[Functional status and quality of life of geriatric patients with wounds in acute hospitals : A comparison between patients with acute and chronic wounds: a cross-sectional study]. / Funktioneller Status und Lebensqualität von geriatrischen Patienten mit Wunden im Akutkrankenhaus : Ein Vergleich zwischen Patienten mit akuten und chronischen Wunden: eine Querschnittsstudie.

BACKGROUND: Geriatric patients are more predisposed to the occurrence of wounds due to age and disease, affecting functional status and quality of life. This aspect has rarely been researched in this population. OBJECTIVE: The aim of this study was to investigate the influence of chronic (cW) and acute wounds (aW) on the objective functional status and wound-related subjective quality of life in hospitalized geriatric patients. METHODS: In this exploratory cross-sectional analysis, data from 41 patients with wounds were examined. Patients were participating and recruited in the TIGER study (n = 244). Depending on the type of wound, patients were assigned to the aW (n = 19) or cW (n = 22) group. The two groups were compared in terms of physical function, hand strength, activities of daily living, depression, cognition, nutrition, quality of life (Wound-QoL) and sociodemographic data. RESULTS: There was a significant difference between the aW and cW groups in terms of gender (p = 0.045) and living conditions (p = 0.047). The type of wound was associated with the Barthel index (p = 0.010) and the Wound-QoL (p = 0.022). CONCLUSION: Compared to aW patients, cW patients were more limited in the physical and social dimensions and reported a lower quality of live. Living alone seems to play a relevant role. Among the patients of the TIGER study, men living alone were particularly more affected by cW. The care for these specific patients population should follow a holistic approach.

24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting.

BACKGROUND: Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. OBJECTIVE: Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. DESIGN AND SETTING: In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156). INTERVENTION AND MEASUREMENTS: Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. RESULTS: After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). CONCLUSIONS: In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate.

BACKGROUND: An increasing number of older people in Germany receive care at home from family members, particularly from spouses. Family care has been associated not only with subjective burden but also with negative effects on caregivers' health. A heterogeneous group, caregivers are confronted with individual situational demands and use different available coping strategies. To date, little is known about the relationship between burden and coping by spousal caregivers, particularly in the context of geriatric patients without dementia. OBJECTIVES: The aim of this study is to explore the burden and coping strategies of caregiving spouses of geriatric patients without dementia and with a hospitalization within the last year. To help explore this population, a typology is presented that has been based on reported perceptions of home care burden and individual coping strategies. Furthermore, a case study is presented for each type of spousal caregiver. METHODS: The study used a concurrent mixed method design with a sample of nine spousal caregivers (mean age: 78.9 years). Four women and five men were recruited in an acute hospital setting during the TIGER study. Quantitative data were collected using a self-questionnaire and qualitative data were gathered through nine problem-centered interviews with spousal caregivers. The latter were subsequently analyzed utilizing the structured content analysis method. The data were then summarized to nine individual cases. Finally, the results were clustered using the empirically grounded construction of types and typologies. Each type of spousal caregiver is presented by a case study. RESULTS: Three types of caregiving spouses were identified: "The Caring Partner", "The Worried Manager" and "The Desperate Overburdened". These types differ primarily in the level of subjective burden and caregiving stress, the coping strategies, the motivation for caregiving, and expressed emotions. CONCLUSIONS: The development of this new typology of caregiving spouses could help health care professionals better understand caregiving arrangements and thus provide more targeted advice. TRIAL REGISTRATION: The TIGER study was registered with clinicaltrials.gov: NCT03513159 . Registered on April 17, 2018.

"EduKation demenz® Nursing" in the acute hospital setting : Evaluation of a dementia training program: a pilot study.

