Understanding healthy eating/nutrition interventions for people living with dementia: A systematic review

This research tests the hypothesis that being underweight in older adulthood carries with it a significant risk of being functionally impaired and having poor physical performance, irrespective of sex, age or sickness. In a cross-sectional study of poor elderly people living around a major teaching hospital in the Indian city of Mumbai, data on anthropometry, self-reported functional ability (activities of daily living and mobility), and physical performance (tests of handgrip and lower body strength, manual dexterity, flexibility and psychomotor co-ordination) were collected from 1,335 non-oedematous people aged 50-96 years (mean age 60). Data on serum albumin and haemoglobin levels and clinically diagnosed morbidity were available from hospital records. Because of exclusions and missing clinical data through hospital non-attendance, statistical analyses were performed on 1,097 (458 men, 639 women) subjects. The prevalence of underweight was high (26-41%). Bivariate analyses revealed significant negative associations between most variables and advancing age, and women to be worse off than men. There was high internal consistency within dimensions of functional ability and physical performance, and strong positive associations between nutritional status and many functional ability and physical performance outcomes. Using multivariate logistic regression, results showed that being underweight (Body Mass Index <18.5 kg/m2, and mid-upper arm circumference of <23 cms in men and <22 cms in women) carries a significantly increased risk (expressed as odds ratios) of having poor handgrip strength and dependence in mobility, dressing and bathing, independent of sex, age, morbidity and other confounders. Results were strongest for handgrip strength : using mid-upper arm circumference, underweight men were 4.5 times (95% Cl 2.5-8.1), and underweight women 4.2 times (95% Cl 2.5-6.9), more likely to have poor handgrip strength than normally nourished elderly in the sample. The hypothesis is upheld. This underlines the important potential of nutritional status improvement in enhancing the quality of life of elderly people in less developed countries.

This study aimed to evaluate the effects of high-protein oral nutritional supplements (ONS) on nutritional status, physical function, and quality of life in older gastric cancer patients undergoing neoadjuvant chemotherapy (NAC). A prospective, randomized controlled trial was conducted between February 2023 and February 2024, including 46 patients aged 65 or older with newly diagnosed, locally advanced gastric cancer. Participants were randomized into two groups: an intervention group receiving high-protein ONS in addition to standard nutrition care, and a control group receiving only standard nutrition care. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), physical function was evaluated through handgrip strength, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) scales, and health-related quality of life was measured using the EORTC QLQ-C30. Bioelectrical impedance was used to analyze body composition. Among the 46 patients (23 in each group), baseline characteristics were similar between the groups (p > 0.05). The ONS group showed significantly higher energy and protein intake than the control group (p < 0.05). MNA scores improved significantly in the ONS group after 8weeks (p < 0.001), with a reduction in malnutrition risk to 4.3%, compared to 17.4% in the control group (p = 0.003). ADL and IADL scores remained stable in both groups, and both groups reduced functions and increased symptoms of HRQL over 8weeks. Emotional functioning scores significantly declined in both groups over the 8-week period (ONS group: from 91.7 [16.67] to 83.3 [8.33], p = 0.001; non-ONS group: from 91.7 [8.33] to 83.3 [16.67], p = 0.011). Fatigue levels also increased markedly in both groups (ONS: from 11.1 [11.11] to 49.3 ± 17.02; non-ONS: from 22.2 [11.11] to 44.4 [22.22], p < 0.001). Additionally, constipation symptoms worsened significantly in the non-ONS group by week 8 (p = 0.008). High-protein ONS improved nutritional status and reduced malnutrition risk in older gastric cancer patients undergoing NAC. Further research is needed to assess the long-term effects of ONS on physical function and quality of life. Registered under ClinicalTrials.gov Identifier no. NCT06645912.

