Letter to the Editor Regarding the Article: “Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward”

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The teas of Portuguese centenarians

Copyright © 2019 Elsevier Inc. All rights reserved.Introduction: Medicinal plants traditional consumption habits, can contribute to longevity. Methods: A sample of 253 centenarian individuals in Portugal, both sexes, median age 100 years, was studied, to verify past habits in relation to medicinal-interest plants use. It was compared with a control group median age 67 year, with a reduced theoretical probability of reaching 100 years. Results: Among the 8 most cited plants, in decreasing frequency order, in centenarian's group: Lemon-balm, barley, lemon-verbena, orange (leaf-flower), linden, whig-plant, pennyroyal and mount-carqueja (Pterospartum-tridentatum); in the control group: Lemon-balm, lemonverbena, chamomile, linden, prince-herb, green-tea, lemon-tea and minttea. Whereas 28% of the control subjects reported not using infusion plants, in the centennial group, only 9.1% reported not routinely use them (χ2¼30,42, po0.001). Among the 8 plants most marked by the centenarians that were not mentioned by the controls, they include barley, whig-plant, pennyroyal and mount-carqueja. Conclusion: the high antioxidant power associated with the use of plants by centenarian individuals, determined by anti-free radical's activity, lipoperoxidation inhibition and antitumor potential, may have contributed to their exceptional longevity.info:eu-repo/semantics/publishedVersio

National survey of the Portuguese elderly nutritional status : study protocol

Acknowledgements We acknowledge the IAN-AF team (in particular to Duarte Torres, Milton Severo and Andreia Oliveira) for the community sampling and their support on dietary assessment methodology and critical discussion along the elaboration of the present protocol. Funding This project (136SI5) was granted by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009-2014.Peer reviewedPublisher PD

Genetic and environment interactions contribute to longevity : a case-control study with centenarians

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Objective: Environmental or genetic factors, together with the interaction between them, may explain the increasing population of centenarians. This research aimed to understand these interactions that underlie centenarian’s phenotypes, namely gene-gene and gene-environment, particularly in relation to cardiovascular risk (CVR).info:eu-repo/semantics/publishedVersio

Avaliação geriátrica da população portuguesa com 65 ou mais anos a residir na comunidade : estudo PEN-3S

Copyright © Ordem dos Médicos 2020Introduction: As populations live longer, they also aim to live better. A crucial step for this is to improve the understanding about older adults’ physical and psychological health. Therefore, the aim of the present study was to characterise the Portuguese population over 65 regarding nutritional status, cognitive function, functional status, symptoms of depression, and loneliness, by sex and age groups. Material and Methods: Cross-sectional study including a nationally representative sample of community-dwelling adults aged 65 and over. Trained interviewers collected data face-to-face on demographic and socioeconomic characteristics, health status, nutritional status, cognitive function, functional status for activities of daily living, symptoms of depression, and loneliness feelings. Complex sample procedures were used in the statistical analysis. Results: Overall, 1120 community-dwellers (49.0% women, 21.3% aged ≥ 85) participated in the study. The estimated prevalence of risk of malnutrition was 16.4% (95% confidence interval: 13.3 – 19.9), while 17.7% (95% confidence interval: 12.8 – 23.9) were cognitively impaired, and 28.5% (95% confidence interval: 23.7 – 33.8) presented limitations to perform daily living activities. Moreover, 23.5% (95% confidence interval: 19.7 – 27.7) presented symptoms of depression and 13.6% (95% confidence interval: 10.6 – 17.1) reported loneliness feelings. These conditions were more prevalent among women, and generally more frequent in the oldest individuals (≥ 85). Discussion: Risk of malnutrition, cognitive impairment, functional limitations, depression and loneliness were moderately frequent, which may justify screening and preventive actions at a community level. Conclusion: This study contributed to a national characterisation of the health of older adults, that may inform policies and interventions targeted at the needs of the Portuguese aging population.The project PEN-3S (136SI5) was granted by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009–2014. TM is supported by a PhD Scholarship (SFRH/ BD/117884/2016) from Fundação para a Ciência e a Tecnologia (FCT) through national funds (MCTES).info:eu-repo/semantics/publishedVersio

Malnutrition among older adults living in Portuguese nursing homes : the PEN-3S study

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Feeding in advanced dementia: consensus report from the Portuguese Society of Internal Medicine and Portuguese Enteral and Parenteral Nutrition Society