BACKGROUND: An increasing number of people with dementia (PwD) are being hospitalized due to acute conditions. The surrounding conditions and procedures in acute hospitals are not oriented to the special needs of this vulnerable patient group. The behavior of PwD poses particular challenges and burdens for nursing staff. OBJECTIVE: The aim of this pilot study was to evaluate the effectiveness of a 2-day dementia training program with a self-reflection component compared to a standard 1.5­h training of nursing staff caring for PwD in acute hospitals. METHODS: A nonrandomized pretest-posttest study with a control group was conducted in three German acute hospitals. Through a questionnaire, nursing staff caring for PwD were examined for potential changes in attitude, strain and confidence levels. The intervention group (n = 32) received a 2-day training program, "EduKation demenz® Nursing", the control group (n = 36) participated in a short,1.5­h dementia training. RESULTS: Compared to the control group, the intervention group demonstrated statistically significant improvement in perceived strain (p = 0.007) and in confidence in caring for PwD (p < 0.001). There were positive but not significant changes in attitude (p = 0.176). CONCLUSION: "EduKation demenz® Nursing", a 2-day training program with a self-reflection component, could provide more effective support for nursing staff in acute hospitals caring for PwD than a 1.5­h training. Results indicate, however, that general conditions in acute hospitals should be changed to allow nursing staff to apply the knowledge gained.

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review.

BACKGROUND: Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). METHODS: Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. RESULTS: Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). CONCLUSIONS: Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.

Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions.

Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians. Recently, clinicians and scientists from other medical disciplines, such as cardiology, pulmonology, gastroenterology, nephrology, endocrinology, rheumatology, surgery and critical care medicine also discovered frailty to be an interesting instrument for risk stratification of patients, including younger patients. In this review we highlight the results of recent studies that demonstrated the significance of frailty to predict adverse clinical outcomes in patients with specific medical conditions, such as cardiac, lung, liver and kidney diseases as well as diabetes mellitus, osteoarthritis, trauma patients, patients undergoing surgery and critically ill patients. Multiple studies in patients with the aforementioned specific medical conditions could be identified demonstrating a predictive role of frailty for several adverse clinical outcomes. The association between frailty and adverse clinical outcomes reported in these studies was in part independent of several major potential confounder factors, such as age, sex, race, comorbidities and disabilities and were also detected in younger patients.

Protein requirements in the elderly.

Adequate protein intake and the maintenance of nitrogen equilibrium are of particular importance in the elderly because this age group is at increased risk of illness and malnutrition. The current recommendation for protein intake of healthy elderly subjects is 0.8 g/kg body weight/day, the same as for younger adults. Nitrogen balance studies in the elderly, however, revealed conflicting results; some studies suggest that not all elderly can achieve a nitrogen balance with a protein intake of 0.8 g/kg body weight/day, particularly if energy supply is not adequate. Beyond the amount of protein needed for nitrogen balance, the optimal protein intake for preservation of lean body mass, body functions, and health is of paramount interest. At present, there is insufficient longer-term research with defined health outcomes to derive recommendations in this regard. Very little is also known about the protein needs of frail and unhealthy elderly. Until more evidence is available, it seems reasonable to ensure a protein intake of at least 0.8 g/kg body weight/day in all elderly persons, particularly in those at risk of malnutrition (e.g., frail and multimorbid elderly). In addition to ascertaining adequate protein and energy intake, physical activity should be encouraged in order to increase energy expenditure and food intake and to facilitate muscle protein anabolism.

Validity of Plate Diagrams for Estimation of Energy and Protein Intake of Nursing Home Residents Receiving Texture-Modified Diet: An enable Study.

