Body mass index in nursing home residents during the first year after admission.

BACKGROUND: Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. METHODS: Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. RESULTS: The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. CONCLUSION: Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes.

Body mass index trajectories and associations with cognitive decline in people with Lewy body dementia and Alzheimer's disease.

Background and Aims: In older adults with dementia, low body mass index (BMI) is associated with higher mortality and other adverse health outcomes. BMI or nutritional status trajectories from diagnosis have not yet been well described in dementia, especially in people with Lewy body dementia (LBD); a group that has a poorer prognosis. With this study, we aimed to evaluate the BMI trajectory in people diagnosed with mild LBD and Alzheimer's disease (AD). Methods: The Dementia Study of Western Norway is a cohort study with annual assessments. Five-year measurements of BMI from 196 patients (LBD = 85 and AD = 111) diagnosed with mild dementia were analyzed using adjusted linear mixed-effects models. Results: There were no differences between LBD and AD in baseline BMI, age, or mini-mental status examination (MMSE). During the follow-up, we observed a significant decrease in BMI in the LBD group across the study period (estimation [Est.]: -0.63, SE: 0.14; p < 0.001). By contrast, there was no significant change in BMI trajectory associated with AD diagnosis (Est.: 0.05, SE: 0.15; p = 0.730). Further, the introduction of an interaction term between diagnosis and time in the study showed that this difference (BMI trajectories) was significant (Est.: -0.63, SE: 0.14; p < 0.001). In addition, there was a significant interaction between MMSE total score and the follow-up time; the lower the MMSE, the lower the BMI (Est.: 0.01, SE: 0.01; p = 0.044). Conclusion: In LBD, BMI significantly decreased with disease progression. In addition, low cognitive performance was associated with a reduction in BMI. These results highlight the importance of BMI evaluation in people with dementia, particularly patients diagnosed with LBD, and suggest that patients with LBD could be targeted for dietary intervention to maintain body weight.

Thyroid stimulating hormone levels and geriatric syndromes: secondary nested case-control study of the Mexican Health and Aging Study.

PURPOSE: To determine the incidence of geriatric syndromes (GS) in community dwelling older adults with subclinical hypothyroidism. METHODS: This is an analysis from the Mexican Health and Aging Study, of a subsample of 2089 subjects with TSH determination. From this last subsample, we included 1628 individuals with TSH levels in the subclinical range (4.5-10 µU/ml). RESULTS: The multivariate analysis showed that when comparing data obtained from the 2012 wave with the 2015 wave results, there was a significant incidence of some GS such as falls (OR 1.79, CI 1.16-2.77, p = 0.0116), fatigue (OR 2.17, CI 1.40-3.38, p = 0.0348) and depression (OR 1.70, CI 1.06-2.71, p = 0.0246) among the subclinical hypothyroidism group. CONCLUSION: This study showed a greater incidence of GS in subjects 50 years and older with sub-clinical hypothyroidism, when compared to those with normal thyroid function.

Muscle Volume and Intramuscular Fat of the Tongue Evaluated With MRI Predict Malnutrition in People Living With Dementia: A 5-Year Follow-up Study.

Malnutrition is highly prevalent in older persons with dementia. Therefore, strong predictors of malnutrition in this population are crucial to initiating early interventions. This study evaluates the association between the probability of having malnutrition with the muscle volume and intramuscular fat (iMAT) of the masseter and the tongue in magnetic resonance imaging (MRI) of community-dwelling older persons diagnosed with mild dementia followed up for 5 years. This is a longitudinal study conducted in the western part of Norway. Muscle volume and iMAT of the tongue and masseter were computed from structural head MRI obtained from 65 participants of the Dementia Study of Western Norway using Slice-O-Matic software for segmentation. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition Index. Linear mixed models were conducted. Having malnutrition at baseline was associated with lower muscle volume (odds ratio [OR] 0.60, standard error [SE] 0.20; p = .010) and higher iMAT (OR 3.31, SE 0.46; p = .010) in the tongue. At 5 years follow-up, those with lower muscle volume (OR 0.55, SE 0.20; p = .002) and higher iMAT (OR 2.52, SE 0.40; p = .022) in the tongue had a higher probability of presenting malnutrition. The masseter iMAT and volume were not associated with malnutrition in any of the adjusted models. In people diagnosed with mild dementia, tongue muscle volume and iMAT were associated with baseline malnutrition and the probability of developing malnutrition in a 5-year trajectory. In the masseter, there were no significant associations after adjustments.

Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms.

Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.

Socioeconomic Disparities and Gender Inequalities in Dementia: a Community-Dwelling Population Study from a Middle-Income Country.

The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.

The Role of Gait Speed in Dementia: A Secondary Analysis from the SABE Colombia Study.

INTRODUCTION: Gait speed (GS) is a predictor of negative outcomes in older adults and in those in risk to develop cognitive impairment; as such, it has been associated with dementia. Studies in Latin-American older adults showing this association are scarce. This study aimed to evaluate the relationship between GS and dementia in a representative sample of Colombian older adults. METHODS: This study is a secondary analysis from the Survey on Health, Well-Being, and Aging, SABE (from initials in Spanish: Salud, Bienestar & Envejecimiento) Colombia's survey conducted in 2015 with a sample of 23,694 elderly adults aged 60 years or older. RESULTS: A total of 19,470 participants from the SABE Colombia survey were available for analysis. The multivariate analysis shows that dementia was associated with slow GS (PR 2.39; CI 1.91-3.01) independently to the other variables (p < 0.001). Similarly, GS as a continuous variable shows a statistically significant association with dementia in the adjusted analysis (OR 0.06; CI 0.04-0.09; p < 0.001). CONCLUSION: Dementia was associated with slow GS. This finding provides evidence to include GS as a complementary parameter in the assessment of Colombian elderly adults.

