Predictors of developing a new need for long-term care of older adults aged ≥70 years: Results from a population-based cohort study in Taiwan.

AIM: To determine the characteristics associated with developing a new need for long-term care among older Taiwanese adults. METHODS: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long-term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long-term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long-term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors. RESULTS: The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P < 0.05) predictors. CONCLUSIONS: The present study identified nine characteristics that predict the subsequent 4-year new need for long-term care of ≥70-year-old Taiwanese adults. Age, sex and functional status are the most powerful predictors. The results are useful for identifying older individuals at risk of developing a new need for long-term care within the next 4 years, enabling implementation of preventive strategies or timely care planning. Geriatr Gerontol Int 2019; 19: 641-646.

Predicted factors for older Taiwanese to be healthy octogenarians: Results of an 18-year national cohort study.

AIM: To identify factors that predict the 62-69 years old Taiwanese to be healthy octogenarians. METHODS: We analyzed the 1989 (baseline), and 2003 and 2007 (end-point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62-69 years at baseline were tracked for 14-18 years. The outcome measure was "being healthy octogenarians", defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors. RESULTS: The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian. CONCLUSIONS: Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; 17: 2579-2585.

Combined association of leisure-time physical activity and fruit and vegetable consumption with depressive symptoms in older Taiwanese: Results of a national cohort study.

AIMS: To determine the independent and combined associations of leisure-time physical activity (LTPA) and fruit and vegetable consumption with subsequent new depressive symptoms in Taiwanese aged ≥53 years. METHODS: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging and used the Center for Epidemiologic Studies Depression scale (score 0-30) to rate depressive symptoms. We excluded those who had depressive symptoms (Center for Epidemiologic Studies Depression scale ≥10) at baseline, and carried out logistic regression analysis to determine the associations of LTPA and fruit and vegetable consumption, independently or in combination, with new depressive symptoms 4 years later (n = 2630). RESULTS: Independently, high LTPA was associated with reduced new depressive symptoms (OR 0.75, 95% CI 0.57-0.99); higher fruit and vegetable consumption showed the same trend, but was not significant. Combining high fruit (OR 0.61, 95% CI 0.41-0.89), vegetable (OR 0.49, 95% CI 0.26-0.93) or fruit and vegetable (OR 0.39, 95% CI 0.20-0.77) consumption with high LTPA all further reduced the likelihood of developing subsequent new depressive symptoms beyond LPTA alone. CONCLUSION: The simultaneous presence of several good lifestyle habits increases the beneficial effect of reducing the risk of developing depressive symptoms in older adults. Thus, older adults are encouraged to have as many good lifestyle habits as possible to reduce the risk of depressive symptoms.

Calf circumference is more effective than body mass index in predicting emerging care-need of older adults - Results of a national cohort study.

BACKGROUND & AIMS: The usefulness of body mass index (BMI) and calf circumference (CC) for predicting emerging care-need of older adults has not been carefully evaluated. We attempted to compare the abilities of these two anthropometrics in predicting emerging care-need in older adults. METHODS: We analyzed the 1999 (baseline) and 2003 (end-point) datasets of the Taiwan Longitudinal Survey on Aging. Participants were 2521 ≥ 65-year old adults without care at baseline. To derive proper cut-offs of BMI and CC, we first drew a plot to show the relationship between the risk of care-need and the cumulative distribution of BMI or CC. We then divided the risk into three levels and calculated the corresponding percentiles of BMI and CC. Multivariable logistic regression was used to build up predictive models. Akaike Information Criterion (AIC) and net reclassification improvement (NRI) were performed to compare the models as well as the predictive abilities of BMI and CC. RESULTS: After controlled other independent variables, CC was significantly associated with emerging care-need in the subsequent 4 years, but BMI was not. The AIC value of the model with CC (1956.3) was remarkably lower than BMI (1968.7). The NRI was 4.8% (p = 0.007) which quantified the improvement of the model with inclusion of CC instead of BMI to predict emerging care-need. CONCLUSIONS: All indices we performed suggest that CC has better ability to predict emerging care-need in older Taiwanese compared to BMI. The potential application of anthropometric indicators, especially CC, for predicting emerging care-need deserves further investigation.

