Geriatrics, Volume 7, Issue 2 (April 2022) – 27 articles

Discriminating between Alzheimer’s disease (AD), mild cognitive impairment (MCI) and functional memory disorders (FMD) can sometimes be difficult because amnesic syndrome can be confused with memory dysfunction due to aging and/or depression. This work aims to translate, adapt and validate the five-word test (FWT) in an Italian sample (Test delle 5 Parole, T5P). FWT is a screening memory task specifically built to discriminate the hippocampal memory deficit—typical of AD and amnesic MCI—from those related to functional disorders. We involved a large number of subjects (n = 264): 60 with AD, 80 with MCI, 46 with FMD, and 78 healthy controls (CTRL). Two traditional screening tests and the T5P were administered to all participants. Results showed an excellent convergent validity of the T5P (p < 0.05). Moreover, the T5P appeared as an effective test able to discriminate between the four conditions, except for FMD and CTRL. In particular, a total score of ≤9 allowed for accurately discriminating subjects with AD + MCI compared to participants with FMD + CTRL with high sensitivity (83.87%) and specificity (76.43%). Overall, the T5P is a simple, rapid and sensible test of the hippocampal memory that is recommended in clinical practice to screen persons with subjective/probable amnesic difficulties and to discriminate between patients with AD or MCI and CTRL. Full article

The doubly labeled water method is a gold-standard method for the measurement of total energy expenditure in daily life. We aimed to identify the relationship between measured aerobic capacity and total energy expenditure, activity energy expenditure, or physical activity level using the doubly labeled water method in adults of advanced old age. A total of 12 physically independent older adults (10 men and 2 women), aged 81–94 years, participated in this study. The aerobic capacity was evaluated according to the lactate threshold. Total energy expenditure under free-living conditions was assessed using the doubly labeled water method, and self-reported physical activity was obtained using the Japanese version of the International Physical Activity Questionnaire. The lactate threshold was significantly positively correlated with total energy expenditure, activity energy expenditure, and physical activity level after adjusting for age and sex. We found that the aerobic capacity of the lactate threshold was positively and independently correlated with total energy expenditure, activity energy expenditure, or physical activity level. The present results suggest that maintaining aerobic capacity is an important factor in preventing frailty, although further research is required. Full article

Dietary habits are determinants in the development of a range of conditions and age-related diseases. We explored the associations of sociodemographic, health-related indicators, and health behavioral factors on dietary guideline compliance in elderly Chileans. We used a cross-sectional design using the publicly available database from the last Chilean National Health Survey (2016–17). The sample of 1831 older adults (≥60 y) from a national representative sample. The dependent variable was compliance with Food Guidelines (FG) (daily consumption of water, dairy, and fruits and vegetables; and weekly consumption of legumes and fish). The independent variables included sociodemographic, health-related, and behavioral factors. Over half (51.8%) of the sample was female and 85.7% belonged to the 60–79 age group. Satisfactory compliance to FG was observed in 3.9% of the sample. In the adjusted analysis, for those between 60 and 79 y, marital status was the only significant variable associated with FG noncompliance (PR: 1.34; 95%CI: 1.04–1.71). For those over 80 y, income of >2 minimum wages (PR: 0.10; 95%CI: 0.02–0.61), living alone (PR: 1.72; 95%CI: 1.20–2.47), and self-reported cardiovascular disease (PR: 0.63; 95%CI: 0.43–0.93) were associated with FG noncompliance. We observed low FG compliance among elderly Chilean adults, especially in the oldest group. Factors associated with the FG compliance was different between age groups. Full article

Extended nursing roles have existed since the 1940s. The first specialist nurse for Parkinson’s disease, a complex neurodegenerative disease, was appointed in the United Kingdom (UK) in 1989. A review was undertaken using MEDLINE and Cumulative Index to the Nursing and Allied Health Literature (CINAHL), relating to the role and evidence for Parkinson’s disease nurse specialists (PDNSs). PDNSs fulfil many roles. Trials of their effectiveness have failed to show a positive benefit on health outcomes, but their input appears to improve the wellbeing of people with Parkinson’s. Now embedded in the UK Parkinson’s multidisciplinary team, this care model has since been adopted widely, including successful dissemination of training to countries in Sub-Saharan Africa. The lack of evidence to support the benefit of PDNSs may reflect an insufficient duration and intensity of the intervention, the outcome measures selected or the need to combine PDNS input with other evidence-based interventions. Whilst the current evidence base for their effectiveness is limited, their input appears to improve subjective patient wellbeing and they are considered a vital resource in management. Better evidence in the future will support the development of these roles and may facilitate the application of specialist nurses to other disease areas. Full article

Recombinant human epidermal growth factor (EGF) has been used to treat adult diabetic foot ulcers and pediatric burns by facilitating wound healing and epithelization, especially for elderly patients. Several formulation types of EGF from different expression hosts are clinically available, such as intralesional injection and topical application. On the other hand, no study has compared the in vivo efficacy of EGF products directly in terms of tissue regeneration and wound healing activity. The present study compared two commercial products, Heberprot-P75^® and Easyef^®, in terms of their tissue regeneration activity in adult zebrafish and the developmental speed of zebrafish embryos. Fluorescence spectroscopy showed that the two EGF products had different Trp fluorescence emission spectra: Easyef^® showed a wavelength of maximum fluorescence (WMF) of 337 nm with weak fluorescence intensity (FI), while Heberprot-P75^® showed WMF of 349 nm with a 4.1 times stronger FI than that of Easyef^®. The WMF of Heberprot-P75^® was quenched by adding singlet oxygen in ozonated oil, while the WMF of Easyef^® was not quenched. Treatment with Heberprot-P75^® induced greater embryo development speed with a higher survival rate after exposure to EGF in water and microinjection into embryos. Under normal diet (ND) consumption, Heberprot-P75^® showed a 1.4 times higher tail fin regeneration activity than Easyef^® during seven days from the intraperitoneal injection (10 μL, 50 μg/mL) after amputating the tail fin. Under ND consumption and diabetic condition caused by streptozotocin (STZ) treatment, Heberprot-P75^® showed 2.1 times higher tail fin regeneration activity than Easyef^® from the same injection and amputation protocol. Under a high-cholesterol diet (HCD) alone, Heberprot-P75^® showed 1.2 times higher tail fin regeneration activity than the Easyef^® group and PBS group from the same injection and amputation. Under diabetic conditions (STZ-injected) and HCD consumption, the Heberprot-P75^® group showed 1.7 and 1.5 times higher tail fin regeneration activity than the Easyef^® group and PBS group, respectively, with a distinct and clean regeneration pattern. In contrast, the Easyef^® group and PBS group showed ambiguous regeneration patterns with a severe fissure of the tail fin, which is a typical symptom of a diabetic foot. In conclusion, Heberprot-P75^® and Easyef^® have different Trp fluorescence properties in terms of the WMF and fluorescence quenching. Treatment of Heberprot-P75^® induced a greater developmental speed of zebrafish embryos in both water exposure and microinjection. Heberprot-P75^® induced significantly higher wound healing and tissue regeneration activity than Easyef^® and PBS in the presence or absence of diabetic conditions and cholesterol supplementation. Full article

Background: Rehabilitation after a hip fracture has long-term importance, prompting some patients to utilise private services. Insufficient data regarding private rehabilitation in the UK can cause ambiguity and potential problems for all involved. Aim: The present study, involving patients with hip fractures rehabilitating in a private UK care setting, examined relationships between length of stay (LoS), discharge destination (DD) and 12 predictor variables. Methods: The variables included the retrospective measurement of the Functional Independence Measure. The variables were informed by a literature review and patient and public involvement. Retrospective data from the records of patients with hip fractures were utilised. Data were analysed using Spearman’s rho, Mann–Whitney U, Kruskal–Wallis H and chi-squared tests as appropriate. Odds ratios, distribution quartiles and survivor analysis were also utilised. Results: The median length of stay (LoS) was 20.5 days: 82% returned home, 6.5% died and 11.5% remained as long-term residents. Significant relationships existed between LoS and age (p = 0.004), comorbidities (p = 0.001) and FIM_admission (p = 0.001). DD was associated with age (p = 0.007), delirium (p = 0.018), comorbidities (p = 0.001) and both FIM_pre-fracture and FIM_admission (p = 0.000). Conclusions: Factors associated with length of stay were identified, but further research incorporating multiple sites is required for greater predictor precision. Discharge destination was evident by 90 days, facilitating long-term planning. Full article

This study reports the case of a lung cancer patient with increasing difficulties in falling asleep and frequent periods of wakefulness. Severe dyspnea related to pneumonitis caused as a side effect of immunotherapy worsened the situation. Eventually, a fear of falling asleep developed, including panic attacks and anxiety around choking, which was shown to lead to nights of complete wakefulness. The patient did not only sleep poorly; he did not sleep at all at night for several days, as evidenced by the notes he made during the night. Polygraphy showed no evidence of sleep-disordered breathing, but frequent periods of wakefulness and a reduced basal saturation of around 90% during sleep due to lung changes such as an extensive functional failure of the left upper lobe with position-dependent shunts. The authors hypothesized that the symptoms described were causally related to a drop in oxygen saturation in the patient’s blood. Therefore, they pursued the goal of finding a measurement technique that is as inexpensive as possible and that the patient can operate without outside assistance and great effort. Thus, the patient started using a low-cost wearable device that allows simultaneous measurements of blood oxygen content, pulse rate, and movement intensity. It consists of a finger ring with a pulse oximetry sensor and a wristband with a control unit containing a vibration motor. The described device reliably warned of disturbances in the oxygen concentration in the blood during the night with its vibration alarm. By use of that device during the whole night at home, the events of reduced oxygen saturation and anxiety symptoms were reduced. Sleep disturbances with sudden awakenings did not occur when using the device. The patient benefited from the security gained in this way and slept much more peacefully, and he could spend nights without waking up again. In conclusion, wearable oximeters with vibration alarms can be recommended for patients’ home care in lung cancer patients. Full article

Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics. Full article

Eating, drinking, and swallowing (EDS) are fundamental to the biomechanical model of the body. They are the processes by which the body obtains fuel essential for existence but are so much more than this mere function. What, when, and how we eat, with whom, even what we do not eat, and when we do not eat, are not physiological restrictions. The Equality Act 2010 prohibits discrimination of patients based on a list of protected characteristics, including religion. There is a paucity of literature addressing religion and EDS issues despite most religions having laws regarding food sourcing, preparation, consumption, and fasting. The diverse perspectives of our patients may influence engagement with services unless we appreciate the significance of the interplay of EDS and religious belief. Our paper addresses religion and EDS with a focus on the activities that lead up to food or drink consumption. Religion, as with many important aspects of humanity, is a highly individual experience. Thus, we need to establish what is important to each person that we deal with, whilst using general knowledge of a religion to guide us. An informed multidisciplinary team including stakeholders from chaplaincy services is critical for optimal patient care. Full article

Background: Many elderly people in Taiwan move to institutional care due to disability or insufficient family resources. This study aimed to understand the place identity and life adaptation of institutional residents and their influencing factors, and to explore the correlation between these two. Methods: This study adopted a cross-sectional survey method. A total of 120 cases were collected with structured questionnaires, and SPSS 22.0 software package was used for statistical analysis. Results: The place identity was the highest in the sense of belonging, while the sense of participation was the worst; adaptation to life was the best in terms of care management, and the worst in terms of adaptation to life and assistive devices. The length of stay in the institution, daily activities, and the number of chronic diseases were significantly different from place identity, and the number of chronic diseases was significantly different from life adaptation. Conclusions: The results of this study can be used as a reference for institutions to improve the quality of care. It is suggested that institutions can organize more activities to promote interaction and participation among residents, to strengthen their local identity and life adaptation. Full article

Aggressive lipid-lowering lifestyle modifications and pharmacologic therapies are the cornerstones of the primary and secondary prevention of atherosclerotic cardiovascular disease events. While statins are highly effective, inexpensive, and generally well-tolerated medications, many clinicians and patients express uncertainty regarding the necessity of statin treatment in older adults. Citing concerns such as polypharmacy, muscle symptoms, and even potential cognitive changes with statins, many patients and health care providers elect to de-intensify or discontinue statin therapy during the process of aging. A lack of clear representation of older individuals in many clinical trials and practice guidelines may contribute to the ambiguity. However, the recently prevailing data and practice patterns supporting the benefits, safety, and tolerability of a variety of lipid-lowering therapeutics in older adults are discussed here, with particular mention of a potential protective effect from incident dementia among a statin-treated geriatric population and an admonishment of the historical concept of “too-low” low-density lipoprotein cholesterol (LDL-C) levels. Full article

