Nutritional support in geriatric patients: definition, diagnosis, assessment and therapeutic

Atualmente, vem ocorrendo um aumento importante no número de pacientes idosos submetidos a internação hospitalar, mantidos em casas de repouso ou atendidos em regime ambulatorial, cujo estado nutricional pode ser considerado crítico. Assim, é fundamental que as alterações próprias do envelhecimento sejam o mais precocemente possível diferenciadas dos sinais clínicos de desnutrição. Um alto grau de suspeita clínica de pacientes idosos desnutridos, e que, conseqüentemente, necessitam de terapêutica nutricional, pode ser obtido por meio da história clínica, exame físico e dados laboratorias apropriados. A má nutrição que ocorre no idoso pode ser devida às alterações fisiológicas do envelhecimento, às condições sócio-econômicas, às doenças e à interação entre nutrientes e medicamentos. Assim sendo, as principais causas de má nutrição podem ser catalogadas como secundárias ao envelhecimento, menor rendimento econômico, isolamento, a morte de entes queridos, doenças e outros fatores relacionados. Como resultado, o idoso apresenta sério comprometimento do estado geral e uma maior morbidade e mortalidade em geral. A intervenção nutricional utiliza nutrientes, como fármacos, visando o tratamento de doenças. Por fim, as recomendações têm por objetivo indicar a quantidade mínima de nutrientes que seria adequada para a maioria das pessoas em seu ambiente usual, sem traumas ou doenças. No entanto, as recomendações, para o idoso são extrapoladas das recomendações obtidas para crianças e adultos jovens, nem sempre próprias para o idoso.Increasing numbers of elderly patients are being admitted to hospital and nursing homes. Clinicians face the challenging task of developing optimal plans for individual treatment and rehabilitation for these patients. Because of the insidious nature of malnutrition in the elderly and of its mimicking of the usual aging process, it is important to recognize early warning signs of the risks of malnutrition. The physician needs to know the triggers or alerts of poor nutritional health during history/physical examination. Those in need of more comprehensive nutrition screen, which encompass not only the routine medical and dietary history and a physical exam but also a broad look at the elderly individual’s psychosocial, functional, socioeconomic, and drug use aspects that are more related to malnutrition. This review paper provides a summary of the accumulated information about these matters, with the purpose of promoting active management of undernutrition of elderly people

Effect of a single session of aerobic walking exercise on arterial pressure in community-living elderly individuals

Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7 +/- 3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (P<0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern. Hypertension Research (2012) 35, 457-462; doi: 10.1038/hr.2011.227; published online 9 February 2012National Council for Scientific and Technological Development (CNPq)Foundation for the Support of Teaching, Research and Care - Clinics Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paul

Study of body composition in elderly active women by the anthropometric and deuterium oxide methods

Com o envelhecimento, ocorrem alterações na composição corporal, observando-se uma redução da massa magra (MM) e um aumento progressivo da massa gorda (MG). O objetivo deste estudo foi descrever a composição corporal de mulheres idosas ativas, pelos métodos de antropometria e óxido de deutério e verificar a concordância do método antropométrico com o método óxido de deutério, considerado como referência nesse estudo. Participaram do estudo 22 idosas independentes, com faixa etária entre 65 a 75 anos. O peso corporal foi avaliado usando balança digital e a altura usando um estadiômetro em barra vertical. Para identificar o nível de atividade física foi usado o questionário internacional de atividade física (IPAQ, versão longa). A composição corporal foi avaliada pela antropometria pelas equações de Jackson et al. e Durnin e Womersley e pelo método de óxido de deutério (²H2O). Para análise estatística, usaram-se o coeficiente de concordância de Lin e o gráfico de Bland e Altman. A média de idade foi 69,3±3,6 anos, o peso 67,2±10,6Kg, a altura 1,55±0,04m e o índice de massa corporal 27,9±5,0 kg/m². Os coeficientes de concordância obtidos pelas equações de Jackson et al. e Durnin e Womersley comparados ao deutério foram: %GC 0,72 e 0,71; MG 0,90 e 0,91; e MM 0,46 e 0,57. As equações utilizadas neste estudo apresentaram boa concordância com o deutério, sendo que, a equação de Durnin e Womersley apresentou melhores resultados para avaliar a composição corporal de idosas ativas