The effectiveness and barriers of implementing a workplace health promotion program to improve metabolic disorders in older workers in Taiwan.

To determine the effectiveness of a pragmatic health promotion program to improve the metabolic disorders in older workers in Taiwan, we conducted a 24-week quasi-experiment in three worksites in southern Taiwan in 2010. Among 1,245 workers, 108 met the inclusion criteria (full-time workers aged over 50 years) and agreed to participate in the study. They were assigned to either the intervention (n = 58) or the reference group (n = 50) according to their availability to participate in health-promoting activities. The intervention group received training in behavioral modifications to improve diet, time-use, stress management and physical activity. Motivational lectures, group activities, and team competitions were used to improve participants' knowledge and skills in managing own health. Subjects in the reference group received no intervention. Lifestyle, anthropometric and biochemical indicators were measured at baseline and end-point. Mixed effects linear models were used to determine the intervention effects. The intervention significantly lowered body weight (intervention vs. reference = -1.22 vs. -0.30kg, p = 0.026), BMI (-0.46 vs. -0.02kg/m2, p = 0.006), and waist circumference (-2.68 vs. +0.79cm, p <0.001), but had no effect on biochemical parameters. These findings suggest the workplace-based health promotion can be effective and useful in reducing the risk of metabolic disorders in older workers in Taiwan.

Gender differences in the longitudinal associations of depressive symptoms and leisure-time physical activity with cognitive decline in ≥57year-old Taiwanese.

OBJECTIVE: This study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese. METHOD: We analyzed 3679 subjects (age ≥57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from <10 to ≥10; decreased symptoms: from ≥10 to <10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores). RESULTS: Women had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ(2)=51.24, p<0.001) and end-point (10.8 vs. 5.2%;χ(2)=39.5, p<0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR=5.28, 95%CI=2.84-9.82, p<0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24-3.51, p=0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19-0.65, p=0.001) and women with increased LTPA had 43% (0.57, 0.34-0.93, p=0.024) reduction in odds of developing cognitive decline. CONCLUSION: We found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging.

Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial.

BACKGROUND: Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance. OBJECTIVES: This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. DESIGN: A 24-week randomized, double-blind, controlled trial. SETTINGS: A privately managed geriatric nursing home in Taiwan. PARTICIPANTS: Ninety-two persons who were ≥65 years old, ≤25 kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. METHODS: Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2). The supplement contained 9.5 g protein, 250 kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. RESULTS: The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations. CONCLUSIONS: "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.

Determinants of new-onset diabetes in older adults­Results of a national cohort study.

BACKGROUND & AIMS: Diabetes mellitus is prevalent in many countries around the world, but the potential causal factors are not clearly known. We attempted to determine the risk factors for new-onset diabetes in ≥53-year old Taiwanese. METHODS: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). We performed logistic regression analyses to determine the cross-sectional and longitudinal (1999-2003) associations of the sociodemographic, lifestyle, and health-related variables with diabetes and new-onset diabetes, respectively. We excluded those who were diabetic at baseline in the longitudinal analysis. RESULTS: Results of the cross-sectional analysis showed that higher weight, past betel-quid chewing, IADL dependency, hypertension, heart disease, chronic kidney disease and depressive symptoms were positively associated with diabetes while alcohol drinking was negatively associated with diabetes. Longitudinal analysis showed that excessive weight, physical inactivity, depressive symptoms, and hypertension were associated with increased likelihood of new-onset diabetes while higher physical activity was associated with reduced likelihood of new-onset diabetes. Cigarette-smoking and moderate alcohol drinking showed no clear impacts on new-onset diabetes in older Taiwanese. CONCLUSIONS: Results show that excessive weight, physical inactivity, hypertension and depressive symptoms are the major risk factors for new-onset diabetes for both Eastern and Western populations, whereas smoking and alcohol drinking have varying impacts among these populations. Better understanding of these relationships should be helpful for planning effective health promotion strategies for reducing the risk of new-onset diabetes in older adults.

