Relationship between Anticholinergic Burden and Health-Related Quality of Life among Residents in Long-Term Care.

OBJECTIVES: Anticholinergic burden defined by the Anticholinergic Risk Scale (ARS) has been associated with cognitive and functional decline. Associations with health-related quality of life (HRQoL) have been scarcely studied. The aim of this study was to examine the association between anticholinergic burden and HRQoL among older people living in long-term care. Further, we investigated whether there is an interaction between ARS score and HRQoL in certain underlying conditions. DESIGN AND PARTICIPANTS: Cross-sectional study in 2017. Participants were older people residing in long-term care facilities (N=2474) in Helsinki. MEASUREMENTS: Data on anticholinergic burden was assessed by ARS score, nutritional status by Mini Nutritional Assessment, and HRQoL by the 15D instrument. RESULTS: Of the participants, 54% regularly used ARS-defined drugs, and 22% had ARS scores ≥2. Higher ARS scores were associated with better cognition, functioning, nutritional status and higher HRQoL. When viewing participants separately according to a diagnosis of dementia, nutritional status or level of dependency, HRQoL was lower among those having dementia, worse nutritional status, or being dependent on another person's help (adjusted for age, sex, comorbidities). Significant differences within the groups according to ARS score were no longer observed. However, interactions between ARS score and dementia and dependency emerged. CONCLUSION: In primary analysis there was an association between ARS score and HRQoL. However, this relationship disappeared after stratification by dementia, nutritional status and dependency. The reasons behind the interaction concerning dementia or dependency remain unclear and warrant further studies.

Evaluation of a mobile team dedicated to behavioural disorders as recommended by the Alzheimer Cooperative Valuation in Europe joint action: observational cohort study.

BACKGROUND AND PURPOSE: Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction. METHODS: A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team. RESULTS: Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days. CONCLUSIONS: The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.

Nutritional guidelines for older people in Finland.

BACKGROUND: Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE: To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN: A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS: The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 µg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS: Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Nutritional Intervention Via Videoconferencing for Older Adults Receiving Home Care - A Pilot Study.

BACKGROUND: Malnutrition is common in aged home care clients and that affects negatively the health of aged people. Nutritional screening is recommended for early detection of malnutrition. OBJECTIVES: The aim was to assess the nutritional status and food intake of home care receivers and improve their nutrient intake with tailored nutritional advice administered via videoconferencing. DESIGN: Intervention with follow-up. SETTING: Home care in the city of Helsinki. PARTICIPANTS: 25 older (>65 years) adults receiving home care. INTERVENTION: After an initial assessment determining their needs, participants received tailored nutritional advice via videoconferencing over a six-month follow-up period. MEASUREMENTS: Participants nutritional status was assessed with a Mini Nutritional Assessment -test (MNA). Nutrient intake was calculated based on a detailed three-day food diary compiled twice during the six-month follow-up period. RESULTS: Altogether 25 persons participated in the study (mean age 78.5 years, 88 % females). According to the MNA test 80 % were at risk of malnutrition at the outset. Energy (1329 kcal) and mean nutrient intakes of protein (54 g) and folic acid (210 µg), for example, were inadequate. After six months of intervention, the mean energy intake had increased to 1450 (SD 319) kcal, protein to 65 (SD 20) g, and folic acid to 231 (SD 105) µg per day. CONCLUSIONS: The energy, protein and other nutrient intake of the study participants increased during the six-month intervention. Videoconferencing seemed to be a well-accepted and feasible method for providing nutritional advice to older home care clients.

Unintended weight loss in the elderly living at home: the aged in Home Care Project (AdHOC).

