Status Of Older Persons Research Articles

Characterization of Vitamin D Status in Older Persons with Cognitive Impairment.

Vitamin D exerts a role in the maintenance of cognitive abilities and in frailty. Although several studies evaluated the interactions between vitamin D and cognitive impairment, results were conflicting. In a cohort of community-dwelling older persons, we described the association between vitamin D levels and cognitive decline and all-cause dementia evaluating frailty’s contribution. Our cohort included 509 adults, aged 64–92 years: 176 patients with mild cognitive impairment (MCI), 59 with Alzheimer’s Disease (AD), 26 with idiopathic Normal Pressure Hydrocephalus (iNPH), 133 with mixed dementia (MD) and 115 without cognitive decline. Frailty was measured by frailty index, and serum 25-hydroxyvitamin D concentrations through electrochemiluminescence immunoassays. We found a significant association between vitamin D levels and Mini Mental State Examination independently of cognitive impairment, age, sex and frailty. The patients with dementia (AD and MD) showed the lowest vitamin D levels, while MCI patients showed higher levels than the other groups. The most severe deficiency was observed in MD patients, the most aged as well as cognitively and functionally impaired. In conclusion, in our community-dwelling older persons investigated for a suspected cognitive impairment, we observed an association between vitamin D levels and cognitive decline, regardless of the frailty status.

Influence of gustatory and olfactory functions on appetite and nutritional status in older persons.

This study investigated olfactory/taste functions in older persons requiring nursing care to clarify whether these functions are associated with appetite or nutritional status. Seventy-two older persons requiring nursing care and 37 unassisted persons were surveyed for olfactory function, taste function, appetite, and nutritional status. Age-adjusted covariance analysis was conducted between the two groups. Both groups showed reduced olfactory and taste functions; these functions were more markedly reduced in participants requiring nursing care compared to those who did not. Both groups had similar appetite and nutritional status findings, suggesting that these factors are not associated with olfactory and taste functions.

Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients.

Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.

Fall Prevalence and Associated Risk Factors in Geriatric Population

Aim: To determine the prevalence of fall among geriatric population and to find out risk factors associated with fall. Method: A cross-sectional study was conducted with a sample of 223, raised through non-probability convenient sampling technique. The inclusion criteria were older adults both genders, aged 60 years and above. The exclusion criteria were older persons with severe and uncontrolled co morbidities that include diabetes, hypertension, memory impairment, stroke, psychiatric disorders, and use of any walking aid. Data was collected through semi structured questionnaire. Fall risk assessment scale was used to categorize fall risk status in older persons. Data was analyzed using SPSS 24. Descriptive statistics and Chi-square test were applied. Results: The overall mean age of participants was 67.61±5.64 years. Out of 223 participants, females were 134(60.1%) and 89(39.9%) were males. The prevalence of falls reported in elderly was 42.6%. Most prevalent fall were reported under category of 1-2 falls, out of which females had 43(32.1 %) and males had 29 (32.6%) falls. Among study participants 87 (39.0%) were in high-risk group while 136(61.0%) participants were in low-risk group. Furthermore, weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions (p<0.05) were considered as most significant risk factors with fall. Conclusion: The study showed significant number of older adults who had fall. Female were at high risk of fall. Weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions were found to be most prevalent risk factors associated with fall. Keywords: Fall, geriatrics, aging, fall risk, prevalence, old age

The association of oral function with dietary intake and nutritional status among older adults: Latest evidence from epidemiological studies.

Inadequate and poor quality of diet and malnutrition are common and associated with adverse health outcomes, including morbidity and mortality, among older persons. This review aimed to establish the latest evidence from studies investigating the association between oral function and nutrition among older adults.An electronic search of MEDLINE using PubMed for literature published in English between March 2018 and March 2021 was conducted, and 27 papers were identified. The selected studies comprised 23 observational studies (17 cross-sectional and 6 longitudinal studies) and 4 interventional studies. Most of the observational studies demonstrated the following associations in older adults: older adults with poor oral function are likely to have poorer dietary intake and poorer nutritional status, and malnourished older adults are likely to have poorer oral function. The results of the intervention studies demonstrated that the combination of prosthodontic treatment and dietary counseling is more effective for improving dietary intake and nutritional status in older persons with tooth loss than the prosthodontic treatment alone.Our review confirmed that a relationship exists between oral function and nutrition and revealed the need for additional high-quality studies investigating comprehensive oral function, rather than a single aspect of oral function, with regard to nutritional status.