Edentulism and dental prostheses in the elderly: impact on quality of life measured with EuroQol--visual analog scale (EQ-VAS).

The objective of this study was to measure the impact of edentulism and dental prostheses on quality of life (QOL) in older adults in Bogota, Colombia. Edentulism is a frequent condition in older adults and has great impact on their QOL. No epidemiological data are currently available on edentulism among older adults in Colombia. Data were obtained from the SABE-Bogota study, a cross-sectional study conducted in 2012, and used to analyze the EQ-VAS (Visual Analog Scale) from the EuroQol instrument to measure the perception of quality of life (QOL) in relation to edentulism. The study included 2,000 individuals over 60 years old. The Spearman-Rho correlation was used to analyze the correlation between EQ-VAS and edentulism. Chi-Square, ANOVA and t-test were used to study the differences in EQ-VAS scores between edentulous and healthy subjects. Statistical significance was set at p<0.05. Of the 2000 respondents, 98.3% were edentulous, 73.0% reported half or more missing teeth, 76.9% used dental prostheses and 23.7% had related eating problems. Older age, lower social class and lower education were related to edentulism. Individuals with fewer teeth and dental prostheses had lower EQ-VAS scores (p<0.05) and dental prosthesis did not improve EQ-VAS scores (p=0.22). Edentulism also showed a significant negative correlation with EQ-VAS scores (rho= -0.102, p<0.01). In summary, EQ-VAS is a useful tool for measuring the perception of QOL in dental health scenarios. Edentulism significantly affects QOL in older adults and the use of dental prosthesis does not improve the perception of QOL.

Edentulism and dental prostheses in the elderly: impact on quality of life measured with EuroQol-visual analog scale (EQ-VAS) / Edentulismo y prótesis dentales en el adulto mayor: impacto sobre la calidad de vida medido con euroqol – escala visual análoga (eq-vas)

El objetivo de este estudio fue medir el impacto del edentulismo y el uso de prótesis dentales en la calidad de vida de los adultos mayores en Bogotá, Colombia. El edentulismo es frecuente en los adultos mayores y afecta profundamente su calidad de vida. Actualmente existen pocos datos epidemiológicos disponibles sobre este tema en nuestro medio. Los datos fueron extraídos del estudio SABE-Bogotá, estudio transversal por conglomerados llevado a cabo en el 2012. Se uso el EQ-VAS (escala visual análoga) como instrumento de medición de la percepción de la calidad de vida. El estudio incluyó 2.000 individuos mayores de 60 años. Se usó el test de Sperman-Rho para analizar la correlación entre el EQ-VAS, el edentulismo y el uso de prótesis. Las pruebas de Chi-cuadrado, ANOVA y t-test se usaron para estudiar las diferencias en los puntajes del EQ-VAS entre los sujetos edéntulos y sanos. La significancia estadística se estableció en <0.05. De los 2000 encuestados, 98.3 por ciento fueron edéntulos, 73.0 por ciento reportaron perdida de mas de la mitad de sus dientes, 76.9 por ciento reportaron usar prótesis dentales y 23.7 por ciento problemas relacionados con la alimentación. La edad avanzada, el estrato social bajo y el bajo nivel educativo se relacionaron con mayor pérdida dental. Individuos con pocos dientes y prótesis dentales tuvieron puntajes bajos en el EQ-VAS (p=0.22). La presencia de edentulismo también mostró una correlación negativa con los puntajes del EQ-VAS (rho= -0.102, p<0.01). Se concluye que EQ-VAS es un instrumento de gran utilidad para la medición de calidad de vida en contextos relacionados a salud oral. El edentulismo afecta significativamente la calidad de vida en los adultos mayores y el uso de prótesis dentales no mejora la percepción de la calidad de vida.

The objective of this study was to measure the impact of edentulismand dental prostheses on quality of life (QOL) in older adults inBogotá, Colombia. Edentulism is a frequent condition in olderadults and has great impact on their QOL. No epidemiologicaldata are currently available on edentulism among older adults inColombia. Data were obtained from the SABE-Bogotá study, across-sectional study conducted in 2012, and used to analyze theEQ-VAS (Visual Analog Scale) from the EuroQol instrument tomeasure the perception of quality of life (QOL) in relation toedentulism. The study included 2,000 individuals over 60 yearsold. The Spearman-Rho correlation was used to analyze thecorrelation between EQ-VAS and edentulism. Chi-Square, ANOVAand t-test were used to study the differences in EQ-VAS scoresbetween edentulous and healthy subjects. Statistical significancewas set at p<0.05. Of the 2000 respondents, 98.3% wereedentulous, 73.0% reported half or more missing teeth, 76.9%used dental prostheses and 23.7% had related eating problems.Older age, lower social class and lower education were related toedentulism. Individuals with fewer teeth and dental prostheses hadlower EQ-VAS scores (p<0.05) and dental prosthesis did notimprove EQ-VAS scores (p=0.22). Edentulism also showed asignificant negative correlation with EQ-VAS scores (rho= -0.102,p<0.01). In summary, EQ-VAS is a useful tool for measuring theperception of QOL in dental health scenarios. Edentulismsignificantly affects QOL in older adults and the use of dentalprosthesis does not improve the perception of QOL.