Status In Community-dwelling Older People Research Articles

A Qualitative Exploration of Factors Associated with Malnutrition among Community-dwelling Malnourished Older People in Kandy District, Sri Lanka

Introduction: Nutrition plays an important role in older people. Numerous factors are associated with malnutrition among community-dwelling older people. However, little is known about how malnourished older people experience their nutritional status. This study aimed to explore how malnourished community-dwelling older people perceive the factors associated with their nutritional status. Methods: An explorative qualitative design was performed in Kandy District, Sri Lanka. A group of 150 malnourished community-dwelling older people identified from a cross sectional survey were invited for Focus Group Discussions (FGDs). A purposive sampling method was used. Fifteen FGDs were conducted among 85 participants. A thematic analysis was done to identify relevant themes related to malnutrition status. Results: The mean age of the participants was 68.74 years (SD± 6.32). Their age range was 60 to 97 years. Four main themes were identified through FGDs: (1) factors affecting dietary patterns, (2) food choices, (3) health status, and (4) psychological challenges.
 Conclusions: Community-dwelling malnourished older people stated factors associated with their dietary patterns, such as age-related factors, food choices, health status and mental status, lead to their malnutrition status. Public health professionals must understand and recognize these realities to improve the nutritional status of community-dwelling older people.
 Keywords: Community-dwelling, Malnutrition, Older people, Sri Lanka

Survey on the oral health status of community-dwelling older people with visual impairment.

Little is known about the impact of low vision (LV) on dental care in the elderly population. The present study aimed to clarify the oral health status and oral health behavior of older people with LV. We surveyed community-dwelling older people (age ≥ 65 years, non-LV = 35, LV = 23); and collected data on sex, age, systemic diseases, oral health status, and oral health behavior. Although there was no difference in dental clinic visits within one year, the LV group received significantly lesser oral health instructions by dental hygienists and dentists than the non-LV (60.9% vs 85.7%, P < 0.05) group. Additionally, the LV group was more than twice as aware of the "8020 Campaign," written by the Ministry of Health, Labor and Welfare in Japan than the non-LV group. The non-LV group had higher awareness of thickening agents and denture cleaners, both of which may require visual input. Although we had assumed that LV would lead to poor results for the oral health status, there were no demonstrable differences between both groups. Older individuals with LV require suitable forms of nonvisual communication to receive oral health instruction and literacy.

The Association Between Gait Speed and Cognitive Status in Community-Dwelling Older People: A Systematic Review and Meta-analysis.

Gait speed and cognitive performance tend to decline with age. A better understanding of the dynamics of the association between gait speed and cognitive status may identify preclinical markers and improve diagnostic assessments. The objective was to quantify the association between gait speed and cognitive status in later life. A systematic search was undertaken of relevant databases for original articles published prior to June 2017, measuring the association between gait speed and cognition cross-sectionally or longitudinally among the community-dwelling population. A meta-analysis pooled results of the mean difference between concurrent measures of gait speed in the normal cognition group compared to non-normal cognition groups. Thirty-six studies were selected, providing data from 29,520 participants. The majority of studies reported a significant association between slower gait speed and worse cognitive function in older people. Results of the meta-analysis of 27 studies showed that, compared to normal controls, clinically meaningful reductions in gait speed ranged from 0.11 m/s in those with cognitive impairment, to 0.20 m/s in those with mild dementia, and to 0.41 m/s in those with moderate dementia. The strength of evidence for an association between gait speed and cognition was demonstrated by the number and consistency of results, as well as quality of the studies. Identification of diagnostic markers of motor-cognitive risk has led to increasing interest in the effects of interventions for prevention of gait speed loss and cognitive decline in aging.

Frailty Is a Major Related Factor for at Risk of Malnutrition in Community-Dwelling Older Adults.

We investigated the relationships among geriatric syndrome, physiological functions, and body composition in community-dwelling older people with varying nutritional statuses. Other factors correlated with nutritional status in community-dwelling older people were also explored. The World Health Organization has initiated preventive programs for addressing malnutrition. However, few studies have focused on the correlations among geriatric syndrome, physiological functions, and body composition in older people at risk of malnutrition. We conducted a cross-sectional study. Older people who lived in an urban Taiwanese community were recruited for this research study. The inclusion criteria were age 65 years or older, ability to communicate in Taiwanese, clear consciousness, and ability to communicate independently. The nutritional status of participants was evaluated with the Mini Nutritional Assessment-Short Form. The frailty status was assessed with the Study of Osteoporotic Fractures (SOF) index. The SOF index included the following three items: body weight loss of >5% within 1 year, difficulty in standing from a sitting position in a chair without an armrest five times, and feeling deprived of energy. Participants over 65 years of age, living in a community and without mental illness or acute disease were included in the study. Compared with well-nourished older adults, those at risk of malnutrition were predominantly male; presented with lower body weight, lower body mass index values, lower skeletal mass indices, and poorer muscle strength; and were unable to rise from a seated position in a chair without using the armrest five times. Subjects at risk of malnutrition were less energetic, were more commonly characterized as being sarcopenia, and demonstrated frailty. Body composition analysis demonstrated that a skeletal muscle index of approximately 9.93 and a body fat mass of less than 12.25kg were related to an increased risk of malnutrition. Older people who were frail exhibited a particularly high risk of malnutrition. The results revealed that the evaluation of malnutrition risk should be conducted in older persons living in the community. Frailty in particular was identified as a major risk factor for malnutrition in community-dwelling elderly persons. Community nurses should pay attention to the nutritional conditions of community-dwelling elderly persons. Community nurses should assess the at-risk population and provide effective preventive strategies and programs to reduce the prevalence of malnutrition and frailty.