OBJECTIVE: To describe associations between unintended weight loss (UWL) and characteristics of nutritional status. DESIGN: A comparative cross-sectional assessment study at 11 sites in Europe. The target population was a stratified random sample of 4,455 recipients of home care (405 in each random sample from 11 urban areas) aged 65 years and older. MEASUREMENTS: the Resident Assessment Instrument for Home Care, version 2.0. Epidemiological and medical characteristics of clients and service utilisation were recorded in a standardized, comparative manner. UWL was defined as information of 5% or more weight loss in the last 30 days (or 10% or more in the last 180 days). RESULTS: The final sample consisted of 4,010 persons; 74% were female. The mean ages were 80.9 +/- 7.5 years (males) and 82.8 +/- 7.3 years (females). No associations were found between single diagnoses and UWL, except for cancer. Cancer patients were excluded from further analyses. Persons with a Cognitive Performance Scale value (CPS) superior 3 (impaired) had increased risk of UWL (OR = 2.0) compared with those scoring inferior or egal 3 (less impaired). Only in the oldest group did we find a significant association between UWL and reduction in ADL and IADL functions, comparing those who scored 3 or less with those who scored more than 3 (disabled). A binary logistic regression model explained 26% of UWL: less than one meal/day, reduced appetite, malnutrition, reduced social activity, experiencing a flare-up of a recurrent or chronic problem, and hospitalisation were important indicators. CONCLUSION: We recommend a regular comprehensive assessment in home care to identify clients with potential risk factors for weight loss and malnutrition, in particular those discharged from hospital, and those with physical dependency or cognitive problems. This study may provide incentives to create tailored preventive strategies.

Increased work-load associated with faecal incontinence among home care patients in 11 European countries.

UNLABELLED: The plurality of definition of faecal incontinence (FI) complicates the cross-national comparisons between studies conducted in the area. The aim of the study was to investigate work-load and subjective care-giver burden associated with FI, among home-care patients, in Europe. DESIGN AND METHODS: In this cross-sectional retrospective study, a random sample of 4010 RAI-HC assessments were collected during 2001-02 from home care patients aged 65 years and over (74% females; age 82.8 +/- 7.2 years) in Czech Republic, Denmark, Finland, France, Germany, Iceland, Italy, The Netherlands, Norway, Sweden and United Kingdom. RESULTS: Of the 4010 individuals, 411 (10.3%) suffered from FI (range 1.1-30.8% from site to site). The factors significantly associated with faecal incontinence were diarrhoea [odds ratio (OR) 10.3, 95% confidence interval (CI) 6.590-15.96], urinary incontinence (OR 3.99, 95% CI 2.991-5.309) and pressure ulcers (OR 3.15, 95% CI 2.196-4.512) together with severe impairments in physical (OR 4.25, 95% CI 2.872-6.295) and cognitive (OR 3.76, 95% CI 2.663-5.304) functions. High use of working hours of the visiting nurses (OR 2.04, 95% CI 1.221-3.414) and home health carers (OR 2.40, 95% CI 1.289-4.470) were additionally associated with faecal incontinence. Use of five or more medications was an inversely associated with FI (OR 0.62, 95% CI 0.473-0.820). CONCLUSIONS: The additional work load associated with faecal incontinence comprises considerable numbers of formal health care hours and should be taken into account when planning home health services for the older in home care patients.

Home care needs of extremely obese elderly European women.

OBJECTIVE: To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. STUDY DESIGN: A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'. MAIN OUTCOME MEASURES: Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. RESULTS: One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. CONCLUSIONS: Extreme obesity is a problem that increasingly affects home care of elderly women.

Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.

OBJECTIVE: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. DESIGN: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. SETTING: All nursing homes in Helsinki community, the capital of Finland. SUBJECTS: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined. RESULTS: One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15). CONCLUSIONS: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

Daily pain, its associates and impact on work load in institutional long-term care.

The objective of this study was to investigate the occurrence of daily pain, its associates and impact on work load in institutional long-term care (LTC) in a geriatric hospital responsible for all the hospital-based LTC-services in one health district (population 71,000) in Helsinki, Finland. All LTC-patients (n=656, females 81%, mean age=83 years) treated during 1 week were examined. Minimum Data Set (MDS 1.0), measurement of patient-related time according to Resource Utilization Groups (RUG-III)-studies, and Mini-Mental State Examination test (MMSE) were performed. If the patients complained or showed verbal or non-verbal evidence of pain at least once per day, they were considered to suffer from daily pain. Daily pain was present in 23% of the patients studied and its occurrence associated significantly with severity of illnesses, dehydration, vomiting, swallowing problems, weight loss, dyspnea, edema and terminal prognosis. It also related to frailty, poor functional capacity, contracture and the lack of body control. The occurrence of pain was increased in patients needing wound care, pressure relieving tools and mechanically altered diet. According to multivariate analysis dehydration, dyspnea, edema, diabetes mellitus, depression, wound care and dependency in locomotion emerged as independent associates of pain. The distribution of daily pain is heterogenic, even though it is accumulated in the sickest and frailest patients. The nursing staff addressed 14% more time to patients with pain than to those with out pain (P<0.05).