Geriatric Services Hub - A Collaborative Frailty Management Model between The Hospital and Community Providers.

BACKGROUND: Frailty is an important geriatric syndrome especially with ageing populations. Frailty can be managed or even reversed with community-based interventions delivered by a multi-disciplinary team. Innovation is required to find community frailty models that can deliver cost-effective and feasible care to each local context. OBJECTIVES: We share pilot data from our Geriatric Service Hub (GSH) which is a novel frailty care model in Singapore that identifies and manages frailty in the community, supported by a hospital-based multi-disciplinary team. METHODS: We describe in detail our GSH model and its implementation. We performed a retrospective data analysis on patient characteristics, uptake, prevalence of frailty and sarcopenia and referral rates for multi-component interventions. RESULTS: A total of 152 persons attended between January 2020 to May 2021. Majority (59.9%) were female and mean age was 81.0 ± 7.1 years old. One-fifth (21.1%) of persons live alone. Mean Charlson Co-morbidity Index was 5.2 ± 1.8. Based on the clinical frailty risk scale (CFS), 31.6% were vulnerable, 51.3% were mildly frail and 12.5% were moderately frail. Based on SARC-F screening, 45.3% were identified to be sarcopenic whilst 56.9% had a high concern about falling using the Falls-Efficacy Scale-International. BMD scans were done for 41.4% of participants, of which 58.7% were started on osteoporosis treatment. In terms of referrals to allied health professionals, 87.5% were referred for physiotherapy, 71.1% for occupational therapy and 50.7% to dieticians. CONCLUSION: The GSH programme demonstrates a new local model of partnering with community service providers to bring comprehensive population level frailty screening and interventions to pre-frail and frail older adults. Our study found high rates of frailty, sarcopenia and fear of falling in community-dwelling older adults who were not presently known to geriatric care services.

Effect of dietary fiber on the activity of intestinal and fecal beta-glucuronidase activity during 1,2-dimethylhydrazine induced colon carcinogenesis.

The effects of fiber isolated from black gram (Phaseolus mungo) and coconut (Cocos nucifera) kernel on the metabolic activity of intestinal and fecal beta glucuronidase activity during 1,2-dimethylhydrazine induced colon carcinogenesis were studied. The results indicated that the inclusion of fiber from black gram and coconut kernel generally supported lower specific activities and less fecal output of beta-glucuronidase than did the fiber free diet. This study suggests that the fibers isolated from coconut or black gram may potentially play a role in preventing the formation of colon tumors induced by the carcinogen 1,2-dimethylhydrazine by reducing the activity of the intestinal as well as fecal beta-glucuronidase.

Effect of coconut oil & safflower oil on lipids in isoproterenol induced myocardial infarction in rats.

Effect of feeding safflower oil and coconut oil in experimental myocardial infarction induced by isoproterenol in rats was studied. Based on the survival rate and histopathological examination, safflower oil was found to offer better protection than coconut oil. Serum GOT levels also confirmed the protective activity of safflower oil. The concentrations of cholesterol and triglycerides in the heart and aorta were lower in the safflower oil fed group, while the level of phospholipids was higher.

Effect of ethanol administration on metabolism of lipids in heart and aorta in isoproterenol induced myocardial infarction in rats.

Effect of ethanol administration on the severity of myocardial infarction induced by isoproterenol in rats was studied. Even though serum CPK and GOT levels as well as the extent of myocardial damage as revealed by histopathological studies, were similar, the survival rate was higher in rats administered ethanol. Concentration of cholesterol and triglycerides in the serum and heart in rats given ethanol and isoproterenol seems to be the additive effect caused individually by ethanol and isoproterenol. Myocardial alcohol dehydrogenase and aldehyde dehydrogenase both showed increased activity in rats treated with ethanol. The rate of recovery from myocardial infarction however, was slower in rats treated with ethanol as judged from the serum CPK value.

Effect of administration of carnitine on the severity of myocardial infarction induced by isoproterenol in rats.

