Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies.

AIM: The aim of the present study was to investigate the proportion of physicians and nurses who agree with the administration of antibiotic therapy (AT), artificial hydration (AH), and artificial nutrition (AN) in patients with advanced dementia and different life expectancies. Furthermore, we aimed at analyzing the correlates of the opinion according to which medical treatments should no longer be given to advanced dementia patients once their life expectancy falls. METHODS: End-of-life decisions and opinions were measured with a questionnaire that was sent to geriatric units, hospices and nursing homes in three different regions of Italy. Multivariate logistic regressions were carried out to ascertain the correlates of the agreement with the administration of AH, AT or AN. RESULTS: When the patient's life expectancy was 1-6 months, 83% of respondents agreed with AH, 79% with AT and 71% with AN. When the life expectancy was less than 1 month, a large proportion of respondents still agreed with AH and AT (73% and 61%), whereas less than one in two respondents (48%) agreed with AN. CONCLUSIONS: The findings of the present study showed that AN creates more ethical dilemmas in the clinical management of end of life than other treatments, such as AH or AT. Opinions on whether or not these practices are appropriate at the end of life were related with feelings, thoughts and ethical issues that played a different part for physicians and nurses. Geriatr Gerontol Int 2017; 17: 487-493.

Prevalence of sarcopenia and associated factors in the healthy older adults of the Peruvian Andes.

AIM: To assess the prevalence of sarcopenia and associated factors in a population of older people living in a rural area of the Peruvian Andes. MATERIALS AND METHODS: The study concerned 222 people aged ≥65 years. Sarcopenia was diagnosed on the basis of skeletal muscle mass, measured using bioimpedance analysis, and gait speed, measured with the 4-m walking test, as recommended by the International Working Group on sarcopenia. Self-reported physical activity, the Short Physical Performance Battery, and the Six-Minute Walking Test also contributed information on participants' physical performance status. Disabilities were investigated by assessing participants' self-reported difficulties in performing one or more basic or instrumental activities of daily living. RESULTS: The prevalence of sarcopenia was 17.6%. Compared with participants without sarcopenia, individuals who were found sarcopenic were significantly older, female and were less frequently farmers, had fewer children, had a worse nutritional status, a significantly lower physical performance, and higher levels of disability in the instrumental activities of daily living. After adjusting for potential confounders, age, female sex, a low body mass index, a self-reported low physical activity level, a worse Six-Minute Walking Test scores, and a low number of children were significantly associated with sarcopenia. CONCLUSION: The prevalence of sarcopenia seems to be quite high among community-dwelling older subjects in the Peruvian Andes. Age, female sex, a low body mass index, little physical activity, a poor Six-Minute Walking Test scores, and a low number of children could be associated with this condition.

Nutritional status, physical performance and disability in the elderly of the Peruvian Andes.

BACKGROUND: Although nutritional status plays an important part in the physical performance and disability of older people, this relationship has been little studied in developing countries. AIMS: A study on the effects of nutritional status on the physical performance and functional status of elderly people living in rural areas of the Peruvian Andes. METHODS: The study concerned 222 people aged ≥65 years living in a rural area of the Peruvian Andes. The Mini-Nutritional Assessment (MNA) was used to classify participants as malnourished (MNA <= 17), at risk of malnutrition (MNA 18-23), or well-nourished (MNA>= 24). The short physical performance battery (SPPB) and six-minute walking test (6MWT) were used to measure participants' physical performance. Disabilities were investigated by assessing participants' self-reported difficulty in performing one or more basic activities of daily living (ADL), and instrumental activities of daily living (IADL). RESULTS: The prevalence of malnutrition was 9.4 %, and more than half of our samples were at risk of malnutrition. After adjusting for potential confounders, malnourished individuals performed significantly worse than the other MNA groups in the SPPB (p for trend=0.001), 6MWT and IADL (p for trend < 0.0001 for both outcomes), but not in the ADL (p for trend = 0.23). Taking the well-nourished for reference, and after adjusting for potential confounders, malnutrition was significantly associated with disability in IADL (OR 5.36, 95 % CI 1.02-56.94; p = 0.05), and poor performance in the 6MWT (OR 2.73, 95 % CI 1.06-12.08; p = 0.03) and SPPB (OR 4.94, 95 % CI 1.01-24.07; p = 0.04). CONCLUSION: Poor nutritional status was found significantly associated with poor physical performance and poor functional status in elderly Peruvian individuals.

Short- and longer-term predictive capacity of the Multidimensional Prognostic Index: The timing of the assessment is of no consequence.

BACKGROUND: Several studies have tested the ability of the Multidimensional Prognostic Index (MPI) to predict mortality for acute elderly patients admitted to hospital. We compared the reliability of MPI scores obtained both on admission to, and at discharge from hospital. We tested MPI performance in predicting short- and longer-term mortality grouped into three risk groups and according to single MPI scores. METHODS: A longitudinal prospective study was conducted on 699 elderly patients admitted to the Geriatric Unit at Padua General Hospital. MPI scores were obtained on admission and at discharge. In-hospital and one-year mortality was recorded. Adjusted Cox's regression models were used to assess the prognostic value of the MPI scores. RESULTS: 691 were included in the study: 459 (66.4%) women and 232 (33.6%) men, mean age=85.2 ± 7.0 years. Patients were grouped as: low risk MPI 12.5%; moderate risk MPI 28.6%; severe risk MPI 58.9%. The cumulative in-hospital mortality rate was 7.4%. In the adjusted model, only MPI score (not MPI risk group) was significantly associated with in-hospital death ([HR]=1.22, 95%CI 1.07-1.39). 1-Year crude mortality rate: 39.2%. The patients' MPI scores at admission and at discharge were equally predictive of death (adjusted HR of MPI on admission 1.20 [1.15-1.27], p<0.0001; at discharge 1.24 [1.18-1.30], p<0.0001). The performance (AUC) of the MPI score on admission and at discharge proved much the same. CONCLUSIONS: This study confirmed the value of the MPI in predicting mortality for acute elderly patients. Grouping MPI scores into risk levels may not be appropriate when applied to hospitalized acute geriatric patients. The prognostic value of MPI scores was confirmed only for MPI value ≥0.68. Judging from our study, the timing of the assessment during a patient's hospital stay (on admission or at discharge) may be irrelevant for longer-term prognostic purposes.