Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly

ABSTRACT Objective To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. Materials and methods Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. Results In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). Conclusion The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.

Study on nursing service needs among elderly people lived in nursing institutions in Fuzhou / 中国实用护理杂志

Objective To investigate nursing care needs of elderly nursing homes residents in Fuzhou, to help to improve nursing care quality provided by elderly nursing homes. Methods A total of 120 elderly residents from 10 elderly nursing homes in Fuzhou were investigated with a self-developed questionnaire focusing on nursing care needs of elderly nursing home residents. The questionnaire included the following two parts: the general information of the elderly residents and the needs of disease care, basic nursing care, daily life care as well as psychological care. Results The retrieving rate was 95.8%(115/120). The overall nursing care needs of elderly nursing home residents was at the middle level (2.59 ±0.80), the highest demand for nursing care was disease care (3.34±1.07), followed by psychological care (2.56±0.93), basic nursing care (2.20±1.15) and daily life care (2.23±0.97). The single living elderly residents got lower scores than the couple living elderly residents in disease care, basic nursing care 3.19±1.07, 2.06±1.10 vs. 3.78±0.96, 2.62±1.20 (t=2.656, t=2.311, P<0.05). Over 90 years old age groups got lower scores than the other age groups in the disease care, 2.25 ±0.69, 3.80 ±0.72, 3.35 ±1.09, which showed significant difference (F=7.10, P < 0.05). The elderly suffering from hypertension, diabetes, cardiovascular disease varied in the demand for different care. Conclusions The overall nursing care needs of elderly nursing home residents was at the middle level. Staying with spouse, age, disease state are the influencing factors of nursing care needs of elderly nursing home residents.

Incontinencia fecal en adultos mayores / Fecal incontinence in the elderly

Fecal incontinence (FI) is a devastating condition that affects quality of life. Age and gender are related with the prevalence of FI. In adults, prevalence varies from 2% to 7%. It is more frequent in women than in men (3:1) and is more prevalent in elderly patients. There are no studies in Mexico that evaluate the frequency of FI in adults older than 60 years. Aim. To investigate the FI frequency, severity and associated factors in patients ≥ 60 years. Patients and methods. Three groups of patients were included: a) Group I: consecutive outpatients patients from the Gastroenterology and Geriatrics Clinics of the INCMNSZ; b) Group II: INCMNSZ inpatients admitted due to a non-related condition with FI; c) Group III: Reyna Sofia nursing home residents (NHR) in Mexico City. A structured questionnaire was used to obtain demographic data, comorbidity and associated factors with FI. Grade of FI was assessed with the Wexner scale. Results. 159 patients were included, 89 (56%) were women. Mean age was 75 years (range 59-98). There were 54 patients in group I, 50 in group II and 55 in group III. Overall frequency of FI was 33% (n = 53). Frequency of FI was 26% in group I, 20% in group II and 53% in group III. Sixty six percent (n = 35) of the FI cases were female. Neuropsychiatric disorders were associated to FI in 29 patients (54%) and diabetes mellitus in 17 (32%). Eighty percent of patients wore disposable pads for FI. Urinary incontinence was associated to FI in 31 (58%). Thirteen (24%) patients had mild FI, 20 (38%) moderate, and 20 (38%) severe FI. The severity score for FI was lower in groups I and II (8.1 y 9.7) than in group III (18, p = 0.001). Age in patients with mild FI was significantly lower (73 years) than in patients with severe FI (83y, p = 0.01). Conclusions. FI in patients older than 60 years old is a very common condition. FI was more frequent and severe in women, in NHR and in those with neuropsychiatric disorders. Urinary incontinence was associated in half of patients with FI.

