The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties.

BACKGROUND & AIMS: Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. METHODS: The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. RESULTS: The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. CONCLUSION: The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.

Low micronutrient intake in nursing home residents, a cross-sectional study.

Low intake of micronutrients is associated with health-related problems in nursing home residents. As their food intake is generally low, it is expected that their micronutrient intake will be low as well. The nutrient intake of 189 residents (mean age 85.0 years (SD: 7.4)) in five different Dutch nursing homes was measured based on 3-day direct observations of intake. Micronutrient intake, without supplementation, was calculated using the Dutch food composition table, and SPADE software was used to model habitual intake. Intake was compared to the estimated average requirement (EAR) or adequate intake (AI) as described in the Dutch dietary reference values. A low intake was defined as >10% not meeting the EAR or when the P50 (median) intake was below the AI. Vitamin A, thiamin, riboflavin, niacin, B6, folate, B12, C, D, E, copper, iron, zinc, calcium, iodine, magnesium, phosphorus, potassium, and selenium were investigated. Our data showed that vitamin and mineral intake was low for most assessed nutrients. An AI was only seen for vitamin B12 (men only), iodine (men only), and phosphorus. A total of 50% of the population had an intake below the EAR for riboflavin, vit B6, folate, and vitamin D. For reference values expressed in AI, P50 intake of vitamin E, calcium, iodine, magnesium, potassium, and selenium was below the AI. To conclude: micronutrient intake in nursing home residents is far too low in most of the nursing home population. A "food-first" approach could increase dietary intake, but supplements could be considered if the "food-first" approach is not successful.

Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study.

OBJECTIVES: To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF). DESIGN: Cross-sectional and prospective routine care cohort study. SETTING: 6874 Residents in Dutch LTCFs (period 2005-2020). PARTICIPANTS: Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing'). MEASUREMENTS: InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'. RESULTS: On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems. CONCLUSION: Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.

The association between polypharmacy and malnutrition(risk) in older people: A systematic review.

BACKGROUND & AIM: Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people. METHODS: The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment. RESULTS: A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, ß ≥ -0.62 and r  ≥ -0.31. CONCLUSION: This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition.

[Is there an association between obesity and periodontitis?] / Is er een relatie tussen parodontitis en obesitas?

Periodontitis and obesity are multifactorial diseases. This literature review shows a weak association between obesity and periodontitis. Physiological mechanisms in obesity and periodontitis, such as increased inflammatory state, are more common in both people with obesity and people with periodontitis. In addition, socio-economic problems, low health literacy and an unhealthy lifestyle are more common in people with obesity and in people with periodontitis compared to people without these diseases.

The Power of mind: Blocking visual perception by hypnosis.

The present study investigated the effects of suggestion on the processing of visual stimuli. Participants counted rare visual stimuli presented on a screen, once during a hypnosis condition where they were suggested that their vision of the screen is blocked by a virtual wooden board in front of their eyes and once during a control condition without suggestion. In the hypnosis condition, counting performance was about 20% worse than in the control condition. At the same time, the P3b amplitude of the event-related brain potential was about 37% reduced. Smaller P3b amplitudes were significantly associated with deficient counting performance, and this effect was largest in participants who reported the blockade as real. In contrast, earlier brain responses (N1, P2) that reflect basic processing of the visual stimuli were not affected by the suggested blockade. We conclude that the suggestion of the blockade affects later stages of visual perception, leaving early processes intact. This illustrates the impact of suggestions and the power of mind.

Effects of the daily consumption of protein enriched bread and protein enriched drinking yoghurt on the total protein intake in older adults in a rehabilitation centre: a single blind randomised controlled trial.