A demência é uma síndrome neurológica de agravamento progressivo, sem cura, cuja prevalência tem vindo a aumentar devido ao envelhecimento da população. Existe um grande desconhecimento entre profissionais de saúde e cuidadores relativamente à melhor abordagem da alimentação nos doentes com demência avançada. Dado não existirem recomendações nacionais acerca deste tema, foi elaborado um documento de consenso da Sociedade Portuguesa de Medicina Interna e da Associação Portuguesa de Nutrição Entérica e Parentérica que explicita as orientações existentes relativas à abordagem dos problemas alimentares nos doentes com demência avançada. A demência avançada é uma condição terminal em que deve ser privilegiado o conforto do doente, frequentemente acamado, incapaz de comunicar verbalmente e com dificuldade na alimentação. Nesta população, a literatura atual não recomenda o uso de alimentação por sonda (nasogástrica, nasojejunal, gastrostomia percutânea ou jejunostomia percutânea), que está associada a maior risco de infeção, maior utilização de meios de contenção e desenvolvimento de úlceras de decúbito. Como alternativa, recomenda-se a alimentação por via oral de acordo com a tolerância e vontade do doente (alimentação de conforto). Do ponto de vista ético e legal, é legítimo não proceder à artificialização da alimentação na fase terminal da demência caso este procedimento seja contrário aos valores da pessoa e não se objetivem benefícios. Esta decisão deve ser tomada após discussão multidisciplinar incluindo o doente (se possível), representante legal, cuidadores, família e equipa de profissionais de saúde envolvidos, elaborando um plano individual de cuidados que permita a tomada de decisões no melhor interesse do doente.ABSTRACT - Dementia is a progressive neurological syndrome without cure whose prevalence is increasing due to population aging. There is a lack of knowledge among healthcare professionals and caregivers regarding the best feeding approach in patients with advanced dementia. As there are no national recommendations on this subject, a consensus report from the Portuguese Society of Internal Medicine and the Portuguese Enteral and Parental Nutrition Society was made, clarifying existing guidelines regarding the approach of eating difficulties in these patients. Advanced dementia is a terminal condition where patient comfort should be the goal. These patients are usually bedbound, have limited ability to communicate verbally and have difficulty eating. In this population, current literature does not support tube feeding (nasogastric tube, nasojejunal tube, percutaneous gastrostomy or percutaneous jejunostomy feeding), which is associated with higher rates of infection, greater use of chemical and physical restraints and development of pressure ulcers. As an alternative, careful hand feeding should be offered (comfort feeding). From an ethical and legal standpoint, it is acceptable not to use tube feeding in the terminal phase of dementia if it is against patient values and offers no benefits. This decision should be made using a multidisciplinary approach including the patient (if possible), legal representative, caregivers, family and healthcare professionals, in order to establish an individual care plan allowing decision making in the patient’s best interest.info:eu-repo/semantics/publishedVersio

Nutritional intake and malnutrition in institutionalised and non-institutionalised older adults

© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition SocietyMalnutrition (synonym: undernutrition) is prevalent among older adults, which may be partly related to changes in dietary intake, but evidence on the link between malnutrition and diet is scarce. The aims of this study were to estimate the association between energy/nutrients intake and malnutrition, and to characterise nutritional inadequacy in institutionalised and non-institutionalised older adults. A national survey was conducted including a Portuguese representative sample of nursing home (NH) residents (n 563) and community-dwellers (n 837) aged ≥ 65 years. Data included socio-demographic characteristics, self-reported health, loneliness feelings, nutritional status (Mini Nutritional Assessment®) and dietary intake (two non-consecutive 24-h recalls). A higher energy intake was associated with lower odds of malnutrition risk (being 'at risk of malnutrition' or 'malnourished') in both settings, but only significant among NH residents after adjusting for confounders (NH: OR = 0·66, 95 % CI 0·50, 0·86; community: OR = 0·64, 95 % CI 0·37, 1·10). The intake of carbohydrates, fat, fibre, vitamin C, Na, K and Mg was inversely associated with malnutrition risk in NH residents, and protein, fat, vitamin B6, folates, Na, K, Ca and Mg intake in community-dwellers. After additional adjustment for total energy, only Na and Mg intake of community-dwellers remained significantly associated. The prevalence of inadequate nutrient intake was generally higher for the malnutrition risk group, which was particularly evident among community-dwellers. The effect of dietary intake on nutritional status seems more dependent on total energy and carbohydrates intake in institutionalised elders, whereas among community-dwellers protein and some micronutrients appear to have a greater impact.The project PEN-3S (136SI5) was granted by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009–2014. T. M. is supported by a PhD Scholarship (SFRH/BD/117884/2016) from Fundação para a Ciência e a Tecnologia (FCT) through national funds (MCTES).info:eu-repo/semantics/publishedVersio