Association of perceived stress with depressive symptoms in older Taiwanese: Results of a population-based study.

AIMS: We determined the association of perceived stress with depressive symptoms in older Taiwanese. METHODS: We analyzed the 2007 dataset of the Taiwan Longitudinal Survey on Aging, a population-based survey of 4534 persons aged ≥54 years. Perceived stress was based on respondents' reports of whether each of the five situations (own health, financial status, job, getting along with family members and family members' problems) "makes you feel stressed or anxious". Participants were rated with the 10-item Center for Epidemiologic Studies Depression scale (score 0-30; ≥10 as having depressive symptoms). Multivariate logistic regression analysis was carried out to determine the association of each perceived stress situation with depressive symptoms in persons aged 54-64 years (middle-aged), 65-74 years (young-old) and ≥75 years (old-old). RESULTS: Over one-third of respondents were stressed over their own health. The middle-aged respondents who were stressed were 2.0-10.9-fold as likely to have depressive symptoms, the young-old were 3.1-8.1-fold as likely and the old-old were 4.3-12.6-fold as likely compared with the non-stressed respondents (all P < 0.001). Financial stress and its association with depressive symptoms deceased with increasing age. Nearly half of the Taiwanese older adults had concerns over family members' problems and the concern was associated with depressive symptoms in the younger age groups. Relationship strain with family members existed in <10% of older Taiwanese, but the association with depressive symptoms was strong. Job-related stress was not associated with depressive symptoms. CONCLUSIONS: Perceived stress and its association with depressive symptoms vary according to stress situations and age. The present findings should be useful for developing appropriate strategies to reduce the risk of depression in older adults.

Caregiver-mediated intervention can improve physical functional recovery of patients with chronic stroke: a randomized controlled trial.

Background and Purpose. Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve physical functioning and social participation in these patients. Methods. A single-blind, randomized, controlled 12-week trial conducted with 51 patients from 3 hospitals in Taiwan who had chronic stroke (>6 months; Brunnstrom recovery stages III-V). Patients and their caregivers in the intervention arm (n = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (n = 26) received visits from the therapist without intervention. All were evaluated for physical recovery through the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Barthel Index at baseline and endpoint. Caregivers were evaluated with the Caregiver Burden Scale. Results were analyzed through Mann-Whitney U test. Results. CHI significantly improved scores of the Stroke Impact Scale: strength (control vs intervention, respectively: 1.4 vs 15.5; P = .002), mobility (-0.5 vs 13.7; P < .001), composite physical (-0.7 vs 11.2; P < .001), and general recovery domain (0.2 vs 17.4; P < .001). CHI also significantly improved free-walking velocity (-1.4 vs 7.5 cm/s; P = .006), 6-minute walk distance (-10.5 vs 15.8 m; P = .003), Berg Balance Scale score (-0.8 vs 4.5; P = .006), and Barthel Index score (0.6 vs 7.2; P = .008). CHI did not significantly increase caregiver burden at endpoint. Conclusion. CHI can improve physical functional recovery and, possibly, social participation in patients with chronic stroke.

The Mini Nutritional Assessment (MNA) predicts care need in older Taiwanese: results of a national cohort study.