Nutritional Assessment in Older Adults: MNA\xae 25 years of a Screening Tool & a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 30 years of clinical research and practice using the MNA® worldwide.

Functional Effects of Intervening Illnesses and Injuries After Critical Illness in Older Persons.

Intervening illnesses and injuries have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after critical illness. We set out to evaluate the functional effects of intervening illnesses and injuries in the year after critical illness. Prospective longitudinal study of 754 nondisabled community-living persons, 70 years old or older. Greater New Haven, CT, from March 1998 to December 2018. The analytic sample included 250 ICU admissions from 209 community-living participants who were discharged from the hospital. None. Functional status (13 activities) and exposure to intervening illnesses and injuries leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after critical illness, recovery of premorbid function was observed for 169 of the ICU admissions (67.6%), and the mean (sd) number of episodes of functional decline (from 1 mo to the next) was 2.2 (1.6). The adjusted hazard ratios (95% CI) for recovery were 0.18 (0.09-0.39), 0.46 (0.17-1.26), and 0.75 (0.48-1.18) for intervening hospitalizations, emergency department visits, and restricted activity, respectively. For functional decline, the corresponding odds ratios (95% CI) were 2.06 (1.56-2.73), 1.78 (1.12-2.83), and 1.25 (0.92-1.69). The effect sizes for hospitalization and emergency department visit were larger than those for any of the covariates. In the year after critical illness, intervening illnesses and injuries leading to hospitalization and emergency department visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors. To improve functional outcomes, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries after critical illness.

Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons.

To evaluate the functional effects of intervening illnesses and injuries, that is, events, in the year after major surgery. Intervening events have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after major surgery. From a cohort of 754 community-living persons, aged 70+ years, 317 admissions for major surgery were identified from 244 participants who were discharged from the hospital. Functional status (13 activities) and exposure to intervening hospitalizations, emergency department (ED) visits, and restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after major surgery, exposure rates (95% CI) per 100-person months to hospitalizations, ED visits, and restricted activity were 10.0 (8.0-12.5), 3.9 (2.8-5.4), and 12.3 (10.2-14.8) for functional recovery and 7.2 (6.1-8.5), 2.5 (1.9-3.2), 11.2 (9.8-12.9) for functional decline. Each of the 3 intervening events were independently associated with reduced recovery, with adjusted hazard ratios (95% CI) of 0.20 (0.09-0.47), 0.35 (0.15-0.81), and 0.57 (0.36-0.90) for hospitalizations, ED visits, and restricted activity. For functional decline, the corresponding odds ratios (95% CI) were 5.68 (3.87-8.33), 1.90 (1.13-3.20), and 1.30 (0.96-1.75). The effect sizes for hospitalizations and ED visits were larger than those for the covariates. Intervening illnesses/injuries are common in the year after major surgery, and those leading to hospitalization and ED visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors.

Study on the role of inflammation in healthy aging and nutritional status in older persons

Objective: The objective of this study is to assess the levels of inflammatory cytokines such as highly sensitive C-reactive protein (hsCRP) and interleukin (IL)-6 in healthy older persons compared to healthy younger persons. To determine the association between the nutritional status and levels of inflammatory markers in older persons. Methods: This is a single center, cross-sectional, analytical study, conducted in the Geriatric Unit of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India, during the period, February 2013–November 2013. Ninety healthy older persons aged 60 years and above and 90 healthy young adults aged 40 years and below were randomly selected to participate in this study. Blood samples were collected from the participants to analyze the hsCRP and IL-6 levels. Mini nutritional assessment was done in older participants to find out the nutritional status. Results: The older participants' mean age was 66.83 ± 6.1, and the mean age of the younger participants was 29.31 ± 7.4. The mean ± standard deviation of hsCRP level in healthy younger participants was 5.69 ± 3.21 and in healthy older participants was 6.05 ± 3.49. There was no significant difference in the level of inflammatory marker hsCRP between healthy younger and older participants (P = 0.476). The mean rank value of IL-6 in healthy younger participants was 84.45 and in healthy older participants was 96.55. There was no statistically significant difference in the levels of inflammatory marker IL-6 between healthy younger and older participants (P = 0.092). In this study, there was no statistically significant association between nutritional status and hsCRP (P = 0.156) and IL-6 (P = 0.286) levels in older people. Conclusion: The hsCRP and IL-6 levels were not significantly elevated in healthy older people than healthy younger adults in this study. There was no significant association between nutritional status and hsCRP and IL-6 levels in the older people in this study.