OBJECTIVES: To investigate the effects of protein enriched bread and drinking yoghurt, substituting regular products, on the total protein intake and the distribution of protein intake over the day in older adults. DESIGN: A single blind randomised controlled trial. SETTING: Rehabilitation centre. PARTICIPANTS: Older adults (≥ 55 years) admitted to a rehabilitation centre after hospital discharge (n=34). INTERVENTION: Participants received a high protein diet (protein enriched bread and protein enriched drinking yoghurt; n=17) or a regular diet (regular bread and regular drinking yoghurt; n=17) for three consecutive weeks. MEASUREMENTS: Total protein intake and protein intake per meal, measured twice weekly over a three weeks period (six measurements per participant). RESULTS: Compared with controls, patients who received the protein enriched products had a significantly higher protein intake (115.3 g/d vs 72.5 g/d, P<0.001; 1.6 g/kg/d vs 1.1 g/kg/d, P<0.001). The intervention group consumed quantities over the recommended level (25-30 g/meal) during each of the three meals (32.5 g, 30.0 g, 34.8 g/meal), where the control group consumed quantities below the recommended level during breakfast (17.7 g) and lunch (18.4 g). CONCLUSIONS: The use of protein enriched products, replacing regular products, results in a significant increased daily protein intake in older adults. In addition, the daily consumption of protein enriched products improves protein distribution over the day.

The emerging trend of work beyond retirement age in Germany. Increasing social inequality?

BACKGROUND: Population ageing, demographic change and the financial crisis has put the financial sustainability of the German pension system at risk. In reaction to these challenges, Germany recently abandoned generous early retirement policies and moved towards policies encouraging higher employment among the elderly. OBJECTIVES: In this article we evaluate how these labour market and pension policies affected the retirement decisions of older workers in Germany over the last three decades. Complementing previous research on early retirement, we focus in particular on those working past the mandatory retirement age of 65 years and examine whether the composition of this group of postretirement-age workers has changed over time. DATA AND METHODS: We analyse pooled cross-sectional data from three rounds of the German Ageing Survey which allow us to cover the last three decades from 1980 to 2008. Estimating multinomial logit models we distinguish explanatory factors on the individual, organizational and institutional level that frame the decision to leave the labour market before the age of 65, to stop working at 65 or to work past 65. RESULTS: Over the last three decades, the share of German workers leaving the labour market after the mandatory retirement age of 65 has increased markedly. This trend towards working longer has changed particularly among the low educated workforce which in previous decades traditionally has exhibited a tendency to retire early. In contrast to high-skilled workers, the decision to work longer among low-educated workers is mainly driven by financial need (and is usually not in line with their desire or their ability to work for longer). CONCLUSION: Our findings suggest an increase in social inequality in retirement decisions as a result of the policy shift towards activation. We conclude by arguing for a more fine-grained understanding of the reasons why people work longer. Such research would provide valuable insights into how to design future labour market and pension reforms preventing a rise in social inequalities.

Differential caloric intake in overweight females with and without binge eating: effects of a laboratory-based emotion-regulation training.

Negative emotions are among the best predictors for the occurrence of binge eating attacks in binge eating disorder (BED). Evidence from self-report and experimental studies suggests that this link may be mediated by deficits in emotion regulation (ER). Therefore, the aim of the present study was to experimentally test the effects of a short laboratory-based ER training on caloric intake in BED. Thirty-nine women with BED and 42 overweight females without BED were randomly assigned to a laboratory-based ER training focusing on either expressive suppression or cognitive reappraisal. They were then given a negative mood induction with the instruction to adopt the learned ER strategy, which was followed by a bogus taste-test. Independent of group membership, caloric intake was significantly higher in the suppression compared to the reappraisal condition. Furthermore, the BED group displayed significantly higher habitual suppression and significantly lower habitual reappraisal scores than the overweight group. The data suggest that therapeutic interventions focusing on the mediation of more adaptive affect-regulation skills may be useful for the reduction of binge eating episodes.

The impact of an implicit manipulation of self-esteem on body dissatisfaction.