This study investigated the efficacy of donepezil treatment on activities of daily living (ADLs) and social functioning in patients with moderate to severe Alzheimer's disease (AD) and the possible benefits of this treatment on caregiving time and stress levels. Randomized, double-blind, placebo-controlled, multinational study. Patients resided in the community or in assisted living facilities who did not require skilled 24-hour nursing care. Two hundred ninety patients with moderate to severe AD (baseline standardized Mini-Mental State Examination score of 5-17). Donepezil (5 mg/d for 4 weeks and 10 mg/d per clinician's judgment thereafter) or placebo for 24 weeks. ADLs were assessed using the Disability Assessment for Dementia (DAD), the modified instrumental activities of daily living (IADL) scale (IADL+), and the modified Physical Self Maintenance Scale (PSMS+). Caregiver time spent assisting patients with basic and instrumental ADLs was recorded as part of the IADL+ and PSMS+ scales. Patients' social behavior was evaluated through the use of a caregiver diary that captured observations of patients' motivation, interactions, and engagement. Caregivers were evaluated for their levels of caregiver stress with a modified, multiple-item Caregiver Stress Scale (CSS). For each outcome measure, the mean change from baseline at Week 24 using a last observation carried forward (LOCF) analysis was calculated. IADL+ and PSMS+ mean change from baseline scores for donepezil-treated patients showed a slower decline during the study than placebo-treated patients (Week 24 LOCF mean treatment differences: IADL+ = 6.83, P <.0001; PSMS+ = 1.32, P =.0015). Significant differences between the groups in favor of donepezil were observed on the DAD for instrumental and basic ADLs and on the three components required for the completion of each ADL: initiation, planning and organization, and effective performance. At baseline, caregivers of patients treated with donepezil (n = 141) did not differ significantly from caregivers of patients treated with placebo (n = 146) with respect to demographics or mean total scores on the CSS. At Week 24 LOCF, the overall distribution of caregiver ratings on each of the three caregiver diary items favored donepezil-treated patients over placebo-treated patients (P <.005). At Week 24 LOCF, mean change from baseline scores for CSS total and individual domain scores (all domains except caregiving competence, personal gain, and management of distress) were better for caregivers of donepezil-treated patients than for those of placebo-treated patients (CSS total, mean treatment difference = 1.82). Caregivers of donepezil-treated patients reported spending less time assisting with ADLs than caregivers of placebo-treated patients (mean difference = 52.4 min/d). Donepezil demonstrated a significantly slower decline than placebo in instrumental and basic ADLs in these patients with moderate to severe AD. The ADL benefits in AD patients treated with donepezil were associated with less caregiving time and lower levels of caregiver stress.

Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial.

Effect of multicomponent intervention on malnutrition in older adults: A multicenter randomized clinical trial

BackgroundIntrinsic capacity (IC) is a relatively new concept in the field of healthy ageing. The World Health Organisation originally proposed IC in 2015 as a central part of their framework...

BackgroundSeveral factors may play a role in the ability of patients with Alzheimer’s disease to perform activities of daily living (ADL). The aim of this study was to examine the impact of different aspects of physical performance and cognitive functions on ADL in patients suffering from mild-to-moderate Alzheimer’s disease.MethodsWe conducted secondary analyses on cross-sectional baseline data from the randomized controlled multicentre study “Preserving quality of life, physical health and functional ability in Alzheimer’s Disease: The effect of physical exercise” (ADEX). In total, 185 AD patients (76 women and 109 men), with a mean age on 70,4 years, were included. Data from physical performance tests (Astrand cycle test, Timed up & Go (TUG), Sit to Stand test (STS)) and cognitive tests (Mini Mental Status Examination (MMSE), Symbol Digit Modalities Test (SDMT), Stroop Color and Word test (Stroop)) were used. Their associations with ADL, measured on the ADCS-ADL scale was assessed in multivariable regression analyses.ResultsSDMT and MMSE had significant, moderate correlations with total ADL (SDMT: r = 0.33, MMSE: r = 0.42) and instrumental ADL (SDMT: r = 0.31, MMSE: r = 0.42), but not with basic ADL. Adjusting for age and sex, the associations between SDMT and MMSE to total ADL and instrumental ADL persisted. No significant associations were found between Astrand, TUG, STS or Stroop and total ADL, basic ADL or instrumental ADL.ConclusionTotal ADL and instrumental ADL are associated with cognitive functions, including executive function. No significant association between examined physical performance parameters and ADL functions was observed, and consequently does not support an impact of physical function on ADL functions in patients with mild-to-moderate Alzheimer’s disease and relatively well-preserved physical function. Strategies aimed to improve cognition may be better suited to improve ADL function in patients with mild-to-moderate Alzheimer’s disease.Trial registrationNCT01681602. Registered 10 September 2012, retrospectively registered.

