ABSTRACT
In 1996, the Sherbrooke Geriatric University Institute introduced a specific health and services program focusing on actualization of potential and psychological autonomy designed for long term care clients presenting few or no cognitive deficits. Some 30 residents who met specific criteria were moved to the same unit. To determine the impact of this specific program on the residents, a study was done using a quasi-experimental design with a control group. The residents in the experimental and control groups were evaluated three times: at the beginning of the program (1996), 1 year (1997) and 2 years (1998) later. The main variables measured were: actualization of potential, psychological autonomy, psychological well-being, satisfaction with care and services, social relations, and perception of the freedom allowed by the institution in regard to their choices and decisions. The results indicate that the new program had no effect on the residents' psychological autonomy, actualization of potential and social relations. In addition, the residents in the experimental group indicated less well-being and less satisfaction than those in the control group. Despite these negative elements, the experimental residents like being and want to stay together on the same unit but seem somewhat concerned about the program objectives. These results led the research team to propose that the program objectives and activities be reviewed.
ABSTRACT
BACKGROUND: Influenza is a major health problem among elderly people in industrialized countries. Nursing homes may be a particularly good setting for outbreaks of influenza. Thus, the aim of the present study was to evaluate some aspects of the nutritional status of institutionalized elderly subjects in relation to their response to influenza vaccination. Certain aspects of the cellular immune response were also investigated. METHODS: Twenty-three patients participated in this cross-sectional study. All patients were vaccinated on day 0 with FluviralR, 1994-95 preparation: A/Shangdong/09/93, A/Texas/36/91, B/Panama/45/90. At the same time the prevaccination antibody titer, the nutritional status by the Mini Nutritional Assessment, biochemical parameters, and lymphocyte proliferation were assessed. On day 28, the postvaccination antibody titer was determined. The determination of pre- and postvaccination antibody titers against the various influenza antigens was carried out by the hemagglutination inhibition test. An increase of 4x for any of the virus antigens was considered as a seroconversion. A titer higher than 40 at the prevaccination period was considered as protective. RESULTS: Eleven elderly subjects were responsive and 12 were not. We have shown that the nutritional parameters such as hemoglobin, hematocrit, total protein, iron and vitamin E levels, as well as the DHEA level and the cellular immune response were significantly lower in the nonresponsive group as compared to the responsive group. Thus, they might be associated with the influenza vaccine responsiveness of institutionalized elderly subjects. CONCLUSIONS: These results will help design intervention studies for improving the immune response by achieving an optimal nutritional status, mainly in the frail elderly population, that could have a great public health impact.
Subject(s)
Influenza Vaccines/immunology , Institutionalization , Nutritional Status , Vaccination , Aged , Aged, 80 and over , Antibodies, Viral/analysis , Antigens, Viral/analysis , Blood Proteins/analysis , Cell Division , Cross-Sectional Studies , Dehydroepiandrosterone/blood , Female , Geriatric Assessment , Hemagglutination, Viral , Hematocrit , Hemoglobins/analysis , Humans , Immunity, Cellular/immunology , Influenza A virus/immunology , Influenza B virus/immunology , Iron/blood , Lymphocytes/immunology , Male , Nursing Homes , Nutrition Assessment , Vitamin E/bloodABSTRACT
Insulin binding parameters have been measured in testicular membranes of streptozotocin diabetic male rats. Insulin binding decrease was ascribed to the well-known depressing effect of diabetes mellitus on circulating luteinizing hormone (LH). Because both LH and insulin receptors are modulated by pituitary LH and because of their reduction in testes of diabetic rats, we conclude that Leydig cell dysfunction is a secondary disorder associated with this complex metabolic condition.