The demand for home dental care is increasing, but how it should be involved in the continuation of life at home for elderly people who need care has not been examined. Therefore, we examined whether items examined by dentists can affect hospitalization and death. The study included 239 patients with oral intake. They were divided into regular and non-regular diet groups, and ages, nutritional statuses, activities of daily living (ADLs), Charlson Comorbidity Indexes (CCI) and swallowing functions were compared. The nutritional statuses and ADLs of the three groups at the first visit and after one year were compared. The groups included those with stable, declined and improved diet forms. Factors influencing hospitalization and death over three years were examined. Nutritional status, swallowing function, CCI and ADLs were worse in the non-regular diet group. The declined diet form group had lower ADL levels and nutritional statuses at the first visit. A proportional hazards analysis showed significant differences in the changes in diet form for the stable and declined groups related to hospitalization (hazard ratio (HR): 6.53) and death (HR: 3.76). Changes in diet form were thought to affect hospitalization and death, and it is worthwhile to assess swallowing function in home dental care. Full article

As the population ages and the prevalence of heart failure increases, cardiologists and geriatricians can expect to see more elderly patients with heart failure in their everyday practice. With the advancement of medical care and technology, the options for heart failure management have expanded, though current guidelines are based on studies of younger populations, and the evidence in older populations is not as robust. Pharmacologic therapy remains the cornerstone of heart failure management and has improved long-term mortality. Prevention of sudden cardiac death with implantable devices is being more readily utilized in older patients. Advanced therapies have provided more options for end-stage heart failure, though its use is still limited in older patients. In this review, we discuss the current guidelines for medical management of heart failure in older adults, as well as the expanding literature on advanced therapies, such as heart transplantation in older patients with end-stage heart failure. We also discuss the importance of a multidisciplinary care approach including consideration of non-medical co-morbidities such as frailty and cognitive decline. Full article

Australian National standards recommend routine screening for all adults over 65 years by health organisations that provide care for patients with cognitive impairment. Despite this, screening rates are low and, when implemented, screening is often not done well. This qualitative pilot study investigates barriers and facilitators to cognitive screening for older people in rural and regional Victoria, Australia. Focus groups and interviews were undertaken with staff across two health services. Data were analysed via thematic analysis and contextualized within the i-PARIHS framework. Key facilitators of screening included legislation, staff buy-in, clinical experience, appropriate training, and interorganisational relationships. Collaborative implementation processes, time, and workloads were considerations in a recently accredited tertiary care setting. Lack of specialist services, familiarity with patients, and infrastructural issues may be barriers exacerbated in rural settings. In lieu of rural specialist services, interorganisational relationships should be leveraged to facilitate referring ‘outwards’ rather than ‘upwards’. Full article

Introduction: Bronchoscopic lung biopsy (BLB) is a widely used procedure. As the world’s population is ageing, more BLBs are performed for older people with comorbidities. The aim of the study was to investigate if an older age is a risk factor for BLB related complications. Materials and Methods: A prospective study at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros klinikos was conducted. Seven hundred and eighty-six patients (male 60.6%), mean age 57 ± 16, who underwent BLB, were included. The complications that occurred due to BLB were evaluated. Bleeding and pneumothorax were classified into I° or II° grades depending on their severity. Potential determinants, which may increase the risk of complications, emphasizing on age, were analyzed. Results: Fifty-seven (7.2%) BLB-related complications occurred. There were 27 (3.4%) pneumothoraxes, and 19 (70%) of them required thoracic drainage. Thirty (3.8%) bleeding complications occurred, and four (16%) of them were severe. Higher rates of bleeding were found in the age group ≥65 years, p = 0.001. The risk of bleeding in older patients was 3.2 times higher (95% CI 1.51–6.87). Conclusions: Older age is related to a higher incidence of mild bleeding during BLB. However, the risk of life-threatening complications is low despite the age, and older age should not be considered as a contraindication for the procedure if needed. Full article

The use of statins for primary prevention in older adults remains controversial. In this manuscript, we present a case of an 81-year-old woman with a history of HTN, HLD, Alzheimer’s dementia and osteoporosis, who presented to a geriatrics clinic with profound muscle weakness accompanied by new functional deficits in the setting of taking double her prescribed dose of atorvastatin. She was admitted to the hospital where she was found to have rhabdomyolysis. Muscle biopsy and serologic work up revealed anti-HMG statin co-reductase myopathy as the cause of her symptoms. The patient was treated with steroids IVIG and immunomodulators with marked improvement in her weakness; however, her course was complicated by delirium and multiple falls, resulting in several fragility fractures. This case highlights the need to conduct a risk–benefit analysis prior to initiating new therapies in patients with limited life expectancy, including the consideration of the potential for medication errors. Full article

Nursing homes (NHs) have been among the care settings most affected by both the virus itself and collateral damage through infection protection and control measures (IPC). However, there is a paucity of research regarding disaster response and preparedness of these institutions. The present study aimed to analyze disaster response and management and to develop prospective strategies for disaster management in NHs. A qualitative survey including (i) residents, (ii) nursing staff, (iii) relatives of residents, and (iv) NHs’ medical leads was performed. Data were collected by 45 in-depth interviews. Our results indicate that the shift from resident-centered care towards collective-protective approaches led through the suspending of established care principles to an emergency vacuum: implementable strategies were lacking and the subsequent development of temporary, immediate, and mostly suboptimal solutions by unprepared staff led to manifold organizational, medical, and ethical conflicts against the background of unclear legislation, changing protocols, and fear of legal consequences. IPC measures had long-lasting effects on the health and wellbeing of residents, relatives, and professionals. Without disaster preparedness protocols and support in decision-making during disasters, professionals in NHs are hardly able to cope with emergency situations. Full article

The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive health and social services to community-dwelling older United States (US) adults. However, little is known about how PACE outcomes compare to similar caregiving programs. This scoping review searched nine databases to identify studies that compared economic, clinical, or humanistic outcomes of PACE to other caregiving programs in the US. Two reviewers independently screened and extracted data from relevant articles and resolved discrepancies through consensus. From the 724 articles identified, six studies were included. Example study outcomes included: limitations and needs, survival and mortality, healthcare utilization, and economic outcomes. In conclusion, there are few published comparisons of PACE outcomes versus other caregiving programs for older US adults, and identified studies indicate mixed results. Further studies are needed to compare PACE outcomes to other programs so that policymakers are well informed to manage and optimize health outcomes for the growing US older adult population. Full article

Subjective cognitive complaints correspond to a heterogeneous construct that frequently occurs in the early stages of older adult life. Despite being a common source of worry for middle-aged people, it can be underestimated when clinical and neuropsychological assessments discard any underlying pathological processes. Negative age stereotyping but also self-stereotyping can contribute to doing so. Although its diagnosis is a challenge, its implication as a possible predictor of mild cognitive impairment or dementia increases the interest in its early diagnosis and intervention. The present systematic review analyzes the empirical data on the relationship between these complaints and early executive dysfunction with possible predictive value for preclinical stages of dementia. The sixteen papers obtained from the PubMed and Embase databases were exploratory, cross-sectional and prospective in scope. The studies corroborated the relationship between subjective cognitive complaints and some executive processes, which is noteworthy since many people with subjective executive complaints progress to dementia. The relational studies confirmed that impaired executive performance is associated with CSF biomarkers and reduced cortical volume in specific brain regions. However, the heterogeneity of reports in these studies demands stronger efforts in future research with specific tools applied in clinical and neuropsychological assessments and analyzed under a gender perspective. Full article

This retrospective cohort study described changes in all-cause healthcare resource utilization (HCRU) and associated costs in dementia patients newly diagnosed with psychosis. Dementia and incident psychosis were identified using diagnostic and pharmacy claims using a Medicare 20% random sample dataset. All-cause HCRU and unweighted and weighted (by person-years of follow-up) HCRU-associated costs were evaluated in the year prior to and the 4 years following diagnosis of psychosis. In 49,509 dementia patients with psychosis, physician visits per patient per year increased from a mean of 26.7 (standard deviation (SD) 20.0) prior to psychosis to 38.4 (SD 41.9) post-psychosis diagnosis. The number of inpatient stay claims increased from 1.0 (SD 1.4) to 1.7 (SD 5.8). Mean unweighted costs for inpatient stays and home healthcare/hospice during 2008–2016 were USD 9989 and USD 3279 prior to a diagnosis of psychosis but increased to USD 25,982 and USD 9901 (weighted: USD 11,779 and USD 6709), respectively, in the year after a psychosis diagnosis. This pattern of a sharp increase in mean costs was also observed in costs adjusted to 2015 USD, and in both unweighted and weighted total and psychosis-related costs. These results indicate the importance of identifying newly diagnosed psychosis in dementia patients as well as the pressing need for management strategies and treatments that can reduce HCRU and costs. Full article

An ageing population, disproportionally affecting developing countries, increases demand on healthcare systems. Digital health offers access to healthcare for older people, particularly those residing in rural areas, as is the case for 71% of older adults in India. This research examined technology uptake and digital and health literacy (eHEALS) among a sample of 150 older adults in rural Mysore and Suttur, India. The study utilised mixed-method, with descriptive analysis of quantitative data and thematic analysis of qualitative data. Low rates of digital (11%) and health literacy (3–27% across domains) were identified. Mobile phone ownership was 50%, but very few owned or used a smartphone and less than 10% used the Internet to contact health professionals. Qualitative analysis found low technology usage, driven by limited exposure and confidence in using digital devices. Barriers to usage included poor traditional literacy and physical aspects of ageing like poor vision. Social support from neighbours, family and local primary healthcare staff may enable adoption of digital health. Access to healthcare through digital means among Indian rural older adults needs to consider low rates of both digital and health literacy and leverage the value of support from family and primary healthcare providers. Full article

Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted. Full article

Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity. Full article

We investigated the biomarker signatures of two previously reported phenotypical prefrailty (PF) types in the first wave of The Irish Longitudinal Study on Ageing (TILDA): PF1 (unexplained weight loss and/or exhaustion) and PF2 (one or two among slowness, weakness, and low physical activity). Binary logistic regression models evaluated the independent associations between available plasma biomarkers and each PF type (compared to robust and compared to each other), while adjusting for age, sex, and education. A total of 5307 participants were included (median age 61 years, 53% women) of which 1473 (28%) were prefrail (469 PF1; 1004 PF2), 171 were frail, and 3663 were robust. The PF2 median age was eight years older than the PF1 median age. Higher levels of lutein and zeaxanthin were independently associated with the lower likelihood of PF1 (OR: 0.77, p < 0.001 and OR: 0.81, p < 0.001, respectively). Higher cystatin C was associated with PF1 (OR: 1.23, p = 0.001). CRP (OR: 1.19, p < 0.001), cystatin C (OR: 1.36, p < 0.001), and HbA1c (OR: 1.18, p < 0.001) were independently associated with PF2, while a higher total (OR: 0.89, p = 0.004) and HDL (OR: 0.87, p < 0.001) cholesterol seemed to be PF2-protective. While PF1 seemed to be inversely associated with serum carotenoid concentrations and hence has an oxidative signature, PF2 seemed to have pro-inflammatory, hyperglycemic, and hypolipidemic signatures. Both PF types were associated with higher cystatin C (lower kidney function), but no biomarkers significantly distinguished PF1 vs. PF2. Further research should elucidate whether therapies for different PF types may require targeting of different biological pathways. Full article

Alzheimer’s disease (AD) is an age-related, progressive neurodegenerative disorder characterized by impaired cognition, memory loss, and altered personality. Many of the available pharmaceutical treatments do not alter the onset of disease progression. Recently, alternatives to developed drug candidates have been explored including medicinal plants and herbal treatments for the treatment of AD. This article examines the role of herbal plant extracts and the neuroprotective effects as alternative modes of intervention for AD progression. These extracts contain key metabolites that culminate alterations in AD progression. The traditional plant extracts explored in this article induce a variety of beneficial properties, including antioxidants, anti-inflammatory, and enhanced cognition, while also inducing activity on AD drug targets such as Aβ degradation. While these neuroprotective aspects for AD are relatively recent, there is great potential in the drug discovery aspect of these plant extracts for future use in AD treatment. Full article

Older adults with dementia experience more frequent and injurious falls than their cognitively-intact peers; however, there are no evidence-based fall-prevention programs (EBFPP) for this population. The Otago Exercise Program (OEP) is an EBFPP for older adults that has not been well-studied in people with dementia. We sought to explore the feasibility of group delivery of OEP in an adult day health center (ADHC) for people with dementia. We collected demographic data, Functional Assessment Staging Tool (FAST), and Mini Mental State Exam (MMSE) scores for seven participants with dementia. Pre- and post-test data included: Timed-Up-and-Go (TUG), 30-Second Chair-Stand (30s-CST), Four-Stage-Balance-Test (4-SBT), and Berg Balance Scale (BBS). We implemented a supervised group OEP, 3x/week × 8 weeks. Most participants required 1:1 supervision for optimal challenge and participation. Five participants completed the program. All had moderately severe to severe dementia based upon FAST; MMSE scores ranged from mild to severe cognitive impairment. Four of five participants crossed the threshold from higher to lower fall risk in at least one outcome (TUG, 30s-CST, 4-SBT, or BBS), and four of five participants improved by >Minimal Detectible Change (MDC₉₀) score in at least one outcome. The group delivery format of OEP required significant staff oversight for optimal participation, making the program unsustainable. Full article