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007- Helping the conditions of the elderly in India

Aging in India is exponentially increasing due to the impressive gains that society has made in terms of increased life expectancy. About 8.6% of the total population in India is in this age group, with 8.2% males and 9% females. With increasing age, an aged person becomes dependent and faces a lot of problems. There is a feeling of neglect and sadness and that the people have an indifferent attitude toward them. Furthermore, the prevalence of mistreatment with the elderly is on the rise. Such a situation has resulted because of degenerating traditional values and weakened family system. The Maintenance and Welfare of Parents and Senior Citizens Act came into existence in the year 2007 to provide maintenance support to elderly parents and senior citizens. Parents according to the Act mean biological, adoptive, and stepparents, and the age of parents is irrelevant to claim maintenance. Adult children and adult grandchildren are legally obligated to pay maintenance; the amount is determined by the needs of the claimant so that the elderly person can lead a normal life. If children intentionally abandon the senior citizen completely, he/she is liable to pay a fine of Rs. 5000 or face imprisonment for 3 months or both. The legislative approach has its limitation, but it has the potential to arouse the social and ethical debates in the country to alleviate the dependent status of older persons.

Prevalence of malnutrition and associated factors among community-dwelling older persons in Sri Lanka: a cross-sectional study

BackgroundMalnutrition in older persons is a public health concern. This study aimed to estimate the prevalence of malnutrition and its associated factors among community-dwelling older persons in Sri Lanka.MethodsA cross-sectional study was conducted in the Kandy district, Sri Lanka. The nutritional status of older persons was assessed using the Mini Nutritional Assessment –Short Form (MNA­SF). A standardised questionnaire was used to record factors associated with malnutrition: demographic characteristics, financial characteristics, food and appetite, lifestyle, psychological characteristics, physical characteristics, disease and care, oral health, and social factors. Complex sample multinomial logistic regression analysis was performed.ResultsAmong the 999 participants included in the study, 748 (69.3%) were females and 251 (25.1%) were males. The mean age was 70.80 years (95% CI: 70.13, 71.47). The prevalence of malnutrition, risk of malnutrition and well-nutrition was 12.5%, 52.4% and 35.1% respectively. In the multivariate model, hypertension (adjusted OR = 1.71; 95% CI: 1.02, 2.89), alcohol consumption (aOR = 4.06; 95% CI: 1.17, 14.07), and increased age (aOR = 1.06; 95% CI: 1.01, 1.11) were positively associated with malnutrition. An increased number of people living with the older person (aOR: 0.91; 95% CI: 0.85, 0.97) was a protective factor among those at risk for malnutrition.ConclusionBoth the prevalence of malnutrition and risk of malnutrition were commonly observed among community-dwelling older persons in Sri Lanka. The associated factors identified in this study might help public health professionals to implement necessary interventions that improve the nutritional status of this population.

Relationships among clinic, home, and ambulatory blood pressures with small vessel disease of the brain and functional status in older people with hypertension

Subcortical small vessel disease, represented as white matter hyperintensity (WMH) on magnetic resonance images (MRI) is associated with functional decline in older people with hypertension. We evaluated the relationships of clinic and out-of-office blood pressures (BP) with WMH and functional status in older persons. Using cross-sectional data from 199 older study participants enrolled in the INFINITY trial, we analyzed the clinic, 24-hour ambulatory, and home BPs and their relationships with WMH burden and mobility and cognitive outcomes. Volume of WMH was associated with clinic and 24-hour ambulatory systolic BP but not home systolic BP. The mobility measure, supine-to-sit time, had a significant association with 24-hour systolic BP and pulse pressure but not with diastolic BP or values obtained by home BP. Cognitive measures of processing speed (Trails Making Test Part A and the Stroop Word Test) were significantly associated with 24-hour systolic BP, but not clinic and home BPs. These data demonstrate that ambulatory BP measurements in older people are more strongly associated with WMH and certain measures of functional status compared to home BP measurements. Hence, home BP may not be a useful substitute for ambulatory BP for assessing subcortical small vessel disease and its consequences. Further longitudinal analyses comparing clinic and various types of out-of-office BP measures with small vessel brain disease are needed. Clinicaltrials.gov identifier: NCT01650402.