The present study determined the ability of the Mini Nutritional Assessment (MNA) to predict care need in older people. We analysed the datasets of the Taiwan Longitudinal Study on Aging. The 1999 survey containing the MNA items served as the baseline and the 2003 survey served as the endpoint. Of the 4440 participants, 2890 were aged ≥ 65 years and served as subjects in the present study. After excluding 150 subjects having incomplete data, 2740 were rated for nutritional status with the normalised long-form (LF) and short-form (SF) MNA-Taiwan version 1 (T1) and version 2 (T2) and evaluated with logistic regression analysis for cross-sectional associations of the rated nutritional status with care need, controlled for age, sex, education level, living arrangement and physical activity. Receiver operating characteristic curves were generated for evaluating the ability of the MNA to predict care need. After further excluding 250 subjects who had care need at baseline and seventy-six who were lost to follow-up, 2414 were evaluated for the ability of the MNA to predict subsequent care need with logistic regression analysis. The results demonstrated that all the MNA predicted concurrent and subsequent care need well. The OR for needing subsequent care in the 'at-risk' and 'malnourished' groups were, respectively, 2·04 and 3·33 for the MNA-T1-LF, 2·10 and 5·35 for the MNA-T2-LF, 1·49 and 2·48 MNA-T1-SF, and 1·80 and 3·44 for the MNA-T2-SF (all P< 0·05), and the respective Nagelkerke R 2 values were 0·190, 0·191, 0·184 and 0·192. In conclusion, all the four MNA have the ability to predict future care need, including the MNA-T2-SF, which appears to have great potential for practical applicability.

Mini-nutritional assessment (MNA) is useful for assessing the nutritional status of patients with chronic obstructive pulmonary disease: a cross-sectional study.

Malnutrition is prevalent in patients with chronic obstructive pulmonary disease (COPD) but is often neglected in clinical practice. This study examined the usefulness of the Mini Nutritional Assessment (MNA) for assessing the nutritional status of patients with COPD. We recruited 83 patients with COPD in stable condition from the pulmonary rehabilitation unit of a medical center in northern Taiwan. Each patient was interviewed with a structured questionnaire to elicit personal and health-related data, and measured for anthropometric and blood biochemical indicators. Nutritional status was rated with two Taiwanese-specific versions of the MNA, MNA-T1 and MNA-T2. Fat-free mass was measured with bioelectrical impedance analysis (BIA), and exercise capacity indicators with the 6-Minute Walk Test. The two MNA versions showed high agreement (kappa = 0.949) in predicting the nutritional risk, and both versions predicted the FFMI well (area under the curve of the Receiver Operating Characteristics = 0.804, p < 0.001 for MNA-T1; and 0.813, p < 0.001 for MNA-T2). MNA scores decreased with increasing disease severity and were highly correlated with FFMI, BMI, mid-arm circumference, calf circumference, and oxygen saturation at rest and during exercise (all p < 0.01). The MNA score was positively correlated with FEV1, FVC and 6-minute walking distance, and negatively correlated with GOLD stages (all p < 0.05). However, the MNA score was not significantly correlated with blood biochemical indicators, perhaps due to inflammatory status associated with COPD. The MNA appears appropriate for rating the nutritional risk of patients with COPD. Routine use of the MNA may help reduce the risk of malnutrition in patients with COPD.

Mini Nutritional Assessment and short-form Mini Nutritional Assessment can predict the future risk of falling in older adults - results of a national cohort study.

BACKGROUND & AIMS: Falling is a major issue in geriatric health. Tools that identify individuals at risk of falling can help reduce the risk of falling. The study aimed to determine whether the full and short-form Mini Nutritional Assessment (MNAs) have the ability to predict the risk of falling in older adults. METHODS: Subjects were 3118 ≥ 53-year old Taiwanese who completed both the 1999 and 2003 "Taiwan Longitudinal Study on Aging" surveys. We rated these subjects with normalized versions of the MNA and applied the standard cut-offs to define under-nutrition (≤23.5 and ≤11 points, respectively). We used multivariate logistic regression analysis and receiver operating characteristics to evaluate the ability of these tools in predicting the risk of falling three years later. RESULTS: Older adults rated as at risk of malnutrition with the full MNA (OR = 1.87, 95% confidence interval = 1.33-2.63, p < 0.001) or the short-form (1.39, 1.07-1.80, p = 0.014) were associated with increased risk of falling three years later. Both versions significantly predicted the risk of falling and performed slightly better in ≥65-year old persons than in younger (53-64-year old) persons. The short-form performed relatively well compared to the full scale. CONCLUSIONS: Results suggest that the full and short-form MNAs, in addition to rating the risk of malnutrition, also predict the risk of falling in older adults. Although the short-form is slightly less effective than the full scale in predicting the future risk of falling, its simplicity, effectiveness and efficiency make it ideal as a multipurpose screening tool in clinical settings.