BACKGROUND AND OBJECTIVES: Given the theoretically postulated causal pathway from low self-esteem on body dissatisfaction, the aim of the present study was to experimentally test this linkage before and after a mirror exposure in body dissatisfied females. METHOD: Thirty-six women with high body dissatisfaction (HBD) and 39 women with low body dissatisfaction (LBD) received either a positive or a negative implicit manipulation of self-esteem and participants' actual body dissatisfaction and negative emotions were assessed (T1). Following that, they underwent a one minute mirror exposure and actual body dissatisfaction and emotions were assessed once more (T2). RESULTS: In the HBD group no effects of the self-esteem manipulation were found prior to the mirror exposure. However, the negative manipulation of self-esteem led to a significant increase of body dissatisfaction over the course of the mirror exposure. The positive manipulation of self-esteem did not decrease body dissatisfaction over the course of the mirror exposure. No effects of self-esteem on body dissatisfaction were found in the LBD group. LIMITATIONS: Formal eating disorder diagnosis in study participants was not established. Therefore, the extension of the results to an eating disordered population is recommended. CONCLUSIONS: The results yield evidence of a close linkage between negative self-esteem and body dissatisfaction in individuals high on body dissatisfaction. Consistent with cognitive theories, this link is only apparent when shape and weight schemas are activated, e.g. by the confrontation with one's own body.

Alteration of cerebral perfusion in patients with idiopathic normal pressure hydrocephalus measured by 3D perfusion weighted magnetic resonance imaging.

OBJECTIVE: It is controversial whether alteration of cerebral perfusion plays an important role in the pathophysiology of patients with idiopathic normal pressure hydrocephalus (NPH) and can help to predict the outcome after shunt surgery. MATERIALS AND METHODS: 28 patients with suspected NPH were examined clinically (Homburg Hydrocephalus Scale, walking test, incontinence protocol) and by 3D dynamic susceptibility based perfusion weighted magnetic resonance imaging (PWI-MRI) before and after cerebrospinal fluid release (spinal tap test, STT). The perfusion parameters (negative integral (NI), time of arrival (T0), time to peak (TTP), mean transit time, and the difference TTP-T0 were analysed. RESULTS: Three different groups of patients were identified preoperatively: In group 1 seven patients showed an increase in the cerebral perfusion and a clinical improvement after STT. The second group (9 patients) also revealed an increase of the cerebral perfusion, but no significant alteration of the clinical assessment could be found. In the third group neither the cerebral perfusion nor the clinical assessment changed. 14 of the 16 patients (group 1 and 2) were examined three months after shunt placement. 11 patients showed a good or excellent result, 2 patients revealed a fair assessment, and only 1 patient had transiently improved. No patient was downgraded after shunting. In the patient group 1 and 2 the NI increased significantly (effect size: 34%), whereas in group 3 no significant alteration of NI was observed. CONCLUSION: PWI-MRI improves the prediction of outcome after shunt placement in patients with NPH and can offer new insights into the pathophysiology.

Suppression of interleukin-6 to interleukin-10 ratio in chronic alcoholics: association with postoperative infections.

OBJECTIVE: To investigate the interleukin-6 (IL-6) to interleukin-10 (IL-10) ratio and levels of sE-selectin in patients undergoing elective surgery of the upper digestive tract and to define the differences in the perioperative immune response between chronic alcoholic and non-alcoholic patients. DESIGN: Prospective pilot study. SETTING: Single center, interdisciplinary intensive care unit (ICU) at a university hospital. MEASUREMENT AND MAIN RESULTS: The study compared chronic alcoholics ( n=25) and non-alcoholics ( n=20) before and after surgery for resection of upper digestive tract tumors. White blood cell counts, C-reactive protein and circulating levels of sE-selectin, the pro-inflammatory cytokine IL-6 and the inhibitory cytokine IL-10, were obtained at hospital admission, preoperatively, postoperatively at ICU admission and 2 and 4 days later. Rates of postoperative infectious complications including pneumonia and sepsis were determined. sE-selectin only differed between chronic alcoholics and non-alcoholics preoperatively. Compared to non-alcoholics, chronic alcoholic patients showed a fourfold increase in circulating levels of IL-10 ( p<0.01) and a suppression of the IL-6/IL-10 ratio ( p=0.001) immediately after surgery. Coincident with the immune alterations, chronic alcoholics had a prolonged ICU stay ( p<0.01) and a threefold increased rate of wound infections ( p<0.05) and pneumonia ( p<0.01). Lower IL-6/IL-10 ratios were associated with increased rates of infectious complications ( p<0.05). CONCLUSION: Chronic alcoholics had decreased IL-6/IL-10 ratios at ICU admission and increased rates of infectious complications in the postoperative ICU course. This may indicate immediate postoperative immune suppression before the onset of infections and may help to identify chronic alcoholic patients at risk.

[Treatment of idiopathic headache in childhood - recommendations of the German Migraine and Headache Society (DMKG)]. / Therapie idiopathischer Kopfschmerzen im Kindesalter. Empfehlungen der Deutschen Migräne-und Kopfschmerzgesellschaft (DMKG).

According to the principles of evidence-based medicine, the controlled studies on the treatment of idiopathic headache in childhood have been analysed and compiled to treatment recommendations. For the acute treatment of migraine attacks or tension-type headache, ibuprofen (10 mg per kg body weight) or acetaminophen (15 mg per kg body weight) are recommended with highest evidence, intranasal sumatriptan (10 to 20 mg) can be given as second choice. For the prophylaxis of migraine, betablockers (propranolol and metoprolol), flunarizine, and valproic acid are recommended. Flunarizine is the drug of first choice in the treatment of migraine-related disorders. No controlled studies are available for the treatment of further headache types. First line methods for the non-drug treatment of headache in childhood are relaxation therapies, biofeedback, and specific training schedules.

The quest for the EEG reference revisited: a glance from brain asymmetry research.

Recent findings suggested that the choice of the EEG reference might be a critical issue for the study of anterior asymmetry in the alpha band. The present paper investigates the validity of different reference schemes for the measurement of alpha asymmetry. A 32-channel resting EEG was recorded with a common vertex reference (Cz), and transformed into computer-averaged ears (A1 + A2), average reference (AR), and current source density derivations. A correlation analysis of an alpha asymmetry measure between all derivation schemes indicated a poor convergent validity for anterior sites but an excellent convergent validity for posterior sites. Further analyses suggested the presence of substantial alpha activity at the various reference sites (Cz, A1 + A2, AR), which might be similar in magnitude to anterior but smaller than posterior alpha. These findings suggest that the validity of a reference scheme is a function of the signal-to-noise ratio of the electrical activities at target and reference sites. The limitations of each reference scheme for the measurement of anterior alpha asymmetry are discussed.

The effects of ocular artifacts on (lateralized) broadband power in the EEG.

OBJECTIVE: Empirical evidence suggests that blinks and eye movements do not generate substantial activity outside the delta and theta range, and that the propagation of ocular activity to the EEG is rather symmetrical. These observations suggest that an alteration of the alpha and beta asymmetry of the EEG due to ocular artifacts is not likely to occur. The aim of the present study is to examine the effects of ocular artifacts on broadband EEG parameters. METHODS: EEG and EOG were recorded from 31 participants in a resting condition with eyes open and closed, allowing for spontaneous ocular activity. General effects of ocular artifacts were examined with mean comparisons, and differential effects were examined with correlation analysis of data portions that were selected for a presence or absence of artifacts. RESULTS: At single sites, blinks and eye movements exerted substantial general effects on the whole EEG spectrum, but there were no substantial differential effects of artifacts in the alpha and beta bands, except at the frontopolar sites. The distorting effects of ocular artifacts were smaller in magnitude for asymmetry than for single site measures. CONCLUSIONS: The control of ocular artifacts may be dispensable for correlation analyses of alpha or beta band parameters.

