One-bite-sized 3D printed finger foods, oriented to malnutrition, sarcopenia and frailty prevention in the older people.

BACKGROUND: In this study, innovative chocolate, citrus and mixture flavoured tofu-based nutritionally customised, dysphagia-oriented, comfortably consumed, appetising, one-bite-sized finger foods, oriented to malnutrition, sarcopenia and frailty prevention in older people were created by using 3D printing technology. Developed products were characterised by evaluating chemical composition and physical properties and performing sensory evaluation among geriatric clinic residents (≥60 years). RESULTS: The dietary composition of the developed foods was: 19-21 g (100 g)-1 protein, 6-8 g (100 g)-1 fibre, 8-9 g (100 g)-1 fat, 11 mg (100 g)-1 iron, 14 mg (100 g)-1 zinc, 70 µg (100 g)-1 selenium. Foods were also enriched with branched-chain amino acids, such as leucine, isoleucine and valine. All formulated foods were classified as level 6 by International Dysphagia Diet Standardisation Initiative classification. Chocolate-flavoured food was much harder (4914 g) with lower adhesiveness value (-33.6 g s), compared to the citrus- or mixture-flavoured foods. Older people evaluated all finger foods as very easy handled by hand, soft, easy to swallow, having a moderate flavour intensity and a weak afterfeel. Despite the fact that the chocolate food was evaluated as having the highest hardness and gumminess values by the instrumental method, this difference was not noticeable to the evaluators. However 7% of the participants said that 3D printed foods were sticky to dentures. CONCLUSION: The results suggest that it is possible to create nutrient-dense comfortably consumed 3D printed foods, oriented to malnutrition, sarcopenia and frailty prevention in older people. © 2024 Society of Chemical Industry.

Alzheimer's Disease Association with Metals and Metalloids Concentration in Blood and Urine.

As there is some evidence that the risk for Alzheimer's disease (AD) is partially attributable to environmental exposure to some metals and metalloids, we examined an association between AD and arsenic, chromium, and selenium in 53 AD patients and 217 controls. Urinary arsenic, blood chromium, and selenium were determined by inductively coupled plasma mass spectrometry. Logistic regression models calculating odds ratios (ORs) and 95% confidence intervals (CI) were used to estimate AD association with arsenic, chromium, and selenium. In AD patients, urinary arsenic and blood chromium were significantly higher, while blood selenium was significantly lower compared to controls. Increased blood selenium was related to a significant decrease in the odds of AD after adjustment for risk factors. Blood selenium per 1 kg × 10-9/m3 × 10-4 increment was associated with 1.4 times lower risk of AD (OR = 0.71; 95% CI 0.58-0.87). A significant increase in the odds of AD associated with increased blood chromium was also seen in the adjusted model: the OR per 1 kg × 10-9/m3 × 10-3 chromium increment was 2.39 (95% CI 1.32-4.31). The association of urinary arsenic with the risk of AD was not significant. The data obtained provide evidence that selenium reduces the risk of Alzheimer's disease, while chromium increases it.

Oropharyngeal Dysphagia as the Main Expression of Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease. Only about 10% of ALS patients survive more than 10 years. Clinical studies show that multidisciplinary care statistically significantly improves survival compared to neurological care. ALS tends to manifest as limb weakness, but some patients present with bulbar symptoms, such as dysphagia and dysarthria. In rarer cases, the main symptom of ALS is oropharyngeal dysphagia. Respiratory muscle weakness is a relatively rare symptom at the onset of this disease and may lead to a fatal outcome due to aspiration pneumonia within about 1.4 years. These reasons led to a particularly complicated diagnosis of ALS in a 66-year-old Caucasian female patient complaining of dyspnoea and coughing while drinking water. Notably, dyspnoea is only present in one out of four treatment-seeking patients, and the course of ALS is non-specific. For these reasons, the diagnosis took an entire year while the patient underwent many tests and visited many specialists. However, the diagnosis was only made at a late stage of the disease. At present, the patient is almost unable to swallow food, water, or saliva, and is at a very high risk of aspiration, but refuses to have a percutaneous endoscopic gastrostomy performed. The objective of this case report is to highlight the fact that a symptom as simple as difficulty swallowing may be the result of severe disease, a frequent outcome of which is death.

Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls.

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

Formulating protein-based beverages for the dysphagia diets of the elderly: viscosity, protein quality, in vitro digestion, and consumers acceptability.

BACKGROUND: Dysphagia is defined as a disorder of the swallowing mechanism. The most common management of dysphagia is diet modification by thickening food and beverages. This study aimed to obtain protein-based beverages for the dysphagia diets of the elderly, corresponding to the 'honey' (III) level of dysphagia fluids according to the National Dysphagia Diet classifications, and containing 100 g kg-1 of good-quality proteins with a high rate of hydrolysis during digestion. RESULTS: Four protein formulations made from pea proteins, milk proteins, a mixture of milk and pea proteins, and milk proteins with added konjac glucomannan, were evaluated on the basis of rheological characterization and proteolysis kinetics during in vitro digestion. The mixture of milk proteins and pea proteins, and the mixture of milk proteins with added konjac glucomannan, showed typical yielding pseudoplastic fluid behavior with similar apparent viscosity but different structural characteristics. These differences were the reason for the differences in proteolysis kinetics during digestion. The mixture of milk and pea proteins showed viscous liquid behavior and was more rapidly hydrolyzed under gastrointestinal conditions than mixtures containing milk proteins and konjac glucomannan acting as a weak gel system. CONCLUSION: We presume that geriatric consumers with swallowing difficulties may benefit from 'honey'-level viscosity, protein-based beverages containing pea and milk proteins through faster proteolysis and better bioaccessibility of amino acids during digestion. © 2020 Society of Chemical Industry.

Older Adults-Potential Users of Technologies.

Background and objective: The successful adoption of technology is becoming increasingly important to functional independence and successful ageing in place. A better understanding of technology usage amongst older people may help to direct future interventions aimed at improving their healthcare. We aimed to obtain the first data regarding technology use, including gerontechnologies, represented by fall detectors, from older adults in Lithuania. Material and methods: The research was carried out in the framework of the project Smart Gerontechnology for Healthy Ageing, which involved assessing the use of technologies and the readiness to use gerontechnologies, as represented by fall detectors. A total of 375 individuals that were more than 60 years of age were enrolled in the study. The self-reporting questionnaires were completed by geriatric in-patients, hospitalized in the geriatric department, and also by community-dwelling older adults. Results: Geriatric in-patients' use of computers and the internet was associated with age (every year of age decreased the probability of computer and internet use by 0.9-times) and a positive attitude towards new technologies-this predictor increased the use of a computer by six-times in comparison with people who did not have such an attitude. Sex and education had no influence on computer use for geriatric in-patients. For community-dwelling older adults, the use of computers and internet was associated with age, education (a university education increased the use of computers and the internet by four times), and a positive attitude towards technologies. Conclusions: Lithuanian older women in the study used computers, the internet, and cell phones equally with men. Increasing age was a strong negative predictor of technology use. A positive attitude to new technologies was a strong positive predictor of technology use. Most geriatric patients and community-dwelling older adults were ready to use technologies that permit ageing in place.

Possible Interaction between Dabigatran and Ranolazine in Patients with Renal Failure.

Dabigatran etexilate is a direct oral anticoagulant (thrombin inhibitor) used for the prevention of stroke and systemic thromboembolic events in patients with permanent atrial fibrillation; prevention of venous thromboembolic events and deep veins thrombosis; treatment and prevention of pulmonary embolism. Dabigatran is a relatively new drug, and as a result, its interactions with other medications and their significance are not fully known. A 72 years old male, having a medical history of heart and renal failure, was hospitalized for pneumonia treatment. The patient was taking several drugs, including dabigatran 150 mg twice daily and ranolazine 750 mg twice daily. His creatinine clearance was 45.22 mL/min, International Normalized Ratio (INR)-7.03. Dabigatran was discontinued. After 9 days, INR decreased to 1.33, and after 6 days, creatinine clearance increased to 64.39 mL/min. The patient was taking an adequate dosage of dabigatran, thus dabigatran was thought to be overdosed due to its interaction with ranolazine because dabigatran is a p-glycoprotein substrate, whereas ranolazine is the inhibitor of this transporter. Dabigatran and ranolazine should be used with caution in patients with renal failure. It is recommended to use smaller doses of both medications and observe coagulation parameters if needed.

