Healthy Eating Enhances Intrinsic Capacity, Thus Promoting Functional Ability of Retirement Home Residents in Northern Taiwan.

Healthy aging is defined as the process of developing and maintaining functional ability in older age with intrinsic capacity, the composite of all the physical and mental capacities of an individual, being the core. This study was conducted to explore the intervention effects of improved dietary quality on intrinsic capacity. A prospective single-group interventional quasi-experimental study with 59 functional independent older adults from retirement homes were recruited. Texture-modified plant-based dietary supplements were provided. In addition, dietary intake, functional ability, and intrinsic capacity in vitality, locomotion, cognition, and psychological capacity were assessed. Vitality was captured by nutritional status, muscle strength, and cardiorespiratory endurance. Locomotor capacity was assessed based on the performance of physical fitness in backscratch test, chair-sit-and-reach test, chair-stand test, one-foot-standing test, and gaits peed. Psychomotor capacity and cognition were measured by using 15-item Geriatric Depression Scale (GDS-15) and Mini-Mental State Examination (MMSE), respectively. In a 4-month of intervention, after controlling for baseline values and covariates, participants with higher dietary intervention adherence showed a significant improvement over time in vitality captured by cardiorespiratory endurance (Pinteraction = 0.009) and significant improvement in locomotion captured by gait speed (Pclusters = 0.034). A significant decrease in the chair-stand test (Ptime = <0.001) and MMSE (Ptime = 0.022) was observed during the four months of intervention. Enhanced intrinsic capacity further contributed to the improvement of ADL over time (Pinteraction = 0.034). In conclusion, healthy eating enhances intrinsic capacity in vitality and locomotion thus promoting functional ability among older adults.

Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older adults with symptoms of dysphagia might have a higher prevalence of frailty or prefrailty than those without dysphagia. METHODS: We systematically searched the PubMed, Embase, and Cochrane Library databases for relevant studies published through 20 April 2022. Cross-sectional and longitudinal studies that examined the associations between dysphagia and the existence of frailty or prefrailty in community-dwelling, facility-dwelling, or hospitalized adults aged 50 years or older were synthesized. The Newcastle-Ottawa Scale was used to evaluate study quality. RESULTS: The meta-analysis comprised 12 cohorts, including 5,503,543 non-frailty participants and 735,303 cases of frailty or prefrailty. Random-effect meta-analysis demonstrated a significant association between dysphagia and the risk of frailty and prefrailty (OR, 3.24; 95% CI, 2.51-4.20). In addition, we observed consistent results across the subgroups and heterogeneity assessments. CONCLUSIONS: We propose including dysphagia assessment as a critical factor in the cumulative deficit model for identifying frailty in older adults. Understanding dysphagia and the potential role of nutritional supplements in older adults may lead to improved strategies for preventing, delaying, or mitigating frailty.

Novel Healthy Eating Index to Examine Daily Food Guides Adherence and Frailty in Older Taiwanese.

This study was conducted to investigate the adherence of Daily Food Guides (DFGs) among older Taiwanese, and the relationship of dietary quality and frailty. 154 functional independent older adults who were retirement home residents or community dwellers involved in congregate meal services were recruited. DFGs adherence was measured using a novel Taiwanese Healthy Index (T-HEI). Dietary quality was further assessed using Dietary Approach to Stop Hypertension (DASH) and Mediterranean Diet Score (MDS). Frailty was defined using modified Fried's criteria. Of the total participants, 12.3% were considered non-frail individuals, while 77.3% were prefrail, and 10.4% were frail. Compared to non-frail participants, prefrail and frail individuals indicated significantly lower adherence to DFGs (ptrend = 0.025). Intake of dark or orange vegetables (ptrend = 0.010), whole grains (ptrend = 0.007), as well as nuts and seeds (ptrend = 0.029) by non-frail individuals were significantly higher than the levels by prefrail and frail individuals. Linear regression model adjusted for age, gender, and functional ability showed that T-HEI was inversely associated with frailty status (ß = -0.16 ± 0, p = 0.047), but additional adjustment for nutritional status attenuated the association (ß = -0.14 ± 0, p = 0.103). A similar relationship was observed for DASH but not MDS (DASH: ß = -0.18 ± 0.01, p = 0.024; MDS: ß = -0.06 ± 0.02, p = 0.465). After adjustment for confounders, the association was not observed. However, the distribution of whole grains component in both DASH and MDS was significantly higher in non-frail than prefrail and frail individuals, indicating the importance of whole grains intake in frailty prevention. In conclusion, higher adherence to DFGs and better dietary quality were associated with a lower prevalence of frailty. Higher nutrient-dense foods intake such as whole grains, dark or orange vegetables, nuts, and seeds mark a watershed in frailty prevention.