Prefrailty in community-dwelling older adults is associated with nutrition status.

This study investigated the differences of demographic characteristics and nutrition status between prefrail and nonfrail older adults. Meanwhile, the factors related to the nutrition status of community-dwelling older adults were also studied. The World Health Organisation has actively developed prevention programmes to address geriatric frailty. However, few previous studies have focused on the relationship between prefrailty and nutrition status. This study adopted a cross-sectional and correlational research design. Community-dwelling older adults were recruited for this study. The participants' nutrition status was assessed using the Mini-Nutritional Assessment tool, and their frailty status was evaluated based on the Study of Osteoporotic Fractures indicators. The Study of Osteoporotic Fractures criteria comprise the following three items: >5% loss in total body weight within oneyear; inability to rise five times from a chair without assistance and a self-reported lack of energy. Inclusion criteria were age ≥65years, living independently at home and exhibiting neither mental impairment nor acute disease. Data were gathered from 152 participants; most were men, lived alone and had a level of education lower than elementary school. Multiple linear regressions were used to evaluate the association between variables and nutritional status, the results of which revealed that prefrailty and body mass index were independently related to the participants' nutrition status. The results showed that nutritional assessment can be employed with community-dwelling older adults. In particular, prefrailty and body mass index were key factors that affected nutritional status in older adults. Community nurses must understand the risk factors related to nutritional status in community-dwelling older people. If nurses use this approach, prefrail older adults are likely to experience improved confidence in maintaining their health and a decreased incidence of frailty and malnutrition.

The effectiveness of beauty care on self-rated health among community-dwelling older people.

The maintenance and improvement of self-rated health is important for prolonging healthy life expectancy in a well-aged society. In the present study, we examined the effectiveness of beauty care on self-rated health among community-dwelling older people through a quasi- randomized controlled trial by propensity score matching (PSM). One hundred twelve community-dwelling older people who were recruited from the local community, participated in a beauty care program that consisted of two training sessions per month for 3 months and daily enforcement of facial skin care (intervention group). Seven hundred fifty-nine participants who received a comprehensive geriatric assessment were treated as a control group. Sex, age, BMI, lifestyle habits, hand grip strength, walking speed, skeletal muscle mass, bone density, medical history and life function (Kihon Checklist) were matched by the PSM method. We compared the subjects' self-rated health, depressive mood status (self-rating depression scale: SDS), and the frequency of going outdoors in the intervention and control groups before and after intervention. The improvements of SDS were significantly greater in the intervention group than in the control group. The self-rated health and the frequency of going outdoors were maintained in the intervention group but were significantly decreased in the control group. We conclude that beauty care is effective for maintaining and improving the self-rated health and depression status of community-dwelling older people and that it may help prolong healthy life expectancy.

P322: Simplified Nutritional Appetite Questionnaire (SNAQ): an alternative test for geriatric nutritional assessment

Introduction: Nutrition is affected negatively in the old age due to physiological changes, acute-chronic diseases, oral-dental health problems, polypharmacy, economical factors, difficulties in food supply, difficulties in preparing and eating food. In this study we aim to evaluate nutritional status of community-dwelling older people by using Simplified Nutritional Appetite Questionnaire (SNAQ) and Mini Nutritional Assessment – Short Form (MNA-SF). Methods: Patients over 75 years of age admitted to outpatient clinic between 3 January 2013 and 31 December 2013 were enrolled. According to comprehensive geriatric assessment; height-weight measurements, weight loss, special diets and difficulty swallowing asked. The participants were evaluated with Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental Activities of Daily Living scores (IADL), Simplified Nutritional Appetite Questionnaire, Mini Nutritional Assessment Short-Form. Results: A total of 203 elders were included in the study. 33% were male and 67% were female. Mean age was 80.9 years. As a result of MNA-SF scores 5.4% had malnutrition and 22.7% had malnutrition risk. In our study group mean SNAQ score 15.5±2.4. Due to SNAQ scores total 20.7% (women 25.7%, men 10.4%) were at risk of weight loss (Table 1). We observed that a positive advanced correlation between SNAQ and functionality by ADL, IADL, the hand grip, physical activity and ambulation status (Table 2). Conclusions: Nutrition and appetite status of the elderly is an important part of a comprehensive geriatric assessment. It should be performed routinely. SNAQ form can be preferred as a alternative and a quick method for screening nutrition.