The association between the 'at risk of developing undernutrition' category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults.

BACKGROUND & AIMS: Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) have been developed for the early recognition of undernutrition in older adults. The SNAQ65+ screens for being undernourished (red), being 'at risk of developing undernutrition' (i.e. 'at risk', orange), or 'not at risk' (green). This study investigated whether community-dwelling older adults 'at risk' (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those 'not at risk' (green). METHODS: Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ65+ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. RESULTS: There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were 'at risk of developing undernutrition' (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ65+ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those 'at risk' (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those 'not at risk' (green) (respective odds ratio's: 2.51 (95%CI 1.74-3.62); 2.16 (95%CI 1.11-4.20); 2.43 (95%CI 1.61-3.65); and 2.08 (95%CI 1.28-3.37)). CONCLUSION: Community-dwelling older adults screened to be 'at risk of developing undernutrition' (orange) with the SNAQ65+ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those 'not at risk' (green).

The sex difference in self-rated health among older Turkish and Moroccan migrants in the Netherlands: an exploratory study of contributing determinants.

BACKGROUND: Although being a woman and having a migration background are strong predictors of poor self-rated health among (older) adults, research on the sex difference in self-rated health among (older) migrants remains limited. This study therefore aims to investigate this topic and explore the contributing role of determinants of self-rated health. METHODS: Cross-sectional data from 360 Turkish-Dutch and Moroccan-Dutch adults aged 55-65 as part of the Longitudinal Aging Study Amsterdam (LASA) were used. Self-rated health (good versus poor) was measured by a single item question. Univariate age-adjusted logistic regression analysis was used to investigate the sex difference in self-rated health and the contribution of sex differences in sensitivity (strength of the association) and/or exposure (prevalence) to socio-demographic, social, lifestyle or health-related determinants of self-rated health. RESULTS: Women had a 0.53 times lower odds (95%CI:0.40-0.82, p = 0.004) on good self-rated health compared to men. Women more often having a lower education level, living alone and having a higher prevalence of depressive symptoms, chronic diseases and especially functional limitations contributed to the lower self-rated health among women. In contrast, men were more sensitive to the impact of memory complaints, depressive symptoms, visual difficulties and functional limitations. CONCLUSIONS: Older Turkish-Dutch and Moroccan-Dutch women have a significant lower self-rated health compared to men. Women having a higher exposure to both socio-demographic and health-related determinants of self-rated health, which contributed to the sex difference. Future research should take these differences in self-rated health and determinants between women and men into account when investigating health among older migrants.

Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging.

BACKGROUND: Women have a higher life expectancy than men but experience more years with physical disabilities in daily life at older ages, especially women with a migration background. This pinpoints older women as an important target group for strategies that stimulate healthy lifestyle, which benefits healthy aging. Our study investigates motivators and barriers for healthy lifestyles and perspectives on determinants of healthy aging of older women. This provides essential information for developing targeted strategies. METHODS: Data was collected by semi-structured digital interviews from February till June 2021. Women aged 55 years and older living in the Netherlands (n = 34) with a native Dutch (n = 24), Turkish (n = 6) or Moroccan (n = 4) migration background were included. Two main subjects were investigated: (1) motivators and barriers on their current lifestyles regarding smoking, alcohol consumption, physical activity, diet and sleep and (2) perspectives on determinants of healthy aging. Interviews were analyzed using Krueger's framework. RESULTS: Personal health was the most common motivator for a healthy lifestyle. In addition, peer pressure and being outdoors were specific motivators for physical activity. Bad weather conditions and personal dislike to be active were specific barriers. The social environment, personal preferences and personal belief to compensate with other healthy lifestyle behaviors were barriers for low alcohol consumption. Personal preferences (liking unhealthy food and not making time) were the main barriers for a healthy diet. Sleep was not perceived as a form of lifestyle behavior, but rather as a personal trait. Since there were no smokers, specific barriers were not mentioned. For Turkish-Dutch and Moroccan-Dutch women, additional barriers and motivators were culture and religion. These were strong motivators to abstain from alcohol consumption and smoking, but a barrier for a healthy diet. With regard to perspectives on determinants of healthy aging, positive views on aging and being physically active were perceived as most important. Women often wanted to increase their physical activity or healthy diet to stimulate healthy aging. Among Turkish-Dutch and Moroccan-Dutch women, healthy aging was also perceived as something in the hands of God. CONCLUSIONS: Although motivators and barriers for a healthy lifestyle and perspectives on healthy aging vary for distinct lifestyles, personal health is a common motivator across all lifestyles. Having a migration background added culture and religion as distinct barriers and motivations. Strategies to improve lifestyle among older women should therefore have a tailored, culture sensitive approach (if applicable) for distinct lifestyle factors.

