ABSTRACT
BACKGROUND: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. OBJECTIVE: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. DESIGN: Randomized controlled trial with 2 parallel arms. SETTING AND PARTICIPANTS: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. INTERVENTION: 6-month multimodal intervention based on diet and a physical activity program. CONTROL GROUP: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. RESULTS: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. CONCLUSIONS: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.
Subject(s)
Frailty , Aged , Frailty/prevention & control , Humans , Independent Living , Obesity/therapy , Quality of Life , Weight LossABSTRACT
BACKGROUND: Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population. OBJECTIVE: Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. DESIGN AND PARTICIPANTS: An open label trial was performed on 186 hospitalized older patients (>70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls. INTERVENTION: The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation; and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI. MEASUREMENTS: Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up. RESULTS: Both groups had similar advanced age (84.87±6.02MMI and 84.42±5.31 years), poor functionality (Barthel 59.51±26.76 MMI and 58.84±26.87), and high comorbidities (Charlson 3.00±1.60 MMI and 3.06±1.45). Main results showed that MMI improved nutritional status (MNA 9.84±2.05 pre-MMI vs. 11.31±2.21 post-MMI; p=0.0038) and functionality (Barthel 62.34±25.43 pre-MMI vs. 73.44±25.19 post-MMI; p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1-109.38) MMI vs. 190.8 (156.0-225.7); p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0-29.82) MMI vs. 74.68 (52.86-96.50); p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96%; p=0.044). CONCLUSIONS: Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.
Subject(s)
Deglutition Disorders/diet therapy , Food, Formulated , Nutritional Status/physiology , Aged , Aged, 80 and over , Body Mass Index , Female , Hospitalization , Humans , Male , Oral Health , Patient Discharge , Patient Readmission , Proof of Concept Study , ViscosityABSTRACT
OBJECTIVES: To assess agreement between the CONUT and Mini Nutritional Assessment (MNA) instruments in detecting malnutrition in hospitalized elderly patients and to determine their prognostic value compared to that of serum albumin alone in relation to in-hospital and 1-month and 6-month post-discharge mortality rates. DESIGN: Prospective observational study. SETTING: A Catalan regional hospital. PARTICIPANTS: 2155 patients admitted to an acute geriatric unit were assessed using MNA and CONUT and were followed up for 6 months after discharge. MEASUREMENTS: On admission, data were collected on age, sex, referral, geriatric syndromes, cognitive status, functional status and nutritional status according to MNA (as the gold standard). Plasma albumin, total cholesterol and lymphocyte levels were recorded to implement CONUT. Mortality was recorded until 6 months after discharge. RESULTS: Sample characteristics: 61.3% females, mean age 84.9 years, mean Charlson index 2.2. CONUT sensitivity and specificity for malnutrition were 43% and 71.6%, respectively, with positive and negative predictive values of 88.9% and 19.2%. MNA, CONUT and albumin alone were good predictors of mortality but showed similar sensitivity and specificity results. CONCLUSION: CONUT agreement with MNA in nutritional risk assessments for elderly people is poor. Although CONUT is a good predictor of short-and medium-term mortality, it adds little to information provided by albumin alone.