Spirituality in geriatric psychiatry

Academic recognition of the implications of religion/spirituality (R/S) for mental health is increasing, with a growing number of studies involving older adults. The present review provides an overview of these studies, highlighting the influence of R/S on older adults' mental health and the clinical implications of addressing R/S in the geriatrics and gerontology context. The available evidence suggests that R/S involvement is usually associated with lower levels of depression, substance use/abuse, and cognitive declining and better quality of life, well being, and functional status in older persons. Despite the number of studies showing this relationship, few have yet investigated the effects of addressing spiritual needs or carrying out R/S interventions in this age group. Evidence is mounting that R/S is most important in geriatric psychiatry. In general, studies have shown a positive relationship between R/S and mental health in the older population. Health professionals should be attentive to these spiritual needs. Nevertheless, more studies are needed to investigate the mechanisms of the R/S-mental health association and how to integrate R/S in clinical practice.

Clinical Aspects of Foot Health in Individuals with Alzheimer's Disease.

Alzheimer’s disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65–95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.

Oral health matters for the nutritional status of older persons-A population-based study.

To explore the association between oral health and nutritional status in the context of daily care for older people. Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people. A retrospective cross-sectional study. Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide-Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8±7.9) had both oral and nutritional assessments registered by the nursing staff in daily care. Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one-third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished. There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems. Nursing staff involved in care for older people should be aware of the importance of including regular oral health check-ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.

Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults

The assessment of weight loss as an indicator of poor nutritional status in older persons is currently widely applied to establish risk of mortality. Little is known about the relationship between changes in mid-upper arm circumference (MUAC) and mortality in older individuals. The aim of the present study was to examine the association between 3-year change in MUAC and 20-year mortality in community-dwelling older adults and compare this to the association between body mass index (BMI) change and mortality. Data on changes in MUAC (cm) and BMI (kg/m2), covariates, and mortality were available for 1307 Dutch older adults (49.7% men) aged 65 years and older in 1995/96 (mean 75.6 years, SD 6.5) from Longitudinal Aging Study Amsterdam (LASA). Anthropometric measurements were performed in 1992/93 with repeated measurements in 1995/96 (baseline), and a mortality follow up until July 2015. BMI and MUAC change were divided into quintiles, with the quintile including zero defined as the reference category. Cox regression analyses were performed to examine the associations of 3-year changes in MUAC and BMI with subsequent 20-year all-cause mortality, adjusted for demographic and health factors. Age, sex and initial measurement of BMI and MUAC (1992/93) were tested for effect modification (P=<0.10). Mean baseline BMI was 26.7kg/m2 (SD 4.2) with a 3-year change of-0.2 (SD 1.5). Mean baseline MUAC was 30.5cm (SD 3.5) with a 3-year change of-0.8 (SD 1.6). Age, sex, and BMI and MUAC 3 years prior were effect modifiers in the associations between change in anthropometric measurement and mortality. Decrease in MUAC was not associated with mortality in persons with a higher initial MUAC (≥31cm), while for persons with a lower initial MUAC, a decrease in MUAC of ≤-2.15 was associated with increased mortality risk (HR 1.54; 95% CI: 1.14-2.09), also when further stratified on median age and sex. In stratified analysis of BMI change for median initial BMI (26.5) and additionally stratified for median age and sex, the associations between a BMI decrease of ≤-1.19 and mortality fluctuated, mostly statistically not significant. No associations were found for gain in MUAC or BMI. Given that MUAC loss is more strongly and consistently associated with an increased mortality risk in older individuals with a low initial MUAC compared to BMI loss, this may be a more recommendable measure to use in clinical practice for assessing poor nutritional status, instead of weight loss.

COMMUNITY SERVICES FOR OLDER PERSONS PROVIDED BY FAMILIES AND THE YOUNG IN INDONESIA

AbstractBy 2050, the number of older people in Indonesia will approach 80 million. To enhance the health status of older persons, a referral program of networking hospitals and health clinics have been created. A survey of health centers in 33 provinces found them to be age-friendly. Our evaluation showed that the health status and daily life activity levels of older persons were maintained but depended on the number and dedication of young generations) providing services. Based on the programs reviewed, we conclude that there is national and community awareness of the issues surrounding the provision of care of older persons. However, it seemed that Indonesia is experiencing a decreasing number of the young supporting older persons. Suggestions are provided to reverse this trend to maintain community resilience and sustainability.