Two dietary advice strategies to increase protein intake among community-dwelling older adults: A feasibility study.

BACKGROUND & AIMS: Expert groups propose that recommendations for protein intake for older adults should be increased to compensate for a blunted anabolic response to protein. As many older adults do not meet the (current and higher) recommendations, we examined the feasibility of two dietary advice strategies to increase protein intake following either an even distribution of protein over the day ('even' strategy) or a peak in protein during one meal moment ('peak' strategy). METHODS: This randomized controlled trial examined the feasibility (effectiveness and appreciation) of an 'even' or 'peak' dietary advise strategy on increasing protein intake after four weeks among community-dwelling older adults aged ≥65 y. Participants (n = 60) were randomized into one of the three groups; two intervention groups ('even' or 'peak' strategy) and one control group. Participants of both intervention groups with a baseline protein intake <0.9 g/kg adjusted body weight (aBW)/day received personalized dietary advice and protein enriched food products to increase their protein intake to at least 1.2 g/kg aBW/day, and those with an intake between 0.9 and 1.2 g/kg aBW/day to increase their protein intake with 0.3 g/kg aBW/day. When current intake was higher than 1.2 g/kg aBW/day they received advice to follow the strategy without increasing protein intake. The 'even' group was advised to consume a maximum of 20 g of protein during each meal or snack moment while the 'peak' group was advised to consume at least one daily meal with 35-45 g of protein. Effectiveness to increase protein intake was assessed by three 24-h recalls after four weeks and appreciation of the dietary strategies by a five point scale questionnaire. RESULTS: Baseline protein intake was 71.0 ± 12.1 g/day in participants with a protein intake <1.2 g/kg aBW/day. Protein increased significantly more in both intervention groups (+28.9 ± 22.9 g/day for the 'even' group and +21.8 ± 21.4 g/day for the 'peak' group) versus control (+5.7 ± 13.0 g/day), and participants following the 'peak' strategy more often had at least one meal per day very high in protein (≥35 g). Both intervention groups considered the advice to increase protein as (very) clear (100% and 93.6% for the 'even' and 'peak' strategy), and most reported they would (partly) continue following the advice (81% and 88% for the 'even' and 'peak' strategy). CONCLUSIONS: The 'even' and 'peak' dietary advice strategies were effective in increasing protein intake in four weeks and both well appreciated by community-dwelling older adults. The study is registered in The Netherlands National Trial Register (NTR6849).

Perspectives on the Causes of Undernutrition of Community-Dwelling Older Adults: A Qualitative Study.

OBJECTIVES: Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults. DESIGN: Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed. SETTING: Community-dwelling. PARTICIPANTS: Older adults. MEASUREMENTS: A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition. RESULTS: 33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food and appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization. CONCLUSIONS: This study provides guidance to better understand the underlying causes of undernutrition from an older adult's perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.

A critical appraisal of nutritional intervention studies in malnourished, community dwelling older persons.

BACKGROUND & AIMS: With the rapidly increasing number of malnourished older persons in the community, this review aims to summarize the effects of nutritional intervention studies for this target group. METHODS: Based on 2 previous reviews (2009, 2011) an update of the literature was performed. Selected were higher quality studies which included malnourished community dwelling older adults who received dietetic counselling and/or oral nutritional supplements. RESULTS: Ten studies were included. Six studies showed (trends towards) weight gain. Meta-analysis showed a modest effect of the intervention on weight gain, standardized mean difference 0.210 kg (95% CI 0.03-0.40). Effects on other relevant functional and clinical outcomes were inconsistent. Studies were hampered by low sample sizes, low adherence to the interventions, and participants not meeting nutritional requirements. CONCLUSION: Currently, nutritional intervention studies for malnourished community dwelling older adults show limited effects, which may be caused by methodological shortcomings and participants not meeting treatment goals. High quality studies are eagerly awaited to be able to identify (sub)groups of older persons who are most likely to benefit from nutritional support.

Reproducibility of measurements of mid-upper arm circumference in older persons.

BACKGROUND: Mid-upper arm circumference (MUAC) is used as an alternative measure for body mass index to determine thinness in older persons. However, there are limited data on the reproducibility of this measurement in an older population. The present study examined the reproducibility of MUAC measurements in older persons, as well as the influence of different body positions and clothing. METHODS: A cross-sectional reproducibility study was performed in a nursing home (n = 43; age 65-96 years) and swimming pool facilities (n = 107; age 65-88 years). A different pair of observers independently measured the MUAC of each participant in the upright position on two occasions within 1 week. In the nursing home, measurements were also performed for each participant in the laying position and with clothes covering the upper arm. RESULTS: Mean differences and the 95% limit of agreement for inter-observer reproducibility of MUAC were 0.0 cm (-2.6 to 2.5 cm) for the swimming pool facilities and 0.3 cm (-0.6 to 1.3 cm) for the nursing home. Intra-class correlation coefficients (ICCs) were 0.89 and 0.92, respectively. Mean differences between laying and upright positions were 0.1 cm (-2.0 to 2.2 cm) and 0.0 cm (-1.9 to 2.0 cm) for each observer, respectively (ICC 0.96-0.97). Mean differences between clothes versus bare upper arm were -2.7 cm (-6.2 to 0.7) and -2.4 (-5.6 to 0.9 cm) (ICC 0.75 and 0.78). CONCLUSIONS: The reproducibility of the MUAC measurement in older persons is acceptable for group comparisons and, although borderline for the swimming pool facilities, remains acceptable for clinical purposes. The measurement can also be performed in the laying position but not with clothes covering the upper arm.

Ethnic aspects of emotional distress in patients with diabetes--the Amsterdam Health Monitor Study.

AIMS: Depression and anxiety are relatively common in patients with diabetes, but it is unclear whether migrant patients with diabetes are at increased risk for emotional distress. We determined levels of emotional distress in patients with diabetes with a Turkish, Moroccan or Dutch ethnic background and compare distress levels with healthy control subjects. Among patients with diabetes, we examined demographic and clinical correlates of higher levels of emotional distress. METHODS: Cross-sectional data were collected within the framework of the population-based Amsterdam Health Monitor Survey. Adult participants were interviewed to assess demographics, presence of chronic disease(s) and ethnic background. Emotional distress was determined with the Kessler psychological distress scale. Blood was drawn to determine HbA(1c) , glucose, HDL and total cholesterol. Anthropometrics and blood pressure were assessed during a medical examination. RESULTS: The total sample comprised of 1736 participants. The prevalence of emotional distress was significantly higher in participants with diabetes (31%) compared with healthy participants (19%). Increased levels of emotional distress were reported by 38% of the Turkish, 35% of the native Dutch and 29% of the Moroccan patients with diabetes. Among patients with diabetes, the presence of two or more co-morbid chronic diseases was most strongly associated with higher levels of emotional distress, whereas glycaemic control, cholesterol, blood pressure or waist circumference were not. CONCLUSIONS: Emotional distress affects approximately one third of adult patients with diabetes living in Amsterdam. Having multiple co-morbid diseases seems related to more emotional distress among these patients, while ethnicity and diabetes-related characteristics are not.

Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents.

