Dietary characteristics of community-dwelling older adults with poor appetite: a cross-sectional analysis.

RATIONALE: Poor appetite is considered a key factor in the development of malnutrition, a link that can be explained by alterations in dietary intake. Given the limited data on dietary characteristics in community-dwelling older adults with poor appetite, the present study aimed to examine whether poor appetite is associated with lower nutrient intake and more unfavourable food choices. METHODS: In 569 participants of the Longitudinal Aging Study Amsterdam aged ≥70 years appetite was assessed using the Simplified Nutritional Appetite Questionnaire and dichotomised into normal (>14) and poor (≤14). Intake of energy, 19 nutrients, 15 food groups, the Dutch Healthy Diet Index 2015 (DHD15) and Mediterranean Diet Score (MDS) were calculated from a food frequency questionnaire. Dietary differences between appetite groups were examined using Mann-Whitney U test and binary logistic regression adjusted for potential confounders. RESULTS: Mean age was 78 ± 6 years and 52% were female. Appetite was poor in 12.5% of participants. Energy intake was 1951 (median; quartiles 1-3: 1,653-2,384) kcal/day with no difference between appetite groups. Poor appetite was associated with lower intake of protein (OR 0.948, 95%CI 0.922-0.973), folate (0.981, 0.973-0.989), zinc (0.619, 0.454-0.846), vegetables (0.988, 0.982-0.994) and lower scores of DHD15 (0.964, 0.945-0.983) and MDS (0.904, 0.850-0.961), as well as higher intake of carbohydrates (1.015, 1.006-1.023), and vitamins B2 (4.577, 1.650-12.694) and C (1.013, 1.005-1.021). CONCLUSIONS: Community-dwelling older adults with poor appetite showed poorer diet quality with a lower intake of protein, folate, zinc and vegetables, compared with those reporting normal appetite and should be advised accordingly.

Characterisation of community-dwelling older adults with poor appetite.

PURPOSE: A poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The present study, therefore, aims to characterise older adults with poor appetite. METHODS: As part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains-physiological, emotional, cognitive, social, and lifestyle-and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model. RESULTS: The prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 [95% confidence interval 1.10-3.44]), self-reported chewing problems (2.4%, 5.69 [1.88-17.20]), any unintended weight loss in the last 6 months (6.7%, 3.07 [1.36-6.94]), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 [1.04-3.39]), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 [1.04-1.21]) were associated with an increased likelihood of having poor appetite. CONCLUSION: According to this analysis, older people with the characteristics described above are more likely to have a poor appetite.

Safer cycling in older age (SiFAr): effects of a multi-component cycle training. a randomized controlled trial.

BACKGROUND: The risk of older adults being injured or killed in a bicycle accident increases significantly due to the age-related decline of physical function. Therefore, targeted interventions for older adults to improve safe cycling competence (CC) are urgently needed. METHODS: The "Safer Cycling in Older Age" (SiFAr) randomized controlled trial investigated if a progressive multi-component training program related to cycling improves CC of older adults. Between June 2020 and May 2022, 127 community-dwelling persons living in the area Nürnberg-Fürth-Erlangen, Germany aged 65 years and older were recruited, who are either (1) beginners with the e-bike or (2) feeling self-reported unsteadiness when cycling or (3) uptaking cycling after a longer break. Participants were either randomized 1:1 to an intervention group (IG; cycling exercise program, 8 sessions within 3 months) or an active control group (aCG; health recommendations). The CC as primary outcome was tested not blinded in a standardized cycle course prior and after the intervention period and after 6-9 months, which consists of variant tasks requiring skills related to daily traffic situations. Regression analyses with difference of errors in the cycling course as dependent variable and group as independent variable adjusted for covariates (gender, number of errors at baseline, bicycle type, age and cycled distance) were performed. RESULTS: 96 participants (73.4 ± 5.1 years; 59.4% female) were analyzed for primary outcome. Compared to the aCG (n = 49), the IG (n = 47) made an average of 2.37 fewer errors in the cycle course after the 3 months intervention period (p = 0.004). People with more errors at baseline had higher potential for improvement (B=-0.38; p < 0.001). Women on average made 2.31 (p = 0.016) more errors than men, even after intervention. All other confounders had no significant effect on the difference in errors. The intervention effect was very stable until 6-9 months after the intervention (B=-3.07, p = 0.003), but decreased with a higher age at baseline in the adjusted model (B = 0.21, p = 0.0499). CONCLUSION: The SiFAr program increases cycling skills among older adults with self-perceived needs for improvement in CC and could easily be made available to a broad public due to its standardized structure and a train-the-trainer approach. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT04362514 (27/04/2020), https://clinicaltrials.gov/ct2/show/NCT04362514 .