Subject(s)
Geriatric Assessment/methods , Hospitalization , Malnutrition/diagnosis , Malnutrition/mortality , Nutrition Assessment , Aged, 80 and over , Albumins/analysis , Cholesterol/blood , Cognition , Female , Follow-Up Studies , Humans , Male , Nutritional Status , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment/methods , SpainSubject(s)
Anxiety Disorders/ethnology , Anxiety/ethnology , Depression/ethnology , Depressive Disorder/ethnology , Emigration and Immigration , Adult , Anxiety/etiology , Anxiety Disorders/etiology , Cross-Sectional Studies , Depression/etiology , Depressive Disorder/etiology , Female , Humans , Male , Prevalence , Spain/ethnologyABSTRACT
Objetivo. Determinar el grado de ansiedad y depresión en inmigrantes en situación irregular sin enfermedad psiquiátrica previa. Diseño. Estudio descriptivo transversal. Emplazamiento. Consulta de atención primaria de inmigrantes en situación irregular, que carecían de tarjeta sanitaria. Los inmigrantes son derivados a través de la asociación Salud y Familia1. El paciente es recibido por una mediadora cultural, quien determina las necesidades del inmigrante y lo deriva a un centro de medicina tropical, de salud mental o a la consulta de atención primaria. Así, los inmigrantes que son atendidos no presentan, en principio, ninguna enfermedad psiquiátrica. Medidas principales. De septiembre a diciembre del 2003 se realiza el test de Goldberg de ansiedad y depresión a todos los pacientes que acudieron a la consulta (se consideró que había ansiedad ante una puntuación 4 y depresión a una puntuación 3 para mayor poder discriminatorio). Se recogen las variables edad, sexo, país de origen, tiempo de estancia en nuestro país, tipo de vivienda, presencia o no de familiares, situación laboral, comprensión del español y motivo de consulta. Los resultados fueron analizados con el programa SPSS. Resultados. Se registraron 27 pacientes (63 por ciento varones y 37 por ciento mujeres) con una edad media de 32,89 años. El tiempo de estancia medio en nuestro país fue de 17,59 meses. Tan sólo el 29,6 por ciento de los inmigrantes tiene algún familiar en España. El 66,7 por ciento vive en pisos compartidos; un 32 por ciento carece de recursos y vive en pensiones pagadas por la Cruz Roja, en edificios abandonados o en la calle. El 48 por ciento tiene el español como primera lengua; un 29,6 por ciento lo entiende con dificultades y un 22,2 por ciento no lo entiende. El 55,6 por ciento no tiene trabajo ni ningún tipo de ingreso. El resto realiza trabajos en situación irregular. La mayoría de los inmigrantes procede del centro y del sur de América, seguidos de los del África subsahariana y Europa del este (fig. 1). Los motivos de consulta fueron principalmente algias específicas (n = 14), problemas dermatológicos (n = 6) y problemas respiratorios (n = 4). El 51,9 por ciento de los pacientes presenta ansiedad y el 40,7 por ciento, depresión. Ansiedad y depresión son más frecuentes en mujeres (70 y 50 por ciento) que en varones (41,2 y 35,3 por ciento). Conclusiones. Las prevalencias de ansiedad y depresión son más elevadas que las de la población general (en Cataluña se estima una prevalencia de depresión del 14,5 por ciento y de ansiedad del 11,3 por ciento)2. En cuanto al sexo, sigue el mismo patrón que el de la población autóctona. No hubo ninguna variable estadísticamente significativa que pudiera relacionarse con el hecho de sufrir ansiedad o depresión, seguramente debido a que se trata de una muestra pequeña, pero sí que se observa una tendencia a sufrir más ansiedad cuanto mayor es el desconocimiento del idioma y más depresión cuanto mayor es el tiempo de estancia en el país y ante la ausencia de trabajo. Habría que poner todos los medios necesarios en acceder a esta población inmigrante que queda al margen del sistema sanitario y valorar siempre una posible depresión y/o ansiedad secundarias al estrés que supone el fenómeno de la inmigración y la situación de irregularidad3-6. Agradecimientos. A todo el personal de PAMEM, especialmente a atención al usuario, que con su paciencia y tolerancia han ayudado a la organización de las consultas y han facilitado a los pacientes inmigrantes todos los trámites y apoyo. Facilitarles aunque sea un poco el proceso de adaptación siempre lo agradecen. Ya no son Nadie (AU)
Subject(s)
Aged , Male , Humans , Adult , Female , Health Services for the Aged , Dependency, Psychological , Emigration and Immigration , Prevalence , Health Status Indicators , Geriatric Assessment , Spain , Anxiety , Activities of Daily Living , Anxiety Disorders , Cross-Sectional Studies , Depression , Depressive DisorderABSTRACT
The reformation of Primary Care (PC) permits a more satisfactory and coordinated approach to family planning (FP). We evaluated the profile of the potential users of FP by means of a survey of 182 females made in a Primary Care center (CAP). The most commonly used contraceptive methods were oral contraceptives (20.3%), coitus interruptus (Cl) (18%), condom (17%) and female sterilization (12.6%). 66.6% of failures were attributed to Cl. 32.25% of the intrauterine device users and 24.4% of those taking oral contraceptives reported problems. 24.7% of females were controlled in the CAP II, 19.7% by their private gynecologist, 16.5% in the municipal CP and 6% in the CAP. 30.2% of the users did not follow and type of control.