UNLABELLED: The effect of equivalent oral doses of vitamin D3 600 IU/day, 4200 IU/week and 18,000 IU/month on vitamin D status was compared in a randomized clinical trial in nursing home residents. A daily dose was more effective than a weekly dose, and a monthly dose was the least effective. INTRODUCTION: It is assumed that equivalent daily, weekly or monthly doses of vitamin D3 equally influence vitamin D status. This was investigated in a randomized clinical trial in nursing home residents. METHODS: The study was performed in ten nursing homes including 338 subjects (76 male and 262 female), with a mean age of 84 (+/- SD 6.3 years). They received oral vitamin D3 either 600 IU/day, or 4200 IU/week, or 18,000 IU/month or placebo. After 4 months, calcium was added during 2 weeks, 320 mg/day or 640 mg/day or placebo. OUTCOME: serum levels of 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and bone turnover markers. Statistical approach: linear multilevel analysis. RESULTS: At baseline, mean serum 25(OH)D was 25.0 nmol/L (SD 10.9), and in 98%, it was lower than 50 nmol/L. After 4 months, mean serum 25(OH)D levels increased to 62.5 nmol/L (after daily vitamin D3 69.9 nmol/L, weekly 67.2 nmol/L and monthly 53.1 nmol/L, P < 0.001 between groups). Median serum PTH levels decreased by 23% (p < 0.001). Bone turnover markers did not decrease. Calcium supplementation had no effect on serum PTH and bone turnover. CONCLUSION: Daily vitamin D was more effective than weekly, and monthly administration was the least effective.

What predicts change in pulmonary function and quality of life in asthma or COPD?

Information about predictors of decline in pulmonary function (forced expiratory volume in 1 second [FEV1]) or health-related quality of life (HRQoL) in patients with asthma or (chronic obstructive pulmonary disease [COPD]) might help to determine those who need additional care. A 2-year prospective cohort study was conducted among 380 asthma and 120 COPD patients. In both asthma and COPD patients, a 2-year change in FEV1 was only weakly associated with a 2-year change in HRQoL (r = .0.19 and 0.24, respectively). In both groups, older age, living in an urban environment, and a lower peak expiratory flow rate (PEFR) at baseline were associated with a decline in FEV1. Additional predictors of FEV1 decline were greater body weight, less chronic cough or sputum production, and less respiratory symptoms in asthma patients and current smoking in COPD patients. A decline in HRQoL was associated with older age, non-compliance with medication, more dyspnea, and a lower PEFR in asthma patients and with male gender, lower education, lower body weight, more dyspnea, and more respiratory symptoms in COPD patients. Our results show that FEV1 and HRQoL appear to represent different disease aspects influenced by different predictors.

The role of coping resources and coping style in quality of life of patients with asthma or COPD.

OBJECTIVE: Sufficient psychosocial coping resources and an adequate coping style may have a beneficial influence on quality of life in patients with a chronic disease. Until now little research has been directed at these associations and particularly not among patients with asthma or chronic obstructive pulmonary disease (COPD). The objective of this study is to examine the association between psychosocial coping resources and coping style with HRQoL, for asthma and COPD separately. METHODS: Fourteen general practitioners in The Netherlands recruited 273 adult patients with asthma (n = 220) or COPD (n = 53). Data were collected by a pulmonary function assessment, a face-to-face interview and validated questionnaires about psychosocial coping resources (self-efficacy, mastery, self-esteem, and social support), coping style (avoidant, rational and emotional), and health related quality of life (HRQoL). RESULTS: A more emotional coping style (p < 0.01) was independently associated with poor HRQoL in both asthma and COPD patients. Furthermore, in asthma patients, less self-efficacy feelings (p < 0.01), less mastery feelings (p = 0.05), a more avoidant coping style (p = 0.04) and poor pulmonary function (p < 0.01) were independently associated with poor HRQoL. In COPD patients, a more rational coping style (p = 0.02) was independently associated with poor HRQoL. CONCLUSION: Our findings suggest that psychosocial coping resources and coping style are independently associated with HRQoL in patients with asthma or COPD. Further research should explore the possibilities of intervening on these factors, aiming to improve HRQoL in patients with asthma or COPD.

The influence of co-morbidity on health-related quality of life in asthma and COPD patients.