La incontinencia fecal (IF) es una condición que afecta la calidad de vida del enfermo. La prevalencia está relacionada con la edad y el género. Afecta de 2 a 7% de los adultos y es tres veces más frecuente en mujeres que hombres. En personas mayores de 65 años la frecuencia de IF se incrementa y varía según la población estudiada. En México no existen estudios que evalúen la frecuencia de IF en los adultos mayores. Objetivo. Investigar la frecuencia, gravedad y factores asociados a la IF en tres poblaciones de pacientes adultos mayores de 60 años. Pacientes y métodos. Se realizó un estudio descriptivo en el cual se evaluaron tres poblaciones de pacientes adultos > de 60 años: a) Grupo I, pacientes consecutivos que acudieron a la consulta externa de Gastroenterología y Geriatría del INCMNSZ; b) Grupo II, pacientes hospitalizados en el INCMNSZ por motivos diferentes a la IF; y c) Grupo III, pacientes residentes del asilo Reina Sofía de la Ciudad de México. Mediante un cuestionario estructurado se investigaron datos demográficos, tiempo de evolución, comorbilidad y factores asociados a la IF. El grado de IF se evaluó mediante la escala de Wexner modificada por Kamm. Resultados. Se evaluaron 159 pacientes, 89 (56%) mujeres. La edad promedio fue de 75 años (rango 59-98). Hubo 54 pacientes en el grupo I, 50 en el grupo II y 55 en el grupo III. Cincuenta y tres pacientes (33%) presentaron IF. La frecuencia de IF fue de 26% en el grupo I, de 20% en el grupo II y de 53% en el grupo III. De los casos con IF, 66% (n = 35) fueron mujeres. Veintinueve pacientes (54%) tuvieron trastornos neuropsiquiátricos asociados y 17 (32%) diabetes mellitus. De los pacientes, 80% utilizaron pañal. La incontinencia urinaria estuvo presente en 31 (58%) pacientes. De acuerdo con la escala de gravedad, 13 (24%) pacientes tuvieron IF leve, 20 (38%) moderada y 20 (38%) tuvieron IF grave. Los pacientes de los grupos I y II tuvieron puntuaciones menores en la escala de gravedad (8.1 y 9.7) que los pacientes del grupo III (18, p = 0.001). Los pacientes con IF leve tuvieron un promedio de edad menor (73 años) que los pacientes con IF grave (83 años, p = 0.01). Conclusiones. La frecuencia de IF en pacientes adultos mayores es elevada y afecta a la mitad de los pacientes residentes de un asilo. El grado de IF es más grave en las mujeres, en los pacientes residentes de un asilo y con trastornos neuropsiquiátricos. La incontinencia urinaria se asoció a IF en más de la mitad de los pacientes.

A longitudinal study of the relationship between osteo sono-assessment index and lifestyle in elderly female in nursing homes

The aim of this study was to investigate the longitudinal effect of mobility and daily activity, in the form of exercise and everyday activities, on the bones of 102 elderly female nursing home residents who had physical disabilities as well as marked postmenopausal bone loss, using calcaneal ultrasound apparatus for bone evaluation.Of the 102 subjects initially measured, 74 (mean age, 83.5±6.55 years; range, 64-99 years) could be measured again approximately one year later. The osteo sono-assessment index (OSI) in this study was determined using an ultrasound bone evaluation device. This device measures the speed of sound (SOS) and transmission index (TI) as ultrasound passes through the calcaneus. The OSI is calculated by computer analysis (OSI=TI×SOS(2)). For mobility, the OSI decreased significantly by an average of 1.8% after 11.8 months in all of the residents who were using a wheelchair (n=41, p<0.01). In contrast, the OSI rose significantly by a mean of 1.9% in the ambulatory group (n=33, p<0.01).The OSI increased significantly in residents who exercised every day, were out of bed for at least seven hours per day, and walked on a regular basis, suggesting that exercise, mainly in the form of walking, may increase the calcaneal OSI.

A Longitudinal Study of the Relationship between Osteo Sono-Assessment Index and Lifestyle in Elderly Female in Nursing Homes

The aim of this study was to investigate the longitudinal effect of mobility and daily activity, in the form of exercise and everyday activities, on the bones of 102 elderly female nursing home residents who had physical disabilities as well as marked postmenopausal bone loss, using calcaneal ultrasound apparatus for bone evaluation. Of the 102 subjects initially measured, 74 (mean age, 83.5±6.55 years; range, 64−99 years) could be measured again approximately one year later. The osteo sono-assessment index (OSI) in this study was determined using an ultrasound bone evaluation device. This device measures the speed of sound (SOS) and transmission index (TI) as ultrasound passes through the calcaneus. The OSI is calculated by computer analysis (OSI=TI×SOS2). For mobility, the OSI decreased significantly by an average of 1.8% after 11.8 months in all of the residents who were using a wheelchair (n=41, p<0.01). In contrast, the OSI rose significantly by a mean of 1.9% in the ambulatory group (n=33, p<0.01). The OSI increased significantly in residents who exercised every day, were out of bed for at least seven hours per day, and walked on a regular basis, suggesting that exercise, mainly in the form of walking, may increase the calcaneal OSI.