Fed State Protein Turnover in Healthy Older Persons under a Usual Protein-Rich Diet

The objective of this study was to verify the protein turnover rates of healthy older persons under a usual protein-rich diet and to compare values to those described in the literature. This cross-sectional study was conducted at Metabolism Unit, Univ. Hospital of the School of Medicine of Ribeirao Preto, Univ. of Sao Paulo, Brazil. In this study, 7 healthy older persons aged 65.4 +/- 2.8 y, with BMI 22.7 +/- 2.4 kg/m(2) and a mean daily protein intake of 1.34 g of protein/kg were studied. A 9-h whole-body (15)N-glycine single-dose study was performed after an overnight fast. During the study, each subject received 6 isoenergetic, isonitrogenous meals at 2-h intervals based on their average intake. Ammonium, urea, and total nitrogen were quantified and analyzed by mass spectrometry, with the determination of total protein turnover rates by the (15)N-glycine method. The results show that total nitrogen output was 3.2 +/- 0.96 g/N and intake 7.7 +/- 1 g/N, (15)N nitrogen flux was 30.6 +/- 6.3 g/9 h. Endogenous nitrogen balance was positive (4.5g +/- g/N in 9 h). In conclusion, the protein turnover of healthy older persons under a usual protein-rich diet is positive during the fed state and has synthesis and degradation rates similar to those previously described in studies involving diet adaptation periods.Nacional de Desenvolvimento Cientifico e Tecnologico[477045/2004-9]IAEA (Intl. Atomic Energy Agency[7008-86572L]CAPES (Coordenacao de Aperfeicoamento de Pessoal de Nivel superior, Brazil

Involuntary weight loss in elderly individuals: assessment and treatment

CONTEXT: The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. DESIGN: Narrative review

Conduct after Epley`s maneuver in elderly with posterior canal BPPV in the posterior canal

Benign Paroxysmal Positional Vertigo is the most common peripheral vestibular disorder, especially in the elderly and presents as the predominant etiology in this population of the degeneration of the utricular macula. Aim: To compare the effectiveness of the approaches after Epley maneuver. Study Design: longitudinal cohort. Materials and Methods: The study included 53 volunteers with Benign Paroxysmal Positional Vertigo of the posterior semicircular canal, divided into Group 1, who underwent Epley maneuver associated with the use of neck collar and post-maneuver instructions, Group 2 underwent the Epley maneuver without the use cervical collar and/or post-maneuver restrictions, and Group 3 underwent the Epley maneuver associated with the use of a mini vibrator, without the use of neck collar and/or post-maneuver restrictions. Results: In the three groups, the number of Epley maneuvers ranged from one to three. We employed the Brazilian Dizziness Handicap Inventory - pre- and post-treatment and observed a statistically significant difference on most scores pre- and post-treatment for both groups. Conclusion: Regardless of the post Epley maneuver treatment selected for the treatment of Benign Paroxysmal Positional Vertigo, it was effective when comparing the Brazilian Dizziness Handicap Inventory pre- and post-treatment

Impact of Aging on Urinary Excretion of Iron and Zinc

Project Data about the influence of aging on urinary excretion of iron and zinc are scarce. The objective of the present study was to compare the concentration of zinc and iron in the urine of healthy elderly subjects and younger adults. Procedure Seven healthy elderly subjects and seven younger adults were selected and submitted to biochemical, clinical, and nutritional tests. After a fasting period, 12-hour urine was collected for the determination of iron and zinc concentrations by graphite furnace atomic absorption spectrophotometry. Results Urinary zinc and iron concentrations of the elderly subjects were not significantly different from that of younger adults. However, the total zinc and iron urinary clearance in 24 hours for the elderly was significantly higher compared with that of younger adults. Conclