[The bacteriological profile of bacteriuria in residents of a long-term geriatric facility].

BACKGROUND: Little is known on the bacteriological profile of consecutive urine samples in elderly patients institutionalized in nursing homes. AIM: This retrospective study aims to characterize urinary pathogens, rates of isolation of the same pathogen in subsequent urine samples and predicting factors associated with such repeated isolations. Data were retrospectively retrieved from medical charts of nursing home patients during a four-year period. The authors looked for changes in rates of positive cultures, changes in urine flora, in rates of repeated isolation of the same pathogens and the possible interrelations with the use of antibiotics. METHODS: A total number of 3229 urine cultures were studied, 1311 of which (43%) were positive and 493 out of these positive cultures (37.6%) were treated with antibiotics. The rates of positive cultures increased consistently during the study period (p=0.003). E. coli (68.1%), Klebsiella pneumoniae and Proteus mirabilis accounted for more than 90% of positive cultures. RESULTS: There was no difference with regard to pathogen types isolated from symptomatic or asymptomatic cases. The rates of recurrent bacteriuria, by the same pathogen isolated at baseline urine culture, were similar in treated and untreated cases. A regression analysis aiming to predict factors associated with subsequent positive cultures had negative results, except for cases of untreated bacteriuria with pseudomonas (CI 1.36-7.09, O.R. 3.11, p=0.006). CONCLUSION: Our data support earlier studies underscoring the need to carefully consider the role of antibiotics and for better clinical guidelines for the treatment of bacteriuria in this population.

[Changes of skeletal muscle mass among disabled elderly].

BACKGROUND: The reduction of skeletal muscle mass and strength, that occurs with aging (sarcopenia), leads to disability in the elderly population. OBJECTIVES: To investigate the prevalence of sarcopenia among older disabled nursing home residents and to examine the relationship between skeletal muscle mass (SMM) and routine data of nutritional, functional status and body composition estimations. PARTICIPANTS: Sixty three men and women aged 63 to 99 years old (mean +/- SD = 84.7 +/- 7.1) suffering from advanced dementia (89.8%), who have undergone evaluations and are considered disabled according to their functional status (FIM = 27-32 +/- 7.2-7.9%). MEASUREMENTS: The whole SMM and body composition (FFM, FM) were assessed by daily urinary creatinine excretion and the results were compared to routine data on nutritional, functional status, body composition, functional status indexes and muscle strength (MMT). RESULTS: Prevalence of sarcopenia was 87.5% and 41.0% for men and women, respectively. Significant differences were found in both gender groups in all indexes of body composition and SMM: prevalence of underweight was 15.4% in women vs 33.3% in men. Absolute levels of FFM and SMM in men were significantly higher, but relative to height2 were reduced among men compared to women. No correlation was found between SMM and routine data of nutritional status, but it highly correlates with values of functional status and body composition. CONCLUSION: Sarcopenia in elderly nursing home residents is one of the important parameters of disability and its prevalence in men is twice as high in comparison to women. The routine nutritional status assessments are limited to estimation of skeletal muscle mass. The method of measuring SMM, based on daily creatinine excretion, is simple but well correlated with body composition and functional status data.

[Artificial tube feeding of elderly suffering from advanced dementia].

BACKGROUND: There is a notable discord between physicians' opinions and reported practice regarding percutaneous endoscopic gastrostomy (PEG) nutrition in nursing homes for demented residents. AIM: The aim of this study was to describe the decision and the outcomes of PEG placement in elderly nursing home residents, suffering from advance dementia and dysphagia. PATIENTS AND METHOD: The retrospective study evaluated frequency, complications of dysphagia and survival in 90 patients of Geriatric Center (61 women, 29 men) who underwent PEG. Average age was 85.7 +/- 0.8 years. Dysphagia diagnosed at 58, refusal of food of 36 patients. Following data was examined: age, time of dysphagia, anthropometric and laboratory tests. RESULTS: Post PEG complications were found in 62.2% of patients and lung aspiration was 38.7% among them. Mortality within 30 days was 14.4% and 1 year survival was 54.4%. Early mortality rate increased with advanced age (over 85 years old), lower serum albumin (< 3.0 gr/dl), hemoglobin (<1 1.0 gr/dl) and cholesterol (< 160 mg/dl), underweight (BMI < 20.0 kg/m2) and time of dysphagia less than 2 months. CONCLUSION: Artificial tube feeding (PEG) of elderly nursing home residents, suffering from advanced dementia, may be clinically beneficial for most patients with dysphagia or meal rejection aside to gradual constriction of the indications for PEG, seeing aforesaid predictor factors.

[Nutritional status assessment in nursing home elderly residents].

BACKGROUND: It is important to correctly assess the nutritional status in elderly nursing home residents because of a direct link between weight loss, general illness and death among this population. METHODS: In 248 nursing home residents (74 men, 174 women; mean age 84.4+/-0.8 years), anthropometric measurements (height, weight, body mass index), serum markers (hemoglobin, total protein, albumin, cholesterol), body composition parameters (fat mass, fat-free mass, total body water) and nitrogen balance (37 patients) were assessed. RESULTS: Most of the patients (48%) were of normal weight, underweight was found in 20% and overweight in 32% of all subjects. Every body weight deviation, under- or overweight, was mainly due to loss or rise of body fat mass and less often due to fat-free mass changes. Unlike stable chronic diseases in older residents, living in nursing home, acute infections and recurrent hospitalizations result in the expansion of the underweight population group (38% versus 11.2%). No correlation was found between serum albumin levels and weight loss or changes in body composition. Nitrogen balance study was found in only 6 cases of catabolic state from 37 patients: half of them suffered from acute infections and at half-daily protein intake that was reduced to 1.0 gr/kg/BM. No correlation was found between laboratory and nitrogen balance tests. CONCLUSION: Deviations of proper weight were found in every second resident at the nursing home, and most of them were overweight. Evaluation of body composition and nitrogen balance enables to differentiate among the residents, identifying those who are likely to be underweight and on the whole improving their health condition.

[Frequency and reasons for falling among residents of the geriatric center].

BACKGROUND: One of the serious problems in geriatrics is falling among the elderly population. It is noted that, as age progresses, the frequency of falling increases, reaching 1.4-4.5 falls per person annually among nursing home residents. Furthermore, recurrent falls are one of the main reasons for their residence in the geriatric nursing home. AIM: The purpose of the study was to determine the frequency and main causes of recurrent falls among mobile nursing home residents, to examine the influence of medications on the frequency of falls and to observe the influence of falls on changes in their health condition and mortality. PATIENTS AND METHODS: During the past 5 years, researchers tracked falls among 242 mobile residents at the "Gil-Ad" Geriatric Center, (mean age 85.2+/-1.2 years). Among observed patients 170 (70.2%) had fallen 959 times, (1.13 falls per person annually). This created a statistical image of the mobile resident, predisposed to recurrent falls: she is the elderly woman aged 83 years and older, suffering from pain, cardiovascular diseases (55.8%), touch infringements due to decreased visual acuity and hearing (76.4%), atrophic musculoskeletal diseases or after orthopedic operations (68.6%) and acute infections (51.2%). A direct link was found between the frequency of falls and the amount of medications provided to the elderly patients: for residents, predisposed to recurrent falls, treatment by 5 and more kinds of drugs, including diuretics, was characteristic. The study proves a mutual dependency between frequency of falls and the functional status of the elderly residents of the geriatric center. CONCLUSION: For prevention of falls and bone fractures among elderly nursing home residents, the clinicians should carefully assess their functional status, in view of diseases and drug treatment.