Institutionalized Subjects Research Articles

Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review.

Hip fractures are a major health issue considerably impacting patients' quality of life and well-being. This is particularly evident in elderly subjects, in which the decline in bone and muscle mass coexists and predisposes individuals to fall and fracture. Among interventions to be implemented in hip fractured patients, the assessment and management of nutritional status is pivotal, particularly in subjects older than 65. Nutrition plays a central role in both primary and secondary preventions of fracture. An adequate protein intake improves muscle mass and strength and the intestinal absorption of calcium. Other nutrients with recognized beneficial effects on bone health are calcium, vitamins D, K, and C, potassium, magnesium, folate, and carotenoids. With reference to calcium, results from longitudinal studies showed that the consumption of dairy foods has a protective role against fractures. Moreover, the most recent systematic reviews and meta-analyses and one umbrella review demonstrated that the combination of calcium and vitamin D supplementation significantly reduces hip fracture risk, with presumed higher efficacy in older and institutionalized subjects. Owing to these reasons, the adequate intake of calcium, vitamin D, protein, and other macro and micronutrients has been successfully implemented in the Fracture Liaison Services (FLSs) that represent the most reliable model of management for hip fracture patients. In this narrative review, papers (randomized controlled trials, prospective and intervention studies, and systematic reviews) retrieved by records from three different databases (PubMed, Embase, and Medline) have been analyzed, and the available information on the screening, assessment, and management of nutritional and vitamin D status and calcium intake in patients with hip fractures is presented along with specific prevention and treatment measures.

Comparative Analysis of Social Networks in Institutionalized Older Adults versus Aging-in-Place Scenarios.

(1) Background: This research aims to compare social networks among institutionalized and aging-in-place (AIP) older adults through the validation of a new questionnaire. (2) Methods: The cross-sectional study included 100 older adults (mean age: 73.53 ± 5.49 years; age range: 65-85 years), with 48 institutionalized subjects and 52 AIP subjects. We developed, validated, and administered a new questionnaire, the Social Network Assessment for Older People Questionnaire (SNAOPQ), to assess older adults' social networks using descriptive and inferential statistical methods. (3) Results: The SNAOPQ demonstrated excellent internal consistency (Cronbach's alpha of 0.91 and McDonald's omega of 0.91). Statistical analysis revealed significant associations between variables, highlighting differences in social networks between institutionalized and AIP individuals (p ≤ 0.001). Sociodemographic factors like age, education, living arrangement status, and number of descendants significantly influenced SNAOPQ scores (p ≤ 0.001). Age and residence type notably impacted participants' scores, indicating reduced social network size with age. Tertiary education and living in a couple were associated with more extensive social networks, while a higher number of descendants correlated with social network expansion. (4) Conclusions: Our study highlights significant differences in social networks among older adults based on residence type, emphasizing the impact of sociodemographic factors such as age, education, living arrangement, and the number of descendants.

P23-033-23 Improving the Dietary Habits of Institutionalized Subjects With Dysphagia: What Alternatives to Traditional Pureed Food?

P23-033-23 Improving the Dietary Habits of Institutionalized Subjects With Dysphagia: What Alternatives to Traditional Pureed Food?

Disturbed Galactose Metabolism in Elderly and Diabetic Humans Is Associated with Cataract Formation

Lactose consumption has been associated with a high incidence of cataract in northern Indian and southern Italian populations. Galactose absorbed after hydrolysis of lactose from milk in individuals with normal lactase activity is considered responsible. However, lactase-deficient subjects who often avoid drinking milk are able to digest lactose and absorb free galactose in fermented milk and yogurt. This study was conducted to evaluate the relationships between milk and yogurt consumption, galactose metabolism and cataract risk. Milk ingestion was dose-related with cataract risk in lactose digesters (particularly in diabetics) but not in lactose maldigesters. Conversely, yogurt intake had a protective dose-effect on cataract formation for the whole population. Maximal galactose concentrations after an oral galactose test increased exponentially with age. Red blood cell galactokinase activity was significantly lower in elderly subjects (> 60 y) than in young individuals (P < 0.05), and galactose-1-phosphate uridyl-transferase activity was significantly lower in institutionalized subjects and in home-living elderly with cataract than in healthy elderly subjects (P < 0.05). We conclude that the cataractogenic action of milk lactose is dependent on the disturbance of galactose metabolism in elderly subjects and that yogurt is not cataractogenic, although the mechanism of the protective effect of yogurt remains unknown.

Cognitive status in institutionalized oldest old

Introduction. Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. A signifi cant part of oldest old are feel lonely, need care and live in long term care facilities (institutionalized). Disability and institutionalization are associated with an increased risk of cognitive impairment in oldest old. The cognitive status in this group has been studied insuffi ciently in Russia. Determination of diagnostic standards for cognitive functions assessment scales in oldest old is important both for clinical practice and for scientifi c research.Objective: to evaluate cognitive functions and to determine diagnostic value for various psychological tests in persons aged ≥ 90, who live in long term care facilities (LTCF).Material and methods. The persons aged ≥ 90 years that live in LTCF (boarding houses or nursing homes) in Moscow were examined. All patients passed neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fl uency tests. In addition, original questionnaire was used for cognitive impairment screening.Results. Dementia was found in 69% of oldest old, who live in LTCF; frontal dysfunction in 89.1% and “hippocampal type” of memory disorders in 57.5%. The results of phonemic verbal fl uency test were normal in 6.7% only and of semantic verbal fl uency test in 8.1%. For diagnosis of dementia in institutionalized subjects sensitivity of MMSE ≤ 23 points was 97% and specifi city was 90.9%. For the FAB optimal sensitivity/specifi city ratio (98/83.7%) was at score of ≤ 14. The clock-drawing test sensitivity for dementia was 91.9% and specifi city was 69.7% at total score ≤ 6 .Conclusion. Institutionalized persons aged ≥ 90 years have a high prevalence of dementia. The above mentioned tests can be used for oldest old examination. Further studies of the relationship of cognitive impairment with other geriatric disorders in oldest old are needed.

Depression and quality of life in Tunisian institutionalized elderly subjects

IntroductionDepression in the elderly is common and closely interrelated with the deterioration of the quality of life, especially in the institutionalized elderly.ObjectivesIn this work, we propose to determine the prevalence of depression in the elderly in institution, to assess their quality of life and to evaluate the correlations between depression and the quality of life.MethodsOur study concerned 30 elderly subjects institutionalized at the retirement home(Sousse, Tunisia). Three validated Arabic version scales were used: The 30-item GDS (Geriatric Depression Scale), the MMSE (Mini Mental State Examination) and the SF36 (assessing the quality of life).ResultsThe mean age of our population was 75±7.3 years, the sex ratio was 1.73. The prevalence of depression was 37%. The elderly had a cognitive impairment in 16.7%. The mean global SF36 score were 11.2, attesting an altered quality of life in all our subjects: the mental component (9.43) were more altered than the physical one (13.03). No correlation between depression and quality of life was found. Depression was significantly correlated with the presence of a medical history (p=0.05). Depression had a negative and statistically significant correlation with the physical score of SF36 (r=-0.41, p=0.02) and tended towards significance for the “general health” dimension of SF36 (r=-0.32, p=0.08).ConclusionsOur study shows a high frequency of depression in the institutionalized elderly as well as a deterioration in their quality of life. Depression is strongly linked to deterioration in physical condition.Our results underline the influence of somatic diseases as a major risk factor for depression in the elderly.DisclosureNo significant relationships.