The association of perceived stress with depressive symptoms in older Taiwanese-Result of a longitudinal national cohort study.

OBJECTIVE: To determine the impact of perceived-stress over one's own health, financial condition, job, and conflict with family members, and family members' problems on depressive symptoms in older adults. METHODS: We analyzed datasets of the Taiwan Longitudinal Survey on Aging, and used self-reported stress in 2003 and 2007 to represent long-term stress conditions in 4854 ≥ 50-year old persons. The impact of long-term stress on depressive status (evaluated with CES-D10, score range 0-30) was determined with multivariate logistic regression analysis. Persons with proxy interviews, incomplete CES-D data, or cognitive impairment were excluded. RESULTS: Perceived-health stress had stronger impacts on depressive symptoms than most other stress situations. Job-related stress showed no impact. Other stress situations showed modest associations in the middle-aged and young-olds. Ongoing stress had stronger impacts than past stress. Excluding health and job stresses, the impact generally decreased with aging. The association with clinically relevant depression generally followed that with depressive symptoms. CONCLUSION: All perceived stresses are not equal in their impacts on subsequent depressive symptoms. Perceived-health stress has stronger impacts under most conditions. Better understanding of the associations of various stressors with depressive symptoms could enhance planning of effective strategies to reduce the risk of depression in older persons.

An alternative short-form Mini-Nutritional Assessment for rating the risk of malnutrition in persons on haemodialysis.

AIMS AND OBJECTIVES: To improve the short-form Mini-Nutritional Assessment (MNA) to ameliorate under-rating the risk of malnutrition in patients on haemodialysis. BACKGROUND: The full MNA was found to be appropriate for rating the risk of malnutrition in persons undergoing haemodialysis but the short-form under-rated the risk. DESIGN: A cross-sectional study with purposive sampling. METHODS: The study recruited 152 adult ambulatory patients on maintenance haemodialysis from one dialysis centre in Taiwan. Each subject was rated with the Subjective Global Assessment (SGA), the original and selected alternative short-forms (by replacing better performing nonshort-form items for lesser performing short-form items) of a Taiwanese-specific MNA (T1). Serum albumin and creatinine concentrations and the SGA were also used as referents. Results were evaluated with Pearson's correlation analysis, binary classification test and receiver operating characteristic (ROC) curves. RESULTS: The full MNA showed good consistency with the SGA, but the original short-form rated fewer patients at risk of malnutrition compared with the full MNA. Exchanging item O (self-rated nutritional status) with item E (neuropsychological problems) produced the best results and restored the predictive ability of the short-form. Replacing item P for E produced the next best results. CONCLUSION: Results suggest that the predictive ability of the short-form can be greatly restored by rearranging the component items of the short-form without affecting the performance of the full MNA. The study is probably the first example of a disease-specific version of the MNA. RELEVANCE TO CLINICAL PRACTICE: The revision makes short-form MNA suitable for rating the risk of malnutrition in patients on haemodialysis in clinical practice.

Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: a randomized controlled trial.