OBJECTIVES: Nursing home (NH) residents receiving texture-modified diet (TMD) are at risk of inadequate nutritional intake and subsequent malnutrition. It is essential to monitor dietary intake to take corrective actions, if necessary. Plate diagrams (PDs) are widely used to assess dietary intake in institutions but little is known about their validity for TMD. DESIGN: Dietary intake at main meals was assessed by nursing personnel via PDs and scientific personnel via weighing records (WRs). SETTING AND PARTICIPANTS: 17 NH residents receiving TMD on a regular basis. METHODS: Intake from main meals (breakfast, lunch, and dinner) at 48 days was estimated by nursing personnel in quarters of the offered amount [nothing, », ½, ¾, all, all plus second helping (54), or I do not know] and by scientific personnel via WRs. PD estimation was multiplied by the energy and protein content of the offered meal determined by WR and compared to WR intake results. Sums of daily PD quarters were drawn against WR intake results. RESULTS: Energy and protein intake from main meals separately and in total per day were highly correlated (r > 0.854, all P < .001). Paired statistics showed no significant differences between assessment methods (P > .05). Mean differences [±standard deviation (SD)] between PD and WR were 13.9 (±68.6) kcal, which is 1.7% of the mean weighed caloric intake, and 0.2 (±3.3) g protein, which is 0.5% of the mean weighed protein intake per day. Daily energy and protein intake from main meals determined by WR varies widely within each category of summed daily intake quarters; for example, a sum of PD quarters of 12 (ie, "all eaten at all meals") showed corresponding WR intake levels from 394.6 to 1368.9 kcal and 16.3 to 63.0 g protein. CONCLUSIONS AND IMPLICATIONS: Energy and protein intake from TMD estimated by PD corresponds very well to WR-determined intake, if the energy and protein content of the offered meals is known.

The Failure of Plate Diagrams in Estimating Individualized Offered Portion Size: An enable Study.

BACKGROUND/OBJECTIVES: Plate diagrams (PDs) are commonly used to monitor dietary intake in nursing homes (NHs). PD intake estimation of texture-modified diet (TMD) is reliable, but only if the offered portion is determined by weighing records (WRs). Offered portion size is usually individualized in NHs and WRs are impractical for NH routine. Thus, an estimation of offered portion size by PDs seems to be appropriate but its validity is unknown. Further, validity of PDs for intake estimation based on estimated offer (instead of WRs) is unknown. DESIGN: Main meal dietary offer and intake were assessed via PDs and WRs. SETTING AND PARTICIPANTS: Seventeen NH residents receiving TMD regularly. METHODS: Offered portion size and intake of breakfast, lunch, and dinner at 42 days were estimated by nursing personnel via PDs (answer options offered portion size: >standard, standard, ¾, ½, », nothing, I do not know; answer options intake: all plus second helping, all, ¾, ½, », nothing, I do not know). In parallel, scientific personnel weighed all offered food items and leftovers. PD estimation of offered portion size was multiplied by energy and protein content of predefined standard portions. Afterward, PD estimation of intake was multiplied by PD determined energy and protein offer to determine the estimated energy and protein intake. PD determined offer and intake were compared with weighed offer and intake. RESULTS: Seventeen residents (14 female) with a mean [±standard deviation (SD)] age of 87.1 (±7.5) years participated in the study. Nursing personnel overestimated offer and intake. Mean daily differences (±SD) between WR and PD determined offer were -349.0 (±315.7) kcal, P < .001, (-36.3% of mean weighed energy offer) and -15.0 (±12.8) g protein, P < .001, (-42.2% of mean weighed protein offer). Mean daily differences (±SD) between WR and PD determined intake were -283.0 (±299.8) kcal, P < .001, (-35.1% of mean weighed energy intake) and -12.6 (±12.7)g protein, P < .001, (-43.1% of mean weighed protein intake). CONCLUSIONS AND IMPLICATIONS: PD estimation of individualized offered portion size of TMD by nursing staff is not valid and can, thus, not be recommended. The mistake in estimation of offered portion size is continued on intake estimation but does not become larger, which supports the use of PDs for intake estimation but just in case of a WR determined offer.

Usual Protein Intake Amount and Sources of Nursing Home Residents with (Risk of) Malnutrition and Effects of an Individualized Nutritional Intervention: An enable Study.