The effect of administration of carnitine on the severity of myocardial infarction in rats induced by isoproterenol was studied by following histopathological and biochemical parameters. Carnitine afforded partial protection against myocardial infarction. Serum aspartate amino transferase (GOT) and creative phospho kinase (CPK) values, serum, heart and aortic lipids, serum protein-bound hexose and sialic acid and glycosaminoglycans in the heart were lower in the carnitine-treated rats. Histopathological examination showed very little necrosis in the carnitine-treated rats when compared to the extensive necrosis in the untreated controls.

Diet, nutrition intake, and metabolism in populations at high and low risk for colon cancer. Determination of fiber and fiber constituents in food and stools.

A procedure is described for the determination of total neutral detergent fiber in composite food and stool samples. This procedure also determines hemicellulose, cellulose, lignin, and cutin + silica in these samples. The quantitation of pectins which involves a separate independent procedure is also described. The present modified neutral detergent fiber procedure yielded values that were significantly higher than the crude fiber method described in previous literature.

Effect of dietary fiber on intestinal bacterial beta-glucuronidase activity in chicks fed a cholesterol-containing diet.

The effect of dietary fiber isolated from blackgram (Phaseolus mungo) was studied on the metabolic activity of microflora in the large intestine and cecum in chicks fed a cholesterol diet. The results indicate that inclusion of cholesterol in the diet increased the bacterial as well as tissue (large intestine, small intestine, and cecum) beta-glucuronidase activity when compared to a cholesterol-free diet. Dietary fiber isolated from blackgram when given at 30% level to chicks fed a cholesterol diet significantly lowered bacterial as well as tissue beta-glucuronidase activity. Pure cellulose at the same level did not have this effect.

Nature of the dietary carbohydrate and metabolism of glycosaminoglycans and glycoproteins in rats.

The polysaccharide from blackgram (Phaseolus mungo) has been previously reported to cause lower cholesterol, phospholipids and triglyceride levels in rats fed either low-or high-fat diets containing cholesterol. The effect of this polysaccharide fraction as compared to that of glucose and sucrose on the metabolism of glycosaminoglycans and glycoprotein has been studied. The pattern of change in the levels of different glycosaminoglycans varied in the different tissues. Sucrose fed animals gave lower levels of sulphated glycosaminoglycans in the aorta and liver. The polysaccharide and glucose fed animals gave comparable values in the aorta except in the case of chondroitin sulfate B which was higher and heparin lower in the polysaccharide group. L-glutamine:D-fructose-6-phosphate amino transferase and UDPG dehydrogenase were lowest in the sucrose fed animals and highest in the polysacchride group with the animals in the glucose group showing intermediate values, but UDPG pyrophosphorylase, while highest in the polysaccharide group, was similar in the glucose and sucrose groups. Some of the degrading enzymes studied-beta-glucuronidase, hyaluronidase and aryl sulphatase-were highest in the sucrose group and generally lowest in the polysaccharide group. Levels of 3'-phosphoadenosine-5'-phosphosulphate, the biological sulphating agent, the sulphate activating system which includes ATP sulphurylase and APS kinase and sulphotransferase activity were also lowest in the sucrose fed group and highest in the polysaccharide group. The glycoprotein concentration was highest in the liver and lowest in the kidney in the sucrose group.

Dietary fibre and cholesterol metabolism: effect of fibre rich polysaccharide from blackgram (Phaseolus mungo) on cholesterol metabolism in rats fed normal and atherogenic diet.

The effect of the fibre rich polysaccharide from black gram was studied on the concentration of cholesterol in the tissues, bile salts in the liver and faecal excretion of sterols and bile salts in rats fed normal and high fat cholesterol diet as compared to glucose and sucrose. The binding of bile salts "in vitro" by the polysaccharide was also studied. The rats fed polysaccharide showed the lowest level of cholesterol in the serum, liver and aorta both in normal and high fat -- cholesterol diet groups. Excretion of faecal sterols and bile salts was maximum in the animals fed polysaccharide. The concentration of bile salts in the liver was also maximum in the animals of this group. There was significant binding of bile salts by the polysaccharide when either natural bile or pure bile salt solution was shaken with it. The extent of binding of bile salts was however decreased in the presence of fatty acids, which also released some of the absorbed bile salts from the polysaccharide on subsequent shaking.