Nutritional status and well being. Is there a relationship between body mass index and the well-being of older people?

Poor nutritional status may impair well being indirectly as a consequence of increased morbidity and decline in functional status. The aim of this study was to examine the independent effect of body mass index on the well being of older people. Thirty one hospital-based patients over 65 years of age were studied. Well being was assessed using the Philadelphia Geriatric Center Morale Scale (PGCMS)--anglicised version. Body mass index and well being were assessed on admission to hospital and at three months. At follow-up, a significant correlation was observed between body mass index and PGCMS values. Further analysis showed that this relationship was linear, with poor nutritional status being associated with low levels of well being and good nutritional status being associated with the highest levels of well being. High or low body mass index was able to predict the PGCMS score with a poor sensitivity of 44% and specificity of 96%. When the contribution of potential confounding variables was analysed, body mass was found to have no significant independent effect on well being. Instead, the presence of depression was the most powerful predictor of levels of well being. In conclusion, this study has demonstrated that nutritional status, as indicated by body mass index, has no detectable independent effect on well being. However, measurement of nutritional status may still have a role in the assessment of well being, in that, while the finding of a low body mass index cannot be taken as indicative of low levels of well being, the finding of a high body mass index is likely to indicate adequate well being. Further studies, however, are required in this area that would involve larger numbers of subjects and alternative measures of nutritional status and well being.

The RCP stroke audit package in practice.

This paper describes the use of the Royal College of Physicians 'stroke audit package' in an audit of the care of 156 patients. Recording of history and management compared favourably with that recorded on the RCP database. For a number of items, recording was significantly improved when a locally developed 'checklist', based on the RCP standards, was utilised by trainee medical staff. Benefits of the audit package, and proposed changes in practice, are briefly outlined.

The double sugar test of intestinal permeability in the elderly.

Tests of intestinal permeability are used as a reflection of upper-small-intestinal mucosal damage. Thirty-two elderly in-patients aged 75-96 years, and 64 hospital volunteers aged 22-64 years with no overt gastro-intestinal disease were studied to determine whether permeability changes with increasing age. Intestinal permeability was assessed by measuring the 5-h urinary excretion of a monosaccharide, L-rhamnose, and a disaccharide, cellobiose, for 5 h after their oral administration in a hypertonic solution. While in the elderly, excretion of both mono- and di-saccharides was significantly reduced by a half to two-thirds, the ratio of the two sugars in the urine was similar in both age groups. We conclude that permeability was unimpaired in the elderly patients whom we studied. Because the test depends on a ratio of excretion rates rather than an absolute rate, accuracy of urine collection and abnormal renal function do not invalidate the results. It is therefore useful as a screening test of upper-small-intestinal mucosal damage in the elderly.