Nursing home (NH) residents with (risk of) malnutrition are at particular risk of low protein intake (PI). The aim of the present analysis was (1) to characterize usual PI (total amount/day (d) and meal, sources/d and meal) of NH residents with (risk of) malnutrition and (2) to evaluate the effects of an individualized nutritional intervention on usual PI. Forty residents (75% female, 85 ± 8 years) with (risk of) malnutrition and inadequate dietary intake received 6 weeks of usual care followed by 6 weeks of intervention. During the intervention phase, an additional 29 ± 11 g/d from a protein-energy drink and/or 2 protein creams were offered to compensate for individual energy and/or protein deficiencies. PI was assessed with two 3-day-weighing records in each phase and assigned to 4 meals and 12 sources. During the usual care phase, mean PI was 41 ± 10 g/d. Lunch and dinner contributed 31 ± 11% and 32 ± 9% to daily intake, respectively. Dairy products (median 9 (interquartile range 6-14) g/d), starchy foods (7 (5-10) g/d) and meat/meat products (6 (3-9) g/d) were the main protein sources in usual PI. During the intervention phase, an additional 18 ± 10 g/d were consumed. Daily PI from usual sources did not differ between usual care and intervention phase (41 ± 10 g/d vs. 42 ± 11 g/d, p = 0.434). In conclusion, daily and per meal PI were very low in NH residents with (risk of) malnutrition, highlighting the importance of adequate intervention strategies. An individualized intervention successfully increased PI without affecting protein intake from usual sources.

Physiological stress in safer cycling in older age (SiFAr-stress): effect of a multicomponent exercise intervention-a study protocol for a randomized controlled trial.

BACKGROUND: SiFAr-Stress investigates the impact of cycling on stress levels in older adults. Uncertainty due to change to motorized bicycle or fear of falling can be perceived as stressors for cyclists. Stress activates different physiological signal cascades and stimulates the hypothalamic-pituitary-adrenal (HPA) axis, which leads to the release of the stress hormone cortisol and further effects such as the development of low-grade inflammation. Both can-in the long term-be associated with negative health outcomes. The aim of the study SiFAr-Stress is to analyze inflammatory processes as well as the activity of stress systems before and after a cycling intervention for older adults. METHODS: In this study, community-dwelling older adults aged 65 years and older will be randomly assigned to either a cycling or a control intervention in a parallel-group design. Objective HPA axis-related measures (saliva cortisol and hair cortisol) will be assessed before, after, and 6-9 months after the cycling and control intervention (T0, T1, and T2). Furthermore, changes in cortisol reactivity in response to the cycling intervention will be investigated at the second and seventh training lessons. Furthermore, secondary outcomes (fear of falling, perceived stress, salivary alpha amylase, and C-reactive protein) will be assessed at T0, T1, and T2. DISCUSSION: The study will be the first, in which stress- and health-related bio-physiological outcomes will be assessed in the context of a multicomponent exercise intervention, addressing cycling in older adults. It will enable us to better understand the underlying patho-physiological and psychological mechanisms and will help to improve interventions for this target group. TRIAL REGISTRATION: ClinicalTrials.gov NCT04362514 . Prospectively registered on 27 April 2020.

Mobility in Older Community-Dwelling Persons: A Narrative Review.

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.

Frail Older Individuals Maintaining a Steady Standing Position: Associations Between Sway Measurements with Frailty Status Across Four Different Frailty Instruments.