ПРОБЛЕМА ИНСТИТУЦИОНАЛЬНОЙ ЭФФЕКТИВНОСТИ СИСТЕМЫ ПАТРИОТИЧЕСКОГО ВОСПИТАНИЯ В РЕГИОНАХ СИБИРСКОГО ФЕДЕРАЛЬНОГО ОКРУГА

The article attempts to assess some aspects of the system of patriotic education of young people in two regions of the Siberian federal district (SFD) – Krasnoyarsk krai (KK) and Irkutsk oblast (IO). The aim of the paper is to compare the quantitative results of the patriotic education work in the regions with the ideas of high-school children about the way such work should be organized. Thus, the nature of patriotic organizations and institutions engaged in patriotic education of young people is analyzed. The key patriotic activities are identified. The financing of patriotic programs and projects is compared. A comparative analysis of the number of participants of patriotic organizations, their involvement in Internet communications, through social networks is carried out. The results of the analysis show that the systems of patriotic education in the studied regions have different funding. At the same time, the number of patriotic education events is quite large and meet objectives of the “Patriotic education of citizens of the Russian Federation” federal project. However, despite the efforts made by the subjects of patriotic education, schoolchildren show poor awareness and involvement in patriotic events. Giving preference to the classical agents of patriotic education, schoolchildren still believe that patriotism should be developed without pressure from institutionalized subjects. They opt for watching feature films and reading patriotic literature as desired impact, while their experience is mostly limited by visiting museums of different levels. Innovations providing for values and expectations of the younger generation should be introduced to increase the effectiveness of the system of patriotic education and boost patriotic feelings among young people.

Stabilization after postural transitions in the elderly: Experimental study on community-dwelling subjects and nursing home residents

BackgroundPostural transitions have been identified as presenting challenging situations for the elderly. Research questionThis study hypothesizes a relationship between age-related factors and postural stabilization performance after a transition movement. In particular, the controlled factors in the experiment are: 1) assistance in living (independent living for community-dwelling subjects vs. assisted living for institutionalized subjects in nursing homes); 2) age of institutionalized individuals, by comparing groups with different age ranges. MethodsSixty-three institutionalized individuals in nursing homes were recruited (17 in the age range 64–79; 46, including 6 drop-outs, in the age range 80–95). Moreover, seventeen (one drop out) community dwelling subjects (64–79 years) were enlisted. The study focuses on the postural stabilization phase after a "step forward" task. ResultsWhen comparing age-matched subjects from the two groups, the residents in nursing homes were characterised by a worse stabilization performance: the stabilization time more than doubled, Instability increased by 39 %, and Promptness decreased by 77 %, although there was no significant difference in the quiet erect posture between the groups. No difference was observed when comparing the two age groups of residents in the nursing homes, however a potential confounding effect has been identified in the unequal mortality rates between the two groups. SignificanceIt is hypothesized that an individual identification of abnormal values of Instability and/or Promptness may inform different rehabilitation approaches.

Correlation between Handgrip Strength and Depression in Older Adults-A Systematic Review and a Meta-Analysis.

Background: Depression remains an important health problem among older adults and it may be correlated with the deterioration of physical fitness, whose chief indicator is hand grip strength (HGS). The aim of the study was to investigate the relationship between depression and HGS among older populations using the available literature. Methods: PubMed, Web of Science and Science Direct databases were searched. The inclusion criteria were as follows: written in English and published after 2009, subject age: ≥60 years, HGS measured using a hand dynamometer, assessment of the depressive symptoms using a validated tool. The following articles were excluded: studies conducted among institutionalized subjects and/or populations with a specific disease. Results: The total combined effect of 33 results presented in 16 studies included in the meta-analysis, converted to the correlation coefficient, was OEr = −0.148 (SE = 0.030, 95%CI: −0.206–−0.091), indicating a weak, negative correlation between HGS and depressive symptoms. Conclusions: The review of the literature and the meta-analysis demonstrated a relationship between low muscle strength and intensified depressive symptoms in older populations. Bearing in mind that depression is often unrecognized or underdiagnosed among older patients, lowered muscle strength should be an important sign for physicians and an incentive to screen them for depression.

Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review

BACKGROUND: The growing number of systematic reviews/meta-analyses (SR/MAs) on the role of vitamin D in fracture prevention has led to conflicting results and contradictory guidelines. METHODS: This umbrella review evaluated SR/MAs of randomized controlled trials that compare the effect of vitamin D (±calcium) to placebo/control on fracture risk in adults, as identified from 4 databases (2010-2020). We assessed the quality of SR/MAs using the latest quality tool, AMSTAR-2. We compared their results and investigated reasons for discordance using matrices and sub-group analyses (PROSPERO registration: CRD42019129540). FINDINGS: We included 25 SR/MAs, 21 were of critically low quality, one of low quality, and three were of moderate quality (2 were on fall-related fracture). Vitamin D combined with calcium (Ca/D) reduced the risk of hip fractures in 8/12 SR/MAs (relative risk (RR) 0.61-0.84), and the risk of any fracture in 7/11 SR/MAs (RR 0.74-0.95), on pooled analyses. Important sources of discordance in results between SR/MAs were identified. These stem from inclusion of different trials, search periods, eligibility criteria, and differences in methodology. There was a trend for sub-group effect by residency, age and vitamin D status, but none reached statistical significance. All 19 SR/MAs on vitamin D alone compared to placebo/control reported no benefit. INTERPRETATION: Ca/D reduces the risk of hip and any fractures, results that seem driven by findings in institutionalized subjects. Age and baseline vitamin D status may be important predictors. Individual participant data meta-analyses of older patients on Ca/D would best unravel determinants for a beneficial response to such supplementation. FUNDING STATEMENT: This study was in part supported by internal institutional funds from the Medical Practice Plan, at the American University of Beirut Medical Center. DECLARATION OF INTERESTS: Drs M. Chakhtoura, D. Bacha, C. Gharios, Y. Jabbour, F. Kahale, A. Bassatne, S. Antoun, E. Akl and G. El Hajj Fuleihan, and Ms S. Ajjour and M. Assaad have no conflict of interest Dr. P. Ebeling reports grants and other from Amgen, grants from Eli-Lilly, grants from Alexion, other from Sanofi, outside the submitted work. Dr. R. Bouillon reports receiving small lecture fees from FAES (Spain), Proctor &Gamble (Belgium), Abiogen (Italy), and support for attending meetings and/or travel from FAES (Spain), Abiogen (Italy). Dr P. Lips reports receiving travel cost for vitamin D workshop from Abiogen.

Correlation between clinical tests for gait and stability using biomechanical variables in the gait of institutionalized elderly subjects

Abstract Study aim: This study aims to identify biomechanical gait variables explaining clinical test results in institutionalized elderly people. Material and methods: Twenty-nine elderly (82.0 ± 6.3 years) residents in a nursing home were assessed. They were able to walk 10 meters without walking aids. First, the spontaneous gait was assessed using inertial measurement units in a 10-meter long corridor. Fifteen biomechanical gait variables were analyzed. Then, three clinical tests usually used in elderly subjects were applied: the Timed Up and Go (TUG) test, the Tinetti Scale and the Sit to Stand (STS) test. A correlation matrix using Pearson’s correlation coefficient between clinical and biomechanical variables was performed, obtaining a total of 45 potential correlations. A stepwise multiple linear regression analysis was then performed to determine the influence of each variable. Results: TUG, Tinetti and STS were significantly correlated with similar biomechanical variables, including temporal, temporo-spatial and kinematic variables. Adults over 80 years old and women showed stronger correlations. Single support and ankle angle at takeoff were the two most important variables in stepwise regression analysis. Conclusions: In institutionalized elderly subjects, clinical variables for gait and postural stability are correlated with the biomechanical gait variables, especially in women and adults aged over 80 years.

Instituição, escola, futuro e satisfação com a vida sob a perspetiva de jovens institucionalizados