Taking action against malnutrition in Asian healthcare settings: an initiative of a Northeast Asia Study Group.

Malnutrition is common in Asia, especially among people who are critically ill and/or older. Study results from China, Japan, and Taiwan show that malnutrition or risk of malnutrition is found in up to 30% of communitydwelling people and as much as 50% of patients admitted to hospitals-with prevalence even higher among those older than 70 years. In Asia, malnutrition takes substantial tolls on health, physical function, and wellbeing of people affected, and it adds huge financial burdens to healthcare systems. Attention to nutrition, including protein intake, can help prevent or delay disease- and age-related disabilities and can speed recovery from illness or surgery. Despite compelling evidence and professional guidelines on appropriate nutrition care in hospital and community settings, patients' malnutrition is often overlooked and under-treated in Asian healthcare, as it is worldwide. Since the problem of malnutrition continues to grow as many Asian populations become increasingly "gray", it is important to take action now. A medical education (feedM.E.) Global Study Group developed a strategy to facilitate best-practice hospital nutrition care: screen-intervene-supervene. As members of a newly formed feedM.E. Northeast Asia Study Group, we endorse this care strategy, guiding clinicians to screen each patient's nutritional status upon hospital admission or at initiation of care, intervene promptly when nutrition care is needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans, including post-discharge. To encourage best-practice nutrition in Asian patient care settings, our paper includes a simple, stepwise Nutrition Care Pathway (NCP) in multiple languages.

A hospital-based multidisciplinary approach improves nutritional status of the elderly living in long-term care facilities in middle Taiwan.

Improvement in nutritional status using two different care models was assessed in 374 elderly people (mean +/- S.D. age = 78.8+/-7.2 years) living in eight long-term care facilities in middle Taiwan. The subjects were divided into two groups using randomized block design; a hospital-based multidisciplinary team was responsible for the care of the intervention group, and the control group received usual care for 6 months. A structured questionnaire, anthropometric measurements, and biomedical markers were checked for each subject before and after the intervention. No significant differences were observed in age, height, weight, body mass index, hemoglobin, and albumin between the intervention (n = 125) and control (n = 249) groups at baseline. After 6 months of intervention, 83 subjects in the intervention group and 182 subjects in the control group had completed the study. The change in albumin level was greater in the intervention group (1.58 g/l) than in the control group (0.15 g/l, p < 0.05). The prevalence of hypoalbuminemia (albumin < 35 g/l) decreased from 69.2% to 52.9% in the intervention group and from 70.3% to 67.0% in the control group. In conclusion, a hospital-based multidisciplinary care effectively improved the nutritional status of elderly patients living in long-term care facilities in middle Taiwan.

Blastocystis hominis infection in long-term care facilities in Taiwan: prevalence and associated clinical factors.

Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection.

The effects of Taiwan's National Health Insurance on access and health status of the elderly.

The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI.

Elderly Nutrition and Health Survey in Taiwan (1999-2000): research design, methodology and content.