Orofacial Pain and Mastication in Dementia.

Orofacial pain is a common condition in the general population. It is likely that this is also the case in older persons with a dementia. However, the assessment of (orofacial) pain in non-verbal individuals is hampered by the subjective nature of pain, and their limited communicative abilities. To overcome this drawback, several tools have been developed for the assessment of pain based on observations of pain-specific facial activities, body movements, and vocalizations. Unfortunately, none of the so far developed observational tools have been designed specifically for the assessment of orofacial pain. While the recent psychometric testing of the Orofacial MOBID Pain Scale did not yield reliable outcomes, the subsequently developed Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) is currently being evaluated and shows good promise to be reliable and valid. Besides the assessment of orofacial pain, an important application of this instrument will be the investigation of the probable causal association between impaired chewing and cognitive decline, in which orofacial pain plays a mediating role by its negative influence on chewing ability. The identification of this negative influence will urge opinion leaders and policy makers to improve the oral health status in older persons with a dementia. Ultimately, pain-free oral functioning may lead to a higher quality of life and might help stabilizing or improving cognition in this frail and vulnerable patient population.

Relation of socio-economic status to the independent application of self-care in older persons of South Africa

Background: Many older persons in South Africa (SA) are affected by a poor socio-economic status, leading to an increase in the use of the public healthcare sector. However, the public healthcare sector is burdened by high volumes of patients and long waiting periods. As a result, professional nurses in primary healthcare (PHC) facilities are not able to spend enough time on proper physical examinations and assessment of needs, including health education and support to older persons to help them apply independent self-care.Aim: To determine if the socio-economic status of older persons affects their ability to apply self-care independently without support from professional nurses in the PHC facility.Design: Quantitative, descriptive research design.Methods: Older persons (N = 198; n = 192 respondents) were asked to complete the Appraisal of Self-care Agency (ASA-A) and Exercise of Self-care Agency (ESCA) questionnaires. Seven self-care deficits were identified through deductive logic after analysis of the two questionnaires. These seven self-care deficits were compared to the socio economic status of the same sample.Results: Seven self-care deficits were identified after analysis of the ASA-A and ESCA questionnaires. One self-care deficit was found to have a relationship with the socioeconomic status of the older persons.Conclusions: Low literacy levels of older persons with a low socio-economic status affect their ability to apply self-care independently without the support from a professional nurse in the PHC facility. Data analysis of the ASA-A and ESCA revealed that these older persons suffer from a “lack of knowledge and ability to acquire knowledge with regard to self-care” which had a relationship with the socio-economic status of older persons with specific reference to low literacy levels and poverty. Implications for practice: More attention should be given to older persons with a low socioeconomic status as their ability to apply self-care independently without the support from a professional nurse is limited. This would lead to less frequent visits to PHC facilities by older persons for minor ailments, decrease healthcare costs, relieve overcrowding in PHC facilities and prevent possible unintentional self-neglect.

Improving Nutritional Status of Older Persons with Dementia Using a National Preventive Care Program.

The aim of the study was to investigate the outcome of change in body weight associated with use of a structured preventive care process among persons with dementia assessed as at risk of malnutrition or malnourished. The preventive care process is a pedagogical model used in the Senior Alert (SA) quality register, where nutrition is one of the prioritized areas and includes four steps: assessment, analysis of underlying causes, actions performed and outcome. An analysis of data from SA with a pre-post design was performed. The participants were living in ordinary housing or special housing in Sweden. 1912 persons, 65 years and older, registered in both SA and the dementia quality register Svedem were included. A national preventive care program including individualized actions. The Mini Nutritional Assessment-Short Form was used to assess nutritional status at baseline. Body weight was measured during baseline and follow-up (7-106 days after baseline). 74.3% persons were malnourished or at risk of malnutrition. Those at risk of malnutrition or malnourished who were registered in all four steps of the preventive care process, increased in body weight from baseline (Md 60.0 kg) to follow-up (Md 62.0 kg) (p=0.013). In those with incomplete registration no increase in body weight was found. Using all steps in the structured preventive care process seems to improve nutritional status of persons with dementia assessed as at risk of malnutrition or malnourished. This study contributes to the development of evidence-based practice regarding malnutrition and persons with dementia.