espanolIntroduccion: Cada vez hacemos mas hincapie en el bienestar y el desarrollo integral del nino / joven, y toda la legislacion que lo rodea es fundamental para garantizar sus derechos. Objetivos: Comprender como los jovenes institucionalizados de una institucion del centro del pais se posicionan a nivel de la institucion, la escuela, las perspectivas de futuro y su satisfaccion con la vida. Metodologia: Se trata de una investigacion cualitativa, utilizando un Instrumento Cuestionario de Indagacion y una Escala de Satisfaccion con la Vida (SWLS), que fue traducido y medido para la poblacion portuguesa por el autor Simoes (1992). El presente estudio conto con una muestra de 11 sujetos institucionalizados con edades comprendidas entre los 11 y los 22 anos, de los cuales 5 eran mujeres y 6 hombres. Resultados: Se concluye que los jovenes consideran que la institucion trabaja a favor de lo que les gusta y, en terminos escolares, la consideran un medio propicio para un futuro mejor. En cuanto a las perspectivas de futuro, se concluyo que han definido sus metas de vida. Para la satisfaccion con la vida, se encontro que mas de la mitad de los encuestados se sienten satisfechos con su vida. Conclusion: Los jovenes, en estudio, valoran su institucion y la escuela, tienen perspectivas de futuro relacionadas con aspectos profesionales y se sienten satisfechos con la vida. EnglishIntroduction: We are increasingly emphasizing the well-being and integral development of the child / young person, and all the surrounding legislation is essential in order to guarantee their rights. Objectives: To understand how institutionalized young people from an institution in the central part of the country position themselves at the level of the institution, school, prospects for the future and their satisfaction with life. Methodology: This is a qualitative investigation, using a Questionnaire of Inquiry Instrument and a Satisfaction With Life Scale (SWLS), which was translated and measured for the Portuguese population by the author Simoes (1992 ). The present study had a sample of 11 institutionalized subjects aged between 11 and 22, 5 of whom were female and 6 were male. Results: It is concluded that young people consider that the institution works in favor of what they like and, in school terms, they consider it a conducive means for a better future. Regarding the prospects for the future, it was concluded that they have defined their life goals. For satisfaction with life, it was found that more than half of the respondents feel satisfied with their life. Conclusion: Young people, in study, value their institution and the school, have prospects for the future related to professional aspects and feel satisfied with life. portuguesIntroducao: O bem-estar e desenvolvimento integral da crianca/jovem institucionalizado e hoje uma prioridade e toda a legislacao envolvente e imprescindivel de modo a garantir-lhes os seus direitos. Objetivos: Compreender como os jovens institucionalizados de uma instituicao da zona centro do pais se posicionam ao nivel da instituicao, escola, perspetivas de futuro e da sua satisfacao com a vida. Metodologia: Trata-se de uma investigacao de cariz qualitativa, utilizando um Instrumento de Inquerito por Questionario e uma Escala de Satisfacao com a Vida (Satisfaction With Life Scale (SWLS)) sendo esta traduzida e aferida para a populacao portuguesa pelo autor Simoes (1992). O presente estudo, contou com uma amostra de 11 sujeitos institucionalizados com idades entre os 11 e os 22 sendo 5 do genero feminino e 6 do genero masculino. Resultados: Conclui-se que os jovens consideram que a instituicao trabalha em prol do que gostam e, em termos escolares consideram que e um meio propicio para um melhor futuro. Referente as perspetivas de futuro concluiu-se que tem definidos os seus objetivos de vida. Para a satisfacao com a vida aferiu-se que mais de metade dos inquiridos se sentem satisfeitos com a sua vida. Conclusao: Os jovens, em estudo, valorizam a sua instituicao e a escola, tem perspetivas de futuro relacionadas com aspetos profissionais e sentem-se satisfeitos com a vida.

Assessing the effect of oral diseases on oral health related quality of life of institutionalized elderly using Oral Health Impact Profile (OHIP-14) questionnaire: a pilot study.

India establishes a geriatric population of about 80 million which is 7.2% of the total population. The geriatric population is often faced by a negative impact on their quality of life due to poor oral health. To assess the impact of oral disease on daily activities and quality of life among the institutionalized elderly in Kanpur, India. A total of fifty-six patients were purposively selected from two old age homes through convenience sampling technique. To assess the oral health status WHO basic oral health survey form (1997) was used. Short version of Oral Health Impact Profile (OHIP - 14) questionnaire was used to assess the Oral Health Related Quality of Life (OHRQoL). Independent t-test and ANOVA test was done to determine the relationship between the groups. Presence or absence of grossly decayed teeth, chronic periodontitis, based on edentulism and remaining sound teeth status produced no significant differences in any of the domains. In comparison with males, females experienced greater impact of oral diseases with respect to mean OHIP-14 score; however, it was non - significant (p=0.45). Oral health status of the institutionalized subjects in Kanpur city is poor, with edentulism and periodontitis. The effect of oral diseases on the lives of elderly is comparatively low and is non-significant.

Cobalamin Deficiency in the Elderly.

Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g., autoimmune gastritis) and drugs (e.g., antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting, particularly elevated, in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple. It requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathy. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available, and may be influenced by some confounders (e.g., folate deficiency, or chronic renal failure). Early recognition and treatment are crucial since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route, even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.

Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic

Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic

Vaza-jato, a modernidade, a correlação de direito e política: o direito ainda como médium entre sistema e mundo da vida?

Argumentamos e correlacionamos dois pontos, no texto. Primeiro, que, na filosofia política e no direito contemporâneos, a imparcialidade, a impessoalidade, a neutralidade e o formalismo metodológico-axiológicos das e por parte das instituições público-políticas, dos e por parte dos sistemas sociais direito e política, são a única base garantidora e fiadora (a) do caráter antifascista, antitotalitário e antimassificador das instituições direito e política; (b) da separação, da autonomia e da sobreposição dos sistemas sociais direito e política em relação às concepções abrangentes de mundo da sociedade civil, bem como da separação, da autonomia e da sobreposição do direito – como base última de validação da democracia em geral – em relação à política; (c) do controle de perspectivas fascistas assumidas por grupos político-culturais sediados na sociedade civil; e (d) do fomento e da efetividade dos direitos e das liberdades básicos e de processos amplos, inclusivos e participativos de crítica social, de reconhecimento cultural, de luta política e de práxis pedagógica dos e pelos diferentes sujeitos político-culturais próprios à sociedade civil. Ora, e este seria o segundo argumento, a “Operação Vaza-Jato” nos tem mostrado que a “Operação Lava-Jato” rompeu com esse pressuposto fundamental, garantidor e fiador do Estado democrático de direito, ao fragilizar e até eliminar essa base metodológico-axiológica institucionalista. Com isso, ela correlacionou política e moral com e como direito, direito com e como política e moral, abrindo espaço para a colonização do direito pela política e pela moral e, principalmente, viabilizando que a política, agora aberta e descaradamente assumindo perspectivas essencialistas e naturalizadas como fundamento público-político dessas instituições, desses sujeitos institucionalizados e da vida social, instrumentalizasse o direito com fins políticos. Por isso, ninguém tem mais medo – na verdade se tem orgulho, no Brasil de hoje – de se ser fascista publicamente, sejam os sujeitos institucionalizados, sejam os sujeitos não institucionalizados!

Bright Light Therapy and Circadian Cycles in Institutionalized Elders.

BackgroundBright light therapy has been found to be an efficient method to improve the main parameters of circadian rhythms. However, institutionalized elders may suffer reduced exposure to diurnal light, which may impair their circadian rhythms, cognitive performance, and general health status.ObjectivesTo analyze the effects of 5 days of morning exposure for 90 min to bright light therapy (BLT) applied to institutionalized elderly subjects with mild/moderate cognitive impairment.SubjectsThirty-seven institutionalized subjects of both sexes, aged 70–93 years.MethodsThe study lasted three consecutive weeks. During the second week the subjects were submitted to BLT (7000–10,000 lux at eye level) on a daily basis. Cognition, attention, and sleep quality were evaluated at the beginning of the first and third week. Circadian variables were recorded continuously throughout the 3 weeks. Non-invasive holders and validated tests were used to analyze the variables studied.ResultsAfter BLT we have found significant improvements in general cognitive capabilities, sleep quality and in the main parameters of the subject’s circadian rhythms. The results show that merely 90 min of BLT for five days seems to achieve a significant improvement in a constellation of circadian, sleep, health, and cognitive factors.ConclusionBright light therapy is an affordable, effective, fast-acting therapy for age-related disturbances, with many advantages over pharmacological alternatives. We hypothesize these effects were the result of activating the residual activity of their presumably weakened circadian system.