This study aimed to clarify the current status of motor function, activities of daily living (ADL), and instrumental ADL (IADL) in hemophilia patients with HIV infection due to treatment with non-heat-treated blood products as they now enter middle and old age. Participants were 70 such patients (mean age, 52.1 years), and their range of motion (ROM), muscle strength, extremity circumference, walking speed, ADL, and IADL were evaluated at checkups of motor function, ADL, and IADL that were held during patients' association meetings. Results showed that ROM was limited in all joints. Ankle dorsiflexion, hip abduction, and shoulder abduction were particularly restricted. Decreased muscle strength was most frequent in ankle plantarflexion, followed by hip extension. The proportion of patients with walking speed and grip strength below reference values increased with age. Walking speed was 73.9-110.9% of reference values. Factors affecting walking speed were knee flexion, ankle dorsiflexion, and hip extension muscle strength. Grip strength was 58.0-83.5% of reference values. Thigh girth most greatly differed between the patients and healthy individuals. Among the ADL items, "standing up from the floor" was reported as "difficult"/"cannot do" by 45.7% of the patients. The most common IADL problem was "putting away futons", which 17.2% responded was "difficult"/"cannot do". Parents were the most common helpers with household tasks (12.9%). "Decreased muscle strength/limited ROM" was the most frequently reported troublesome problem (35.7%). These results reveal the current status of motor function, ADL, and IADL limitations in hemophilia patients with HIV.

Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center. In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27kg/16kg, and 35kg/20kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1. Among a total of 1970 patients, 195 had follow-up of median 560days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan-Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07-3.30), and 1.9 (1.04-3.6); for Model 1 and Model 2, respectively)]. Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis.

Introduction: The desired goal of the neurological rehabilitation is the restoration of neurological deficit. Some compensatory means including assistive devices and orthoses improve client’s activities of daily living (ADLs) and instrumental ADLs (IADLs). In the rehabilitation for malignant central nervous system (CNS) tumor clients, providing their caregivers with assistive techniques sometimes seems effective in order to bring good quality of life (QOL). Authors report the experiences of the rehabilitation for malignant CNS tumor clients. CASE 1: Female; 62Y.O. She had undergone the surgery and radiotherapy 16 years before in a cancer center hospital owing to the right breast cancer. Hormone therapy was being continued. Magnetic resonance (MR) image showed a tumor in the right parietal area. This was assessed as the metastatic tumor. She underwent the cerebral tumor resection since she had fallen a lot of times. Her ADLs became worse owing to the left hemiparesis. Even after the hemiparesis improved by the rehabilitation in our hospital, she fell a few times due to stereoagnosis. An assistive device improved her ADLs and IADLs in home. Her participation in social activities was achieved with her husband’s assistive techniques. CASE 2: Male; 64Y.O. He had undergone several times of surgery, radiotherapy, and chemotherapy because of anaplastic astrocytoma in the left parietal area during 12 years at a university hospital. Right hemiparesis and memory disturbance deteriorated his ADLs after the last surgery. Histological examination showed glioblastoma. The rehabilitation in our hospital enabled him to walk with an ankle foot orthosis in 2 weeks. His wife’s assistive techniques were also helpful in the return to his domestic situation. Meningeal dissemination was found in MR image 6 weeks after the beginning of the rehabilitation. He underwent chemotherapy at the former hospital and died several weeks after the transition to home. DISCUSSION AND conclusions: The rehabilitation for malignant CNS tumor patients may have had little importance in the treatment owing to the rapid exacerbation of their diseases. While many patients survive by the developed treatment of malignant CNS tumors, the neurological deficits require the rehabilitation. The rehabilitation needs to aim not only to recover ADLs and IADLs, but also to aid the preparation for the client’s good QOL. Every rehabilitation staff needs to consider how the client will act in home and participate in the community. This view of consideration possibly benefits the client’s QOL. Assistive techniques can be useful for the client’s QOL even when the independent ADLs or IADLs are not expected during the inpatient rehabilitation.

Introduction: Colorectal cancer (CRC) is a disease of older patients, but evidence-based guidelines for chemotherapy in older patients are scarce. Geriatric assessment (GA) evaluates a patient’s functional status (FS) and helps in decision-making when choosing chemotherapy for older patients. However, the change of FS during chemotherapy is rarely studied as GA is mostly performed once instead of sequentially. Methods: We performed a subgroup analysis of a prospective, multicenter study EpiReal 75. Patients aged ≥75 years with gastrointestinal malignancy prior to initiation of chemotherapy or receiving palliative chemotherapy were screened. We defined geriatric core assessments including the Eastern Cooperative Oncology Group score, Barthel’s activities of daily living (ADL) scale, Lawton’s instrumental activities of daily living (IADL) scale, and G-8 questionnaire, which were performed at baseline and repeated every 3 months. Quality of life (QoL) assessed by QLQ-C30 questionnaire was also re-evaluated every 3 months. We defined any deterioration in any of the geriatric parameters as unstable in the corresponding function. Results: 28 patients with CRC were enrolled between April 2014 and December 2018. 20 patients were evaluable for statistical analysis with a mean age of 78.5 years (range, 75–88). Most patients received chemotherapy in palliative setting. During 3 months of chemotherapy, 25% of patients became more dependent as measured by ADL or IADL. During a median follow-up of 15 months, patients with unstable ADL or IADL had a significantly shorter overall survival (OS) than those with stable ADL or IADL (p_logrank = 0.0055 and 0.0253, respectively), without a significant difference in progression-free survival (PFS). Also, unstable IADL correlated with a deterioration in aspects of QoL such as role functioning and emotional functioning (p = 0.0189 and 0.0239, respectively). 20% of patients experienced treatment-related grade 3 adverse events (AEs), no grade 4–5 AEs occurred. Conclusion: Sequential GA revealed changes in FS in older patients with CRC receiving chemotherapy. A deterioration of FS during chemotherapy did not influence PFS but had a negative impact on OS and QoL. It is therefore important to maintain FS in older patients with cancer, and regular performance of geriatric core assessments should be encouraged in the clinical practice.

Research reports about the associations of leisure-time physical activity (LPA) and Body Mass Index (BMI) with activities of daily living (ADL)- or instrumental activities of daily living (IADL)-dependent disability in older adults are inconclusive. Data were obtained from the 2000 Missouri Older Adult Needs Assessment Survey. Logistic regression was used to examine the associations of LPA and BMI with ADL- or IADL-dependent disability, while controlling for factors known to be associated with LPA, BMI, ADL and IADL. ADL- or IADL-dependency decreased with LPA and increased with BMI regardless of each other's level, presence of functional limitation, education, gender, race-ethnicity, and health care coverage. Physically active individuals were less likely than inactive ones to be ADL- or IADL-dependent. BMI was modestly associated with ADL- or IADL-dependency and this relationship was confounded by LPA. If confirmed by well designed longitudinal studies, LPA and BMI independent associations with ADL- or IADL-dependent disability lends supports to a strategy for improving older adult quality of life through improved physical activity. Etiological studies on the associations between risk factors and quality of life outcomes in older adults should consider the joint confounding effect of LPA and BMI.

A New Frailty Assessment Model Incorporating Gait Speed and Grip Strength for Multiple Myeloma and Consistency Analysis with IMWG-FI

Unleashing the Power of Renal Nutrition in Value-Based Models of Kidney Care Choices: Leveraging Dietitians’ Expertise and Medical Nutrition Therapy to Delay Dialysis Initiation

Purpose Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. Method Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. Findings Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14–1⋅74], p = 0⋅002). Conclusion Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.