OBJECTIVE: An analysis of the relationships between static equilibrium parameters and frailty status and/or severity across four different frailty measures. DESIGN: Cross-sectional analysis. SETTING: Geriatric wards of a general hospital. PARTICIPANTS: One hundred twenty-three geriatric inpatients comprising 70 women (56.5%) and 53 men (42.7%) with an age range of 68-95 years. METHODS: The variation in the center of pressure (CoP), ie, the length of sway, the area of sway, and the mean speed, was assessed for different positions/tasks: 1) wide standing with eyes open (WSEO); 2) wide standing with eyes closed (WSEC); 3) narrow standing with eyes open (NSEO) and 4) narrow standing with eyes closed (NSEC), using a force plate. Frailty status and/or frailty severity were evaluated using the frailty phenotype (FP), the clinical frailty scale (CFS), the 14-item frailty index based on a comprehensive geriatric assessment (FI-CGA), and a 47-item frailty index (FI). RESULTS: WSEO length of sway (FP, CFS, FI-CGA, FI), WSEO area of sway (FP, CFS, FI-CGA, FI), and WSEO mean speed (FP, CFS, FI-CGA, FI), WSEC length of sway (FP, FI-CGA, FI), WSEC area of sway (FP, FI-CGA, FI) and WSEC mean speed (FI-CGA, FI), NSEO length of sway (FP, FI-CGA, FI), NSEO area of sway (FP, CFS, FI-CGA, FI), and NSEO mean speed (FP, CFS, FI-CGA, FI), NSEC length of sway (FI-CGA, FI), NSEC area of sway (FI-CGA, FI) and NSEC mean speed (FI-CGA, FI) were associated with the frailty status and/or severity across the four different frailty instruments (all p < 0.05, respectively). CONCLUSION: Greater fluctuations in CoP with increasing frailty status and/or severity were a uniform finding across various major frailty instruments.

Changes of a frailty index based on common blood and urine tests during a hospital stay on geriatric wards predict 6-month and 1-year mortality in older people.

BACKGROUND: We aimed to evaluate the abilities of a 21-item frailty index based on laboratory blood and urine tests (FI-Lab21) assessed at different points in time, ie, at admission to hospital (FI-Lab21admission) and before discharge from hospital (FI-Lab21discharge), and the change of the FI-Lab21 during the hospital stay to predict 6-month and 1-year mortality in hospitalized geriatric patients. METHODS: Five hundred hospitalized geriatric patients aged ≥65 years were included in this analysis. Follow-up data were acquired after a period of 6 months and 1 year. RESULTS: The FI-Lab21admission and FI-Lab21discharge scores were 0.33±0.15 and 0.31±0.14, respectively (P<0.001). The FI-Lab21admission and FI-Lab21discharge both predicted 6-month and 1-year mortality (areas under the receiver operating characteristic curves: 0.72, 0.72, 0.77, and 0.75, respectively, all P<0.001). The predictive abilities for 6-month and 1-year mortality of the FI-Lab21admission were inferior compared with those of the FI-Lab21discharge (all P<0.05). Patients with a reduction in or stable FI-Lab21 score during the hospital stay revealed lower 6-month and 1-year mortality rates compared with the persons whose FI-Lab21 score increased during the hospital stay (all P<0.05). After adjustment for age, sex, and FI-Lab21admission, each 1% decrease in the FI-Lab21 during the hospital stay was associated with a decrease in 6-month and 1-year mortality of 5.9% and 5.3% (both P<0.001), respectively. CONCLUSION: The FI-Lab21 assessed at admission or discharge and the changes of the FI-Lab21 during the hospital stay emerged as interesting and feasible approaches to stratify mortality risk in hospitalized geriatric patients.

Long-Chain Fatty Acids and Inflammatory Markers Coaccumulate in the Skeletal Muscle of Sarcopenic Old Rats.

Obesity and inflammation are reportedly associated with the pathogenesis of sarcopenia, which is characterized by age-related loss of skeletal muscle mass. Intramuscular fat deposits have been found to compromise muscle integrity; however, the relevant fat compounds and their roles as mediators of muscular inflammation are not known. The aim of this study was to identify potential correlations between inflammation markers and lipid compounds that accumulate in the quadriceps muscle of previously described Sprague-Dawley (SD) rat model for high-fat diet- (HFD-) induced muscle loss. Six-month-old SD rats were continuously fed a control (CD) or HFD until the age of 21 months. Magnetic resonance imaging (MRI) revealed a significant decline in muscle cross-sectional area in male SD rats as a result of HFD, but not in female rats. Here, we developed a new procedure to quantitatively identify and classify the fatty acid methyl esters (FAMEs) in rats' quadriceps muscles from our former study using gas chromatography-mass spectrometry (GC-MS). Fatty acid analysis revealed accumulation of octadecadienoic (linoleic acid), octadecanoic (stearic acid), and octadecenoic (vaccenic acid) acids exclusively in the quadriceps muscles of male rats. The designated fatty acids were mainly incorporated into triacylglycerols (TAGs) or free fatty acids (FFAs), and their proportions were significantly elevated by consumption of a HFD. Furthermore, the number of resident immune cells and the levels of the chemokines RANTES, MCP-1, and MIP-2 were significantly increased in quadriceps muscle tissue of HFD-fed male, but not female rats. Together, HFD-induced muscle loss in aged male SD rats is associated with greater deposits of long-chain fatty acid esters and increased levels of the inflammatory markers RANTES, MCP-1, and MIP-2 in skeletal muscle tissue. This trend is further reinforced by long-term consumption of a HFD, which may provoke synergistic crosstalk between long-chain fatty acids and inflammatory pathways in sarcopenic muscle.

Dysphagia in Nursing Homes-Results From the NutritionDay Project.

OBJECTIVES: Dysphagia is a major healthcare problem as it increases the risk of malnutrition, dehydration, aspiration pneumonia, and death. The aims of this analysis of data from nursing homes (NHs) worldwide were to examine prevalence rates of dysphagia, to identify characteristics of residents with dysphagia, and to describe which type of nutrition residents with dysphagia receive. DESIGN: One-day cross-sectional study, repeated in yearly intervals since 2007. SETTING: 926 NH units from 19 countries. PARTICIPANTS: NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older, from Europe and North America, and with available information on dysphagia. MEASUREMENTS: Data on resident and unit level were collected on nutritionDay by local nursing staff using standardized questionnaires. Residents' nutritional status, nutritional intake, general residents' characteristics, and unit characteristics were of interest as potential predictors of dysphagia (no vs yes). Univariable generalized estimating equations were performed for all variables, and significant predictors (P < .01) included in a multivariable analysis. Nutritional strategies (type of diet, use of oral nutritional supplements, tube feeding, and parenteral nutrition) are described for residents with and without dysphagia. RESULTS: Dysphagia was reported in 13.4% of the 23,549 residents included, with great variation in the prevalence rates between participating countries. Twelve variables of 23 remained in the multivariable model [area under the receiver operating curve = 0.898; 95% confidence interval (CI) 0.892-0.904; P < .001]. Residents who were not able to eat lunch orally on nutritionDay were 14.90 [odds ratio (OR); 95% CI 9.61-23.11] times more likely to have dysphagia compared with residents who ate everything. ORs of dysphagia were higher for residents with chewing problems (OR 10.48; 95% CI 8.98-12.23), immobile (OR 5.10, 95% CI 4.25-6.11) and partially mobile residents (OR 1.94; 95% CI 1.64-2.29) compared to mobile residents, and residents with severe cognitive impairment (OR 1.99; 95% CI 1.64-2.42). Poor nutritional status, digestive diseases, neurologic diseases, dehydration, and use of antibiotics were also related to a higher risk of dysphagia. The most common nutritional strategy for residents with dysphagia was providing texture-modified diet (42.5%) followed by normal diet (28.2%). One-quarter of residents with dysphagia received oral nutritional supplements additionally, 7.4% of residents with dysphagia received tube feeding exclusively, and 8.0% in combination with oral nutrition. CONCLUSIONS: This analysis of NHs participating in the nutritionDay provides important insight into the current awareness of dysphagia, associated factors, and nutritional strategies. Residents who were unable to eat orally, malnourished, or dehydrated suffered more often from dysphagia, which substantiates the challenges of providing safe and adequate nutrition for residents with dysphagia. Adequacy and efficiency of different nutritional strategies need to be clarified in future studies.