BACKGROUND: Nutrition is a key element in geriatric health. Protein-energy malnutrition is common in institutionalized persons. OBJECTIVE: This study examined the effectiveness of a need-based "routine screening and timely intervention" strategy in improving the nutritional status of persons living in nursing homes. DESIGN: A 24-week randomized, double-blind, controlled trial. SETTING: A privately managed geriatric nursing home in Taiwan. PARTICIPANTS: Ninety-two ≥65-year old persons who were ≤25kg/m(2), >1 month residence, able to self-feed or receive oral feeding, without acute infection and non-bed-ridden. METHODS: Prospective participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each subject in the intervention group was given a 50g/day soy-protein-based nutritional supplement if he/she was rated as undernourished according to the Mini Nutritional Assessment (MNA, score ≤24) and BMI ≤24kg/m(2). The supplement contained 9.5g protein, 250kcal energy and all essential micro-nutrients. The supplementation would be suspended once either one of the "at risk" condition was corrected. Nutritional rating with the MNA took place at baseline and every 4 weeks during the trial. Biochemical indicators were measured at baseline, mid-point (week-12) and end-point (week-24). Results were analyzed with the two-sample t-test, and the generalized estimating equations (GEE) controlled for demographic and health-related variables. RESULTS: Of the 92 subjects, 82 completed the trial; 7 withdrew and 3 died during the trial. Results showed that the need-based intervention was an effective and appropriate strategy for improving the nutritional status of persons at risk of undernourishment. The intervention significantly improved body weight, BMI, mid-arm circumference, calf circumference, and serum albumin and cholesterol concentrations at all intervals (all p<0.05). However, the intervention did not significantly improve hematocrit, hemoglobin or lymphocyte count status. CONCLUSIONS: Results suggest that the need-based nutritional intervention can be a practical and useful strategy for improving the nutritional status of persons living in nursing homes and save on healthcare cost. The potential application of this strategy deserves the attention of health planners.

Cross-sectional and longitudinal associations of lifestyle factors with depressive symptoms in ≥ 53-year old Taiwanese - results of an 8-year cohort study.

OBJECTIVE: The objective of this study is to determine the concurrent and longitudinal associations of lifestyle factors including smoking, alcohol drinking, betel quid chewing, tea (Camellia sinensis) drinking and physical activity with depressive symptoms in older Taiwanese. METHODS: The study analyzed Taiwan Longitudinal Study on Aging (TLSA) datasets to determine the association of lifestyle variables with concurrent depressive symptoms in 4122 ≥ 50-year-old Taiwanese at baseline (1999) and with the new development of depressive symptoms 8 years later. RESULTS: Heavy/problem alcohol drinking increased the association with concurrent depressive symptoms (OR=1.85, 95%CI=1.02-3.36); frequent tea drinking (OR=0.63, 95%CI=0.50-0.79) and frequent physical activity (OR=0.59, 95%CI=0.48-0.71) reduced the association; whereas smoking and betel quid chewing showed no significant associations. Smoking (OR=1.56, 95%CI=1.06-2.30) increased the development of depressive symptoms 8 years later; past smoking and current betel quid chewing showed similar trends (OR=1.47, 95%CI=0.93-2.31); exercising ≥ 3 times/wk reduced the development (OR=0.77, 95%CI=0.60-0.99) while alcohol drinking showed no impact. CONCLUSION: Lifestyle variables can impact the mental wellbeing of older Taiwanese. Interventions to reduce the risk of depressive symptoms in older adults should include strategies aimed at improving these modifiable risk factors.

Short-form Mini-Nutritional Assessment with either BMI or calf circumference is effective in rating the nutritional status of elderly Taiwanese -- results of a national cohort study.