Nutritional status of rural community-dwelling older people and changes after following nutritional recommendations.

BACKGROUND: It is crucial that community nurses in remote areas are competent to recognize the risk of malnutrition in older people and be able to help them to improve their nutritional status. AIM: To examine the factors associated with malnutrition and the impact of nutritional recommendations in rural community-dwelling older people. DESIGN: This was a cross-sectional descriptive study. METHOD: The study was conducted in 2014 in a rural primary health care setting in Lithuania with 169 older people. Nutritional status was assessed using the Mini Nutritional Assessment tool. Older people who were at risk of malnutrition or were already malnourished (n = 82) received written nutritional recommendations and were reassessed after 6 months. RESULTS: Nutritional status was normal for 51.5% of participants, 43.2% had risk of malnutrition, and 5.3% had malnutrition. Risk of malnutrition or malnutrition was associated with chronic and intermittent pain, chewing difficulties, swallowing disorders, dental problems, and medication use. The nutritional status of participants at risk of malnutrition or malnourished had improved 6 months later. CONCLUSIONS: Risk of malnutrition or malnutrition was prevalent among rural community-dwelling older. The study highlighted that positive health outcomes are achievable in undernourished or at risk of malnutrition older people when nutritional recommendations are applied with minimal resources.

Seasonal influenza vaccine effectiveness against laboratory-confirmed influenza in 2015-2016: a hospital-based test-negative case-control study in Lithuania.

OBJECTIVE: A case-control study was conducted to assess seasonal influenza vaccine effectiveness (SIVE) during the 2015-2016 influenza season. METHODS: A study was performed in three departments in Lithuania between 1 December 2015 and 1 May 2016. Data on demographic and clinical characteristics including influenza vaccination status were collected from the patients recommended to receive the seasonal influenza vaccine. Influenza virus infection was confirmed by multiplex reverse transcription polymerase chain reaction (RT-PCR) . RESULTS: Ninety-one (56.4%) of the 163 included subjects were ≥65 years old. Fifteen (9.2%) subjects were vaccinated against influenza at least 2 weeks before the onset of influenza symptoms, 12 of them were ≥65 years old. Of the 72 (44.2%) influenza virus positive cases, 65 (39.9%) were confirmed with influenza A (including 50 cases of influenza A(H1N1)pdm09), eight (4.9%) were confirmed with influenza B and one was a co-infection. Unadjusted SIVE against any influenza, influenza type A and influenza A(H1N1)pdm09 was 57% (95% CI -41% to 87%), 52% (95% CI -57% to 85%) and 70% (95% CI -43% to 94%) respectively. CONCLUSION: Although SIVE estimates were not statistically significant the point estimates suggest moderate effectiveness against influenza type A.

Perioperative factors affecting length of hospital stay among elderly patients.

BACKGROUND AND OBJECTIVE: Timely assessment and prevention of risk factors for the main perioperative complications in elderly patients provide an opportunity to avoid them, decrease mortality, and diminish costs associated with longer hospital stay. The aim of this study was to estimate perioperative factors that could potentially predict the length of stay and to estimate their predictive value using a comprehensive geriatric assessment among elderly patients. MATERIAL AND METHODS: The study population comprised 99 surgical patients aged 65 and more. The patients were followed up until discharge. Study data analysis included questionnaires, anthropometric measurements before surgery, assessment and interviews after surgery, and case histories. Univariate and multivariate logistic regression analysis was performed. RESULTS: Malnutrition was detected in 53.5% of the patients. Postoperative cognitive disorder was documented in 18.2% of elderly patients. The mean length of hospital stay was 10.1 days (SD, 9.14). Multivariate logistic regression analysis revealed that the best predictors for longer hospital stay in elderly patients were malnutrition (OR, 4.2; 95% CI, 1.5-11.8; P=0.007) together with postoperative cognitive impairment (OR, 9.2; 95% CI, 1.0-83.3; P=0.048). The total predictive value of the model was 70.5%. CONCLUSIONS: . Malnutrition and a postoperative cognitive disorder were independent risk factors for longer hospital stay, while depression, cognitive impairment, functional dependence, and poor physical status were not independently associated with longer hospital stay. A comprehensive geriatric assessment can help assess the risk factors for longer treatment and predict the length of hospital stay, thus enabling the planning of optimal healthcare management of elderly patients.

[Postoperative cognitive dysfunction of older surgical patients]. / Vyresnio amziaus pacientu pazinimo funkciju pooperacinis sutrikimas.

Light changes in mental function after operation occur in patients of all ages, but more frequent they are observed in older patients. The incidence of early postoperative cognitive dysfunction varies depending on surgical procedure and may be as high as 20-90% in aged patients, and occurs most often in patients undergoing cardiovascular surgery. Early postoperative cognitive dysfunction is a predictor of late postoperative cognitive dysfunction. Delirium develops in at least 50% of older surgical patients and even more frequently after cardiac surgeries (72%). Postoperative delirium, like delirium manifesting with co-existing disease, and late postoperative cognitive dysfunction are strong predictors of functional and cognitive decline in one-year period after discharge and are associated with higher morbidity and mortality, longer hospital stay, and a higher rate of institutionalization. The reasons of postoperative cognitive dysfunction and delirium are not well understood. An assessment of cognitive function should be completed as a routine in older patients, and effective prevention requires the identification of risk factors for delirium: advanced age, preexisting dementia and depression, visual and hearing impairment, Parkinson disease, emergency operation, anticholinergic drugs, and others. After operation, elderly patients must be carefully monitored for probable postoperative delirium. It is important to deepen health care professionals' knowledge of postoperative cognitive complications in older surgical patients.

[Use of technologies in maintaining autonomy of frail older persons]. / Technologiju pritaikymas pagyvenusio amziaus zmoniu savarankiskumui palaikyti.

Although Lithuanian population is aging and the number of older persons is increasing, the expectancy of autonomous life is one of the shortest in Europe. An increasing number of the elderly results not only in aging society, but in increasing morbidity as well. Reality of life is encouraging health care systems to take into account the needs of older patients and to seek for comprehensive assessment, which is not limited by physical assessment only but includes evaluation of functional state, cognition, socioeconomic status, home environment, identification of geriatric syndromes and vulnerability factors, and assessment of frailty. The term "frailty" is used to describe the status of the elderly person who can usually perform the main practical and social daily tasks, but due to loss of various functions, changes, or disorders cannot restore quickly the strength. Concomitant diseases, disorders, disability, and frailty were considered as synonyms, but the researchers have recently agreed that these terms are not the same. The social part of supportive environment is composed of people (family, friends, professional caregivers) who provide help. The physical part includes technologies that make living easier and more autonomous. Gerontechnologies in vulnerable and frail elderly people can compensate impaired orientation and memory, widen the possibility to communicate, exchange information, and move. With the help of gerontechnologies, safe home environment and monitoring of health state can be ensured. In the article, algorithm for maintenance of autonomy in older persons made by the authors is presented.

[Nutritional status of elderly surgical patients]. / Pagyvenusio amziaus operuotinu pacientu mitybos bukle.

UNLABELLED: The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it. MATERIAL AND METHODS: A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0. RESULTS: Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (P<0.05). Obesity was diagnosed in 32.3% of elderly patients and in 40.4% of middle-aged patients (P<0.05). Among men, obese patients made up 20%, among women - 54.4% (P<0.05). Malnutrition was more prevalent among elderly patients who underwent urgent operations than in patients who underwent planned operations (69.6% and 34.1%, respectively; P<0.05) and among elderly patients with impaired cognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, P<0.05). Malnourished elderly patients had lower functional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P<0.05). The prevalence of malnutrition did not differ significantly in the groups of older patients with depression, probable depression and not depressed patients - 75.0%, 57.7%, and 46.7%, respectively (P>0.05). CONCLUSIONS: Malnutrition was diagnosed more frequently in elderly surgical patients than in middle-aged patients. Obesity was more common in women than in men. The prevalence of obesity was not associated with age. Malnutrition in elderly surgical patients was associated with poor functional status, impaired cognitive function, and urgent operation.