Extramedullary plasmacytoma: Tumor occurrence and therapeutic concepts-A follow-up.

BACKGROUND: Extramedullary plasmacytoma (EMP) is a solitary tumor consisting of neoplastic plasma cells, with very little to no bone marrow involvement. EMPs are usually located in the head and neck region, but can also occur along the digestive tract, in lungs, or extremities. METHODS: Following our publication on EMP, which appeared in 1999 (Cancer 85:2305-14), we conducted a literature search for EMP-related reports published between 1999 and 2021. The documented cases, as well as 14 of our own patients from the ENT Clinic Erlangen, were extensively analyzed. RESULTS: Between 1998 and 2021, 1134 patients with EMP were reported, for whom information about the tumor localization was available. Among those, 62.4% had EMP in the head and neck area and 37.6% in other body regions. Data on therapy were reported in 897 patients, including 34.3% who received radiation, 28.1% surgery, 22.6% a combination of surgery and radiation, and 15.9% another therapy. In 76.9% patients no recurrence or transformation to multiple myeloma (MM) was reported, 12.8% showed local recurrence and 10.2% developed MM. Radiotherapy alone was associated with a tendency for increased occurrence of MM. In patients with EMP of head and neck area, combination therapy (surgery and radiation) resulted in a 5-year overall survival rate of 98.3%, surgery alone of 92.4%, and radiotherapy of 92.7%. CONCLUSIONS: Collectively, our analyses indicate that surgical resection alone can achieve long-term tumor control in patients with EMP, if the tumor can be removed within safe limits without causing serious functional impairment. However, if this is not certain, either radiation or a combination of surgery and radiation therapy is suggested as an effective means of local tumor control.

[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.

Safer cycling in older age (SiFAr): a protocol of a randomized controlled trial.

BACKGROUND: Cycling has positive effects on health and the proportion of older cyclists is rising. However, the risk for older adults to be injured or killed by a bicycle accident increases. The aim of the ongoing project "Safer Cycling in Older Age (SiFAr)" is to promote safer cycling in community-dwelling older adults with a structured, multi-component exercise training. METHODS: SiFAr is a randomized, controlled trial with a duration of 3 months for the intervention and a 6-9 months follow-up. We address community-dwelling persons aged 65 years and older living in the area Nürnberg-Fürth-Erlangen (Germany) who are either 1) beginners with the e-bike or 2) feeling self-reported unsteadiness when cycling or 3) uptaking cycling after a longer break. Long-term, experienced cyclists without subjectively reported limitations or worries when cycling are excluded. Participants are either randomized 1:1 to an intervention group (IG; receiving multi-component exercise program related to cycling, MEPC) or an active control group (aCG; receiving health and bicycle-related presentations, HRP). The purpose of this study is to investigate if the cycling competence of the IG will improve compared to the aCG. The cycling competence as primary outcome is tested not blinded in a standardized cycle course prior and after the intervention period, which consists of variant tasks requiring motor and cognitive skills related to traffic situations in daily life. Additional assessments such as physical functioning, quality of life, fear of falling, questionnaires regarding cycling behavior are obtained. To investigate the primary objective, regression analyses with difference of errors in the cycling course as independent variable and group as dichotomous dependent variable adjusted for covariates (sex, bicycle type) will be performed. The trial design is described in the present manuscript, using the extended CONSORT checklist for reporting pragmatic trials. DISCUSSION: Since there is a lack of cycling-related interventions for older people, SiFAr aims to evaluate a standardized intervention to enhance cycling safety. The results of the SiFAr trial could contribute to the implementation of an evaluated cycling course concept promoting mobility and independence of older adults. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov : NCT04362514 on April 27, 2020.