Benzodiazepine Dispensing to Persons With Dementia in France, 2011-2016: A Nationwide Study

ObjectiveTo study temporal trends of benzodiazepine exposure among incident Alzheimer's disease and related dementia (ADRD) cohorts between 2011 and 2016. DesignRepeated cross-sectional study. Setting and ParticipantsThree nationwide incident ADRD cohorts (community-dwelling and institutionalized subjects) were identified in 2011, 2013, and 2016 through the French health insurance database. Subjects were followed 4 semesters around ADRD identification [Semester −2 (S−2) to Semester 2 (S2)]. MeasuresOdds ratios (ORs) for semestrial prevalent exposure, initiation, and adherence to benzodiazepine prescription recommendations (prescription duration <3 months, single reimbursement) were computed using multivariate logistic regressions for each cohort and according to benzodiazepine half-life. ResultsAmong 262,024 community-dwelling subjects, as compared to 2011, overall benzodiazepine prevalence risk decreased slightly immediately after ADRD identification [S1: aOR2013 = 0.93 (0.91-0.95), aOR2016 = 0.95 (0.93-0.97)] and did not differ during S2. Among 72,013 institutionalized subjects, it increased over time [S2: aOR2013 = 1.16 (1.11-1.21), aOR2016 = 1.26 (1.21-1.32)]. Long half-life benzodiazepine prevalence risk decreased in the 4 semesters among recent cohorts, for both populations [S2: community-dwelling: aOR2013 = 0.77 (0.74-0.79), aOR2016 = 0.61 (0.59-0.64); institutionalized: aOR2013 = 0.74 (0.68-0.80), aOR2016 = 0.58 (0.54-0.63)]. Short half-life benzodiazepine prevalence risk increased [S2: community-dwelling: aOR2013 = 1.13 (1.10-1.16), aOR2016 = 1.22 (1.20-1.25); institutionalized: aOR2013 = 1.26 (1.21-1.32), aOR2016 = 1.44 (1.38-1.50)]. The same patterns were observed for benzodiazepine initiation. Adherence to benzodiazepine prescription recommendations (based on French prescription duration) worsened over years [prescription duration <3 months: aOR2013 = 0.90 (0.86-0.95), aOR2016 = 0.90 (0.85-0.95), single reimbursement: aOR2013 = 0.95 (0.91-1.00), aOR2016 = 0.94 (0.90-0.99)]. Conclusions and ImplicationsLong half-life benzodiazepine exposure was reduced whereas short half-life benzodiazepine exposure increased, and adherence to recommendations worsened (prescription duration longer than 3 months and more than a single reimbursement in recent cohorts). Efforts from prescribers and authorities are required in order to restrict psychotropic exposure among the ADRD population. Further research among institutionalized ADRD subjects could provide useful data to disentangle the effects of changes in prescribing practices and in patients' characteristics.

Vitamin D: Giveth to Those Who Needeth.

ABSTRACTSevere vitamin D deficiency may cause rickets. While this point is not disputed, the use of vitamin D in the elderly to prevent fractures has been challenged recently by a meta‐analysis of 81 RCTs, suggesting that the effects of vitamin D were trivial. As is true for any review of the literature, the interpretation of a meta‐analysis can be confounded by the choice of publications to include or exclude. Indeed, the authors excluded RCTs with combined vitamin D and calcium supplementation, included futile studies of very short duration, or studies with high bolus doses known to transiently increase fracture risk. The best available data show that calcium and vitamin D supplementation of elderly subjects can decrease the risk of hip and other non‐vertebral fractures, especially in institutionalized subjects or elderly subjects with poor calcium and vitamin D status. Vitamin D deficiency is associated with many chronic diseases. The VIDA and VITAL trials did not show a protective effect on cardiovascular diseases and cancer. The D2d study also did not influence the progress of prediabetes to diabetes. However, the baseline 25OHD concentrations of the majority of the participants of all these trials were essentially normal. Post‐hoc analysis of these studies suggest some possibly beneficial health outcomes in vitamin D deficient subjects. A meta‐analysis suggested that vitamin D could partly prevent upper respiratory infections. Mendelian randomization studies suggest a causal link between lifelong low vitamin D status and multiple sclerosis. A vitamin D supplement in pregnant women may decrease maternal morbidity and improve the health of their offspring. Better‐designed studies are needed to answer all outstanding questions. However, based on all available data, it seems that correction of vitamin D and/or calcium deficiency of infants, pregnant women and elderly subjects can improve their health. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy.

The oral health state plays an important role in the concept of ‘elderly frailty’, since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set—Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.