The present study was aimed to validate two normalised short-form (SF) Mini-Nutritional Assessments (MNA) that contained either BMI (Taiwan version 1, T1) or calf circumference (CC; Taiwan version 2, T2) for rating the nutritional status of elderly Taiwanese. Both versions adopted Taiwanese anthropometric cut-offs, but T2 further had the BMI item replaced by CC. We compared the ability of the two SF in rating the nutritional status of 2674 elderly Taiwanese in the 1999 'Taiwan Longitudinal Survey on Aging' with their respective full versions. We evaluated the agreement between the SF and full scales with weighted κ and performed Cox regression analysis for the follow-up 4-year mortality according to nutritional status rated at baseline. The results showed that the agreements between the respective SF and the full MNA were good (weighted κ: 0·679 for T1 and 0·667 for T2). Both SF performed well in predicting follow-up 4-year mortality relative to the full MNA. In conclusion, MNA-T1-SF and -T2-SF have good consistency with the full MNA and have quite comparable abilities in rating the nutritional status of elderly Taiwanese. Both SF versions appear appropriate for functioning as stand-alone units for rating the nutritional status of the elderly in community-living settings or the general population.

A comparison of the full Mini Nutritional Assessment, short-form Mini Nutritional Assessment, and Subjective Global Assessment to predict the risk of protein-energy malnutrition in patients on peritoneal dialysis: a cross-sectional study.

BACKGROUND: The full Mini Nutritional Assessment (full-MNA) and short-form MNA (MNA-SF) are simple and effective nutrition screening scales, but their usefulness for identifying patients with peritoneal dialysis (PD) at risk of protein-calorie malnutrition (PEM) has not been investigated. OBJECTIVES: This study was aimed to investigate the convergent validity of the full-MNA and MNA-SF for identifying patients with PD at risk of PEM. DESIGN: A cross-sectional study. SETTING: A hospital-managed dialysis center. PARTICIPANTS: 80 adult ambulatory PD patients. METHODS: Patients were interviewed for personal data and rated with the full-MNA, MNA-SF and the Subjective Global Assessment (SGA) for nutritional status. The consistency among the scales was assessed with kappa coefficients. The ability of each scale to differentiate undernutrition was evaluated with external standards including serum albumin and creatinine concentrations, mid-arm and calf circumferences, and dialysis-related indicators. Statistical significance was evaluated with Wilcoxon rank-sum test. RESULTS: The full-MNA and MNA-SF showed low agreements with the SGA (kappa=0.346 and 0.185, respectively). The full-MNA and MNA-SF performed better than the SGA in differentiating undernutrition according to the external standards. However, contrary to general expectation, MNA-SF rated a significantly smaller proportion of subjects at risk of undernutrition. CONCLUSION: The full-MNA and MNA-SF are more able than the SGA in identifying PD patients at risk of PEM. However, MNA-SF rates a smaller proportion of PD patients at risk of undernutrition than the full-MNA. The use of MNA-SF as a stand-alone unit requires further confirmation.

Complementarity of the Mini-Nutritional Assessment and Activities of Daily Living for predicting follow-up mortality risk in elderly Taiwanese.

Physical functional ability and nutritional status are two major indicators for predicting the risk of mortality in older adults. The present study examined the complementarity of the Activities of Daily Living (ADL) and the Mini-Nutritional Assessment (MNA) for predicting follow-up 4-year all-cause mortality risk in elderly Taiwanese. We analysed data of the 'Survey of Health and Living Status of the Elderly in Taiwan', a population-based longitudinal cohort study which involved 2872 men and women of ≥ 65 years old at baseline (1999). We rated their functional dependency with the ADL scale and nutritional status with the MNA (both the long form, LF and the short form, SF) at baseline, and analysed the complementarity of the two scales in predicting follow-up 4-year all-cause mortality with Cox regression analysis and the net reclassification improvement (NRI) to quantify the improvement. The results showed that both ADL and MNA offered improvement in predicting follow-up mortality risk beyond that predicted by either one alone according to the Akaike information criterion and the NRI. The MNA-SF was nearly as effective as the MNA-LF in improving the predictive ability of the ADL. The present study suggests that the MNA (especially the SF because of its simplicity and time-saving feature) together with the ADL scale might be of value for predicting the mortality risk of frail elderly living in various settings.