[Personality and rehabilitation in young adults with renal replacement therapy]. / Persönlichkeitsstruktur und Rehabilitation bei jungen Erwachsenen mit Nierenersatztherapie.

To evaluate the personality structure of young adults treated with renal replacement therapy (RRT) since childhood, we studied 36 patients who had commenced RRT before age 18. At the time of investigation 17 patients were dialyzed and 13 had a functioning renal transplant. Of the dialysis patients, 7 had been transplanted previously. These patients were compared to 26 young adults (minimum age 16) with diabetes mellitus type I (DM) of comparable duration. We used the FP1 test (half-form R; 138 items) by J. Fahrenberg to evaluate personality structure in patients and controls. The results show in general very little difference compared to published normal values and only slight differences between the groups studied. However, there was a trend for RRT patients to feel more aggressive and inhibited than patients with DM. Transplanted patients tended to feel more worried about health problems, while hemodialysis patients felt more self-assured than DM patients. Although it is difficult to assess the psychological burdens of chronic illness and the influence of continuing psychosocial support, it seems remarkable that a better than expected psychiatric adjustment has also been reported in other studies of patients with RRT. In conclusion, adult patients with RRT since childhood have a favorable personality profile as measured by self-evaluation with the FP1-R test, inspite of the well-known multiple medical and social handicaps of this patient population.

Effects of dehydroepiandrosterone replacement in elderly men on event-related potentials, memory, and well-being.

BACKGROUND: In humans, concentrations of the adrenal steroid hormone dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) decline with age. Results from studies in rodents have suggested that DHEA administration can improve memory performance as well as neuronal plasticity. However, a first study from our laboratory could not demonstrate beneficial effects of DHEA substitution on cognitive performance and well-being in elderly subjects. To further evaluate whether DHEA replacement has effects on the central nervous system, an experiment using event-related potentials (ERPs) was conducted. METHODS: In this placebo-controlled crossover study, 17 elderly men (mean age, 71.1 +/- 1.7 yr; range 59-81 yr) took placebo or DHEA (50 mg/day) for 2 weeks (double blind). After each treatment period subjects participated in an auditory oddball paradigm with three oddball blocks. In the first two blocks subjects had to count the rare tone silently, whereas, in the third block they had to press a button. In addition, memory tests assessing visual, spatial, and semantic memory as well as questionnaires on psychological and physical well-being were presented. RESULTS: Baseline DHEAS levels were lower compared with young adults. After 2-week DHEA replacement, DHEAS levels rose 5-fold to levels observed in young men. DHEA substitution modulated the P3 component of the ERPs, which reflects information updating in short-term memory. P3 amplitude was increased after DHEA administration, and only selectively in the second oddball block. DHEA did not influence P3 latency. Moreover, DHEA did not enhance memory or mood. CONCLUSIONS: A 2-week DHEA replacement in elderly men results in changes in electrophysiological indices of central nervous system stimulus processing if the task is performed repeatedly. However, these effects do not appear to be strong enough to improve memory or mood.

Frontal brain asymmetry and affective style: a conceptual replication.

Recent studies have demonstrated that positive and negative affective reactivity can be predicted by resting electroencephalographic (EEG) asymmetry in frontal brain regions. These studies used different methods to assess asymmetry and affectivity. The goal of the present study was a conceptual replication of these results and to investigate their independence of employed procedures. Resting EEG of 37 subjects was recorded and affective slides were presented to obtain ratings of subjects' emotional reactions. Different procedures were applied to the data to assess the relation between asymmetries and affective reactivity. Depending on the particular analysis procedure, there were associations between anterior asymmetry and affectivity in line with the published findings, opponent to those findings, or no relation between anterior asymmetry and affective reactivity.