The purpose of the Elderly Nutrition and Health Survey in Taiwan (1999-2000) was to assess the diet, nutrition and health of persons aged 65 and above in Taiwan. A multi-staged, stratified, clustered probability sampling scheme was used in the survey. The survey population was stratified into a total of 13 strata. The four strata of "Hakka areas", "Mountain areas", " Eastern areas", and "PengHu islands" were unique in their ethnicity or geographic locations. The remaining areas of Taiwan were stratified into "Northern", "Central", and "Southern" parts with these 3 strata, then each subdivided into a further 3 strata based on population density. The household interview of the survey was arranged such that effect of seasonal variation was taken into account. A total of 1,937 persons completed the interview and 2,432 persons completed the health exam. The following data were collected: (1) Interview data : household information, basic demographics, 24 hour dietary recall, food frequency and habit, knowledge, attitudes and practice, medical history, 36-item Short Form for generic health status, and physical activity. (2) Health exam data: blood sample for measurement of nutritional biochemical indicators and complete clinical chemistry profile, urine sample for urinary electrolytes, anthropometric measurements, ECG, blood pressure, body temperature, pulmonary function, and an osteoporosis assessment. Data from the survey were analyzed using SUDAAN to adjust for the design effect and to obtain unbiased estimates of the mean, standard error and confidence intervals. Survey respondents were slightly younger compared to non-respondents; however, after weighting and adjustment with SUDAAN, the education levels and ethnicity of respondents and non-respondents were similar indicating lack of bias. We anticipate that the results of this survey will be of benefit in understanding the nutritional status of the elderly, the relationship between nutrition and health, and factors influencing elderly persons' nutritional status. Furthermore, this information could be used in the development of public health nutrition policy aimed at improving the nutrition and health of the elderly in Taiwan.

Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan.

OBJECTIVES: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly. RESEARCH METHODS AND PROCEDURES: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non-institutionalized subjects (age, 72.8+/-9.4 years; BMI, 23.6+/-6.4 kg/m2) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist-to-hip ratio (WHR). RESULTS: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI>or=25 kg/m2) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI>or=27 kg/m2). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut-off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2-88.0 cm in men and 82.0-84.0 cm in women, respectively. DISCUSSION: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.

[Common nutritional problems in the elderly: the experience of residents of a long-term care facility].

Nutrition is an unavoidable issue throughout the field of long-term care, occupying a key position in the system. Along with the current trends of population aging, chronic changes in morbidity, functional impairment of health, progressive complexity of care content, the elongation of the caring period and the consequences of these trends, the long-term care burden has become more challenging than ever. Nutrition is just one of many key issues presented by these challenges. The factors associated with nutritional problems are numerous and complex. Residents of long-term care facilities are both representative of elderly people generally and reasonably approachable, and therefore constitute a suitable sample for investigation. To grasp and define the causes of the nutritional problems, conduct periodic nutritional assessments, monitor diet & nutrition, and actively intervene to improve these areas, can be regarded as necessary if the needs of basic and advanced nutrition are to be met, and nutrition is to take its rightful place in the practice of long-term care. Nutritional problems usually consist of malnutrition from inappropriate intake, over-nutrition from over-intake, deficiency of special nutrients, and imbalance of intake from inappropriate ratio of food components. Associated factors include physiological change, morbid condition, medication, financial support and social support.

Utilization of well-baby care visits provided by Taiwan's National Health Insurance Program.

In April of 1995, Taiwan's National Health Insurance Program started providing each eligible child a total of six well-baby care visits. The first four are for infancy, the fifth is for the second and the third years of life, and the sixth is for the fourth year. These services are in addition to neonatal screening and a series of primary immunizations that have been publicly financed and utilized conventionally for years. The purposes of this study were to investigate the utilization level of these well-baby care visits, and explore relevant factors. The results reveal that 36% of eligible children did not use any of the first four visits, 58% did not utilize the fifth, and 82% did not use the sixth in the late 1990s. It appears that the take-up of these services is much less than satisfactory. Maternal awareness of and attitudes toward the services appeared to be the most important factors influencing utilization. These two factors not only were most influential, but also significantly contributed to disparities in utilization among different regions and types of residential districts. As a result, they should be the focus of interventions for advancing well-baby care. While these two factors are at the individual level, they are not independent from the health care system because the health care system has impacts on individual factors. Since physicians can serve as a good vehicle for teaching parents about relevant information and correct attitudes, and most physicians in Taiwan complained about the payment scheme, offering stronger incentives for physicians to promote such services might be helpful for achieving a high utilization level of well-baby care.