approach conducted among older people institutionalized living in nursing homes. Respiratory function was assessed by measuring the forced vital capacity, forced expiratory volume in the first second, the ratio between FEV1 and FVC (FEV1/FVC), and peak expiratory flow in percentage by means of spirometric analysis (values of the forced expiratory volume measured during the first second of the forced breath (FEV1) and forced vital capacity (FVC)). Nutritional assessment and anthropometry analyses were performed to evaluate under or over nutrition/weight. There was a significant (p<0.05) and positive correlation between FEV1 and skeletal muscle mass index, whereas fat mass index correlated significantly (p<0.01) with the FEV1/FVC index. FEV1/FVC values were both significantly (p<0.05) associated with high body mass index and triglyceride levels in the blood. The prevalence of individuals with ventilator restrictive pattern (FEV1/FVC>70% with FEV1 and FVC<80%) was 27.6% and 12 individuals (21.1%) received daily bronchodilators as part of the pharmacological treatment for respiratory disorders. Logistic regression was performed to identify predictors of restrictive respiratory patterns. The following variables were included in the model: age group, female gender, Charlson comorbidity index, body-mass index (BMI), fat mass index, skeletal muscle mass index, total cholesterol, and triglycerides concentration. The model was statistically significant (p < 0.05; R2 = 0.39), correctly classifying 70.0% of cases, with a sensitivity of 89.3% and a specificity of 50.0%. Area under curve was 0.71 (IC95% 0.54-0.88; p=0.023).The highest OR for the restrictive respiratory pattern was for BMI (OR=5.09) and triglycerides concentration in blood (>150 mg/dl) (OR=5.59). The relationship between a restrictive pattern of respiratory function and fat mass deserves future investigation to manage these parameters as a possible modifiable factor of altered respiratory function in overweight institutionalized older individuals.

Resistance training with or without nutritional supplementation showed no influence on muscle thickness in old-institutionalized adults: a secondary analysis of the Vienna Active Ageing Study.

Resistance training and protein supplementation are recommended strategies to combat sarcopenia. Quantification of muscle thickness (MT) by musculoskeletal ultrasound is a promising method to follow changes in skeletal muscles. The aim of this study was to investigate the effect of six months of resistance training with or without nutritional supplementation on MT of M. quadriceps in institutionalized old adults. This is a prospective, randomized, multi-arm parallel and controlled intervention study. This study was conducted in five different retirement care facilities. Institutionalized individuals (mean age 82.6±6.2 years) were randomly assigned to an elastic band resistance training (N.=41), training with nutritional supplementation (N.=36) or control group (N.=40). Health status and handgrip strength were investigated at baseline. MT of all parts of M. quadriceps of the left leg was assessed using musculoskeletal ultrasound at baseline and after six months. Linear regression models adjusted for age, BMI and sex were calculated to investigate the influence of baseline characteristics on MT. Multivariable regression analyses were performed for investigation of study intervention on MT. Follow-up examinations were performed after 12 and 18 months. Handgrip strength of both hands was significantly correlated with MT of M. vastus lateralis. Moreover, the sum of regularly taken medication was significantly correlated to MT of all parts of quadriceps. Six months of training or nutritional supplementation was not able to alter MT. However, participants with lower baseline MT values or a higher number of diseases and medications at baseline showed significant higher increases in MT after intervention. Resistance training using elastic bands with or without nutritional supplementation did not alter MT of M. quadriceps of old institutionalized individuals. However, baseline values and health status had a significant influence on the training effect. As old individuals are very heterogenic according to their health and muscle status; further studies might focus on individualizing training regimes with particular emphasize on accompanied diseases and medications of this population.

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.