The Impact of Dysphagia on Mortality of Nursing Home Residents: Results From the nutritionDay Project.

OBJECTIVES: Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia. DESIGN: One-day, annually repeated cross-sectional study, evaluating the nutritional situation of nursing home residents with 6-month mortality as outcome. SETTING: 191 nursing homes from 14 countries in Europe and the United States participating in the nutritionDay study between 2007 and 2012. PARTICIPANTS: Data of all nursing home residents in the nutritionDay study aged 65 years or older with available information about dysphagia and outcome were analyzed. MEASUREMENTS: Residents' characteristics and mortality rate were calculated by group comparison, and mortality risk was calculated by multivariate regression analysis with adjustment for potential confounding factors. RESULTS: 10,185 residents (78% female) with a mean age of 85 ± 8.1 years were included in the analysis. Dysphagia was reported in 15.4% of residents. The 6-month mortality of residents with dysphagia was significantly higher than of those without dysphagia (24.7% vs 11.9%; P < .001). The multivariate regression analysis revealed dysphagia [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.24-1.68, P < .001] along with body mass index <20 (OR 1.78, 95% CI 1.55-2.03, P < .001) and weight loss >5 kg (OR 1.61, 95% CI 1.37-1.88, P < .001) as independent and significant risk factors for mortality. Because of significant interaction, a disproportionately high mortality of 38.9% was found in residents with dysphagia accompanied by previous weight loss >5 kg (OR for interaction 1.44; 95% CI 1.03-2.01; P = .032). Tube feeding was reported in 14.6% of residents with dysphagia. The mortality rate of dysphagic residents receiving tube feeding vs those who were not was not significantly different (21.4% vs 25.3%; P = .244). CONCLUSION: In this nutritionDay study, dysphagia was identified as an independent risk factor for mortality in nursing home residents. Residents with dysphagia accompanied by weight loss are at a particularly high risk of mortality and should therefore receive special attention.

[Significance and diagnosis of malnutrition in the elderly]. / Bedeutung und Diagnostik der Mangelernährung im Alter.

In certain high-risk groups like geriatric hospital patients and nursing home inhabitants malnutrition has a high prevalence and is highly relevant for morbidity and mortality in these populations. The diagnosis of malnutrition in the elderly can be achieved by simple parameters like loss of weight, BMI and oral intake. The available screening and assessment instruments like Mini Nutritional Assessment (MNA) and Nutritional Risk Screening (NRS 2002) aim at the standardization of the diagnosis and early recognition of malnutrition. While the MNA seems to be more appropriate for the community-dwelling elderly, the NRS 2002 offers advantages for the hospital setting. The dissimilarity of the two instruments makes the comparison of study populations difficult. Both the results of the MNA and those of the NRS 2002 are unsuitable as follow-up parameters and inappropriate for the evaluation of nutritional intervention. There is still a strong need for studies on the diagnosis and therapy of malnutrition in the elderly, especially in the nursing home setting. For scientific purposes a standardization of the instruments used for the diagnosis of malnutrition and for the evaluation of the study results is essential. The Minimum Data Set may be a first step in the right direction.

Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards.

BACKGROUND: Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited. OBJECTIVE: This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients. DESIGN: Prospective cohort study. PATIENTS AND SETTING: A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study. MEASUREMENTS: The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year. RESULTS: Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65-82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all P<0.001). Thereby, CFS-7 (in all patients and the two patient subgroups) and FI (in the subgroup of patients aged ≥83 years) showed greater discriminative accuracy for 1-year mortality compared to other instruments (all P<0.05). CONCLUSION: All the different instruments emerged as suitable tools for risk stratification in geriatric inpatients. Among them, CFS-7, and in those patients aged ≥83 years, also the FI, might most accurately predict 1-year mortality in the aforementioned group of individuals.