This study examines the association between somatic co-morbidity and both general and disease-specific health-related quality of life (HRQoL) in patients with asthma and chronic obstructive pulmonary disease (COPD). A cross-sectional analysis was done among 161 COPD patients and 395 asthma patients, aged 40-75 years, recruited from general practice. In the total study population, 47% had no, 32% had one, and 21% had two or more somatic co-morbid conditions, with no significant differences between asthma and COPD patients. Co-morbidity appeared to be associated with poor disease-specific HRQoL in asthma [odds ratio (OR) = 2.08 (1.37-3.18)] and with poor general HRQoL in asthma [OR = 2.96 (1.93-4.53)] and COPD [1.81 (0.91-3.60)] patients. Poorest HRQoL was found in patients with more than one co-morbid condition. Cardiac disease and hypertension were associated with poor disease-specific HRQoL in asthma. Of all co-morbid conditions, musculoskeletal disorders were most strongly associated with poor general HRQoL. Cardiac disease was found to be associated with general and disease-specific HRQoL in asthma but not in COPD. In studies on patients with asthma or COPD aged 40-75 years, co-morbidity should be treated as a determinant of HRQoL.

Determinants of different dimensions of disease severity in asthma and COPD : pulmonary function and health-related quality of life.

OBJECTIVE: To identify determinants of pulmonary function and health-related quality of life (HRQOL) to better understand disease severity in patients with asthma and COPD. DESIGN: Observational study. SETTING: Dutch general practice. PATIENTS: We studied 837 asthma patients and 231 COPD patients. RESULTS: The association between pulmonary function and HRQOL was poor for asthma (beta = 0.10) and COPD (beta = 0.19). Multivariately, in asthma, lower pulmonary function was associated with male gender, region of living, current smoking, use of inhaled short-acting bronchodilators, longer duration of disease, and higher diurnal variation in peak expiratory flow. In COPD, lower pulmonary function was associated with male gender, use of inhaled bronchodilators, more days and nights disturbed by respiratory complaints, not wheezing, and bronchial hyperresponsiveness. Reduced HRQOL was associated most strongly with more days and nights disturbed by respiratory complaints and dyspnea in both asthma and COPD. In asthma, additional associations were found with younger age, lower educational level, region of living, comorbidity, use of inhaled bronchodilators and corticosteroids, wheezing, chronic cough, sputum production, and bronchial hyperresponsiveness. In COPD, lower age, not smoking, chronic cough, and sputum production were associated with reduced HRQOL. CONCLUSIONS: Pulmonary function and HRQOL appear to highlight different aspects of disease severity in asthma and COPD. Therefore, both measures should be taken into account in order to get a complete picture of severity of disease.

Determinants of an incorrect inhalation technique in patients with asthma or COPD.

OBJECTIVE: To determine the prevalence of an incorrect inhalation technique and to examine its determinants among primary care patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional study. SETTING: 28 general practitioners in The Netherlands. SUBJECTS: 558 asthma and COPD patients, aged 16-75 years. MAIN OUTCOME MEASURES: Inhalation technique was assessed using a standardised inhaler-specific checklist. Pulmonary function assessment and questionnaires were used to collect data about inhaler, patient and disease characteristics. RESULTS: Overall, 24.2% of the patients made at least one essential mistake in their inhalation technique. The type of inhaler appeared to be the strongest independent determinant of an incorrect inhalation technique. Compared to patients using the Diskhaler, patients using the Rotahaler/Spinhaler, Turbuhaler, Metered Dose Inhaler (MDI) or Cyclohaler/Inhaler-Ingelheim were at significantly higher risk of making inhalation mistakes (odds ratios (OR) were 16.08, 13.17, 11.60 and 3.27, respectively). Other significant determinants of an incorrect inhalation technique were low emotional quality of life (OR = 1.73) and being treated in a group practice (OR = 2.26). CONCLUSIONS: An incorrect inhalation technique is common among pulmonary disease patients in primary care. Our study suggests that especially patients using the Rotahaler/Spinhaler, Turbuhaler or MDI, patients with emotional problems and patients in a group practice are at increased risk for an incorrect inhalation technique.