Does a 12-Month Transitional Care Model Intervention by Geriatric-Experienced Care Professionals Improve Nutritional Status of Older Patients after Hospital Discharge? A Randomized Controlled Trial.

At hospital discharge, many older patients are at health and nutritional risk, indicating a requirement for ongoing care. We aim to evaluate the effects of comprehensive individualized care by geriatric-experienced care professionals, the so-called "pathfinders", on nutritional status (NS) of older patients after discharge. A total of 244 patients (median age 81.0 years) without major cognitive impairment were randomized to Intervention Group (IG: 123) or Control Group (CG: 121) for a 12-month intervention, with up to 7 home visits and 11 phone calls. The comprehensive individualized care contained nutritional advice, when required. The intervention effect after three (T3m) and 12 (T12m) months on change in MNA-SF (Mini Nutritional Assessment-Short Form) and BMI was evaluated by Univariate General Linear Model (ANOVA), adjusted for age, sex, living situation, and activities of daily living. At baseline, mean MNA-SF did not differ between IG and CG (10.7 ± 2.6 vs. 11.2 ± 2.5, p = 0.148); however, mean BMI was significantly lower in IG compared to CG (27.2 ± 4.7 vs. 28.8 ± 4.8 kg/m2, p = 0.012). At T3m, mean change did not differ significantly between the groups, neither in MNA-SF (0.6; 95%CI: -0.1-1.3 vs. 0.4; -0.3-1.1, p = 0.708) nor in BMI (-0.2; -0.6-0.1 vs. 0.0; -0.4-0.4 kg/m2, p = 0.290). At T12m, mean change of MNA-SF was significantly higher in IG than in CG (1.4; 0.5-2.3 vs. 0.0; -0.9-0.8; p = 0.012). BMI remained unchanged in IG, whereas it slightly declined in CG (0.0; -0.7-0.6 vs. -0.9; -1.6--0.2 kg/m2, p = 0.034). We observed rather small effects of comprehensive individualized care by pathfinders on NS in older patients 12 months after discharge. For more pronounced effects nutrition expertise might be needed.

More than one way: exploring the capabilities of different estimation approaches to joint models for longitudinal and time-to-event outcomes.

The development of physical functioning after a caesura in an aged population is still widely unexplored. Analysis of this topic would need to model the longitudinal trajectories of physical functioning and simultaneously take terminal events (deaths) into account. Separate analysis of both results in biased estimates, since it neglects the inherent connection between the two outcomes. Thus, this type of data generating process is best modelled jointly. To facilitate this several software applications were made available. They differ in model formulation, estimation technique (likelihood-based, Bayesian inference, statistical boosting) and a comparison of the different approaches is necessary to identify their capabilities and limitations. Therefore, we compared the performance of the packages JM, joineRML, JMbayes and JMboost of the R software environment with respect to estimation accuracy, variable selection properties and prediction precision. With these findings we then illustrate the topic of physical functioning after a caesura with data from the German ageing survey (DEAS). The results suggest that in smaller data sets and theory driven modelling likelihood-based methods (expectation maximation, JM, joineRML) or Bayesian inference (JMbayes) are preferable, whereas statistical boosting (JMboost) is a better choice with high-dimensional data and data exploration settings.

The effect of different test protocols and walking distances on gait speed in older persons.

BACKGROUND AND AIMS: Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions. METHODS: For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway. RESULTS: A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001). CONCLUSIONS: Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.

Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care.

Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5-9.7], IC-LO 1.4 [0.3-6.6], IC-LA 1.4 [0.3-6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.