The association between dietary patterns and nutritional status in community-dwelling older adults-the PEN-3S study

© The Author(s), under exclusive licence to Springer Nature Limited 2020.Background: Diet plays a key role in the ageing process. Despite this, little is known about the effect of dietary patterns on older adults' nutritional status. The main aim of this study was to analyse the association between a posteriori derived dietary patterns (DPs) and nutritional status among community dwellers aged ≥65. Methods: Cross-sectional study including a representative sample of the community-dwelling Portuguese population aged ≥65 (n = 849, mean age 74.1 years old). Data were collected through computer-assisted, face-to-face interviews. Dietary patterns were derived a posteriori based on two 24-h recalls by a latent class transition model. Nutritional status was assessed by the Mini Nutritional Assessment (MNA®) and measured body mass index (BMI). Associations were estimated by regression models. MNA score was reversed and log-transformed considering its skewed distribution. Results: Two DPs were identified: 22.0% of the studied population followed a 'Protein-based foods' DP (highest consumption of legumes, meats and sweets), and 59.1% followed a 'Mediterranean' DP (highest consumption of vegetables, fruits, dairy, cereals/tubers, bread, fishery and olive oil). Moreover, 18.9% switched between those patterns ('In-between' DP). After adjustment, the 'Protein-based foods' DP was associated with better MNA score (EXP(β) = 0.716, 95% CI 0.533, 0.962), compared to the 'Mediterranean' DP, particularly for total energy intake up to 2200 kcal/day. No significant associations were found between DPs and BMI. Conclusions: A protein-based pattern is associated with lower malnutrition risk in older adults, when considering an adequate energy intake. This should be taken into account when designing and disseminating food-based guidelines for healthy ageing.The project PEN-3S (136SI5) was granted by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009–2014. TM is supported by a PhD Scholarship (SFRH/BD/117884/2016) from Fundação para a Ciência e a Tecnologia (FCT) through national funds (MCTES). AO is supported by a FCT Investigator Grant (IF/01350/2015).info:eu-repo/semantics/publishedVersio

Sarcopenia, more than dehydratation, can be associate to Portuguese underweight centenarians

Poster apresentado na 17th European Congress of Endocrinology, 16-20 May 2015, Dublin, IrelandIntroduction: Fat-free mass has a functional significance in aging. The objective of this study was to evaluate the prevalence of underweight in a Portuguese population of centenarians and their relationship with dehydration or sarcopenia. Methods/design: Anthropometric data were obtained using standard procedures from 252 centenarians (100.26±1.99 years), 77.8% women (W). Body composition was assessed by tetrapolar bioimpedance. It was considered dehydration: total body water (TBW) (%) 35 (W) and >25 (M). The fat mass index (FMIndex): FM (kg)/height (m2) and muscle mass index (MMIndex): MM (kg)/height (m2) were calculated. Statistical methods: T-student, ANOVA, χ2, linear correlation. Results: In the sample, 61.4% had normal weight (BMI=21.42±1.86), but 25.3% were underweight (BMI=16.84±1.51), and of these, 28.8% were women. Instead, overweight (BMI=27.52±2.40) checked in 13.3% subjects, was predominant in men (10.6 vs 22.6%). Dehydration was observed in 12.9% of subjects and was tendentiously higher in women (15.4 vs 5.0%, P=0.087). Excess of FM was found in 6.0% of subjects with no gender differences (P=0.225). In the overweight subgroup there were differences in TBW (P=0.003) and FM (P=0.022) between genders, which was not observed in the underweight subgroup. The FMIndex in underweight or overweight subgroups did not vary significantly with gender. Muscle mass and MMIndex were different between genders, with the lowest values observed in underweight W compared to M (31.7±3.96 vs 36.3±2.84; P=0.01) or to the other subgroups. There was a direct linear correlation between BMI and MM (β(M)=0.749; β(W)=0.683) and inverse with TBW (β(M)=−0.428; β(W) =−0.397), men and women, P<0.001. Conclusion: The underweight was more represented in the Portuguese centenarians. More than body water and FM, sarcopenia may be responsible for this low weight particularly in the women.info:eu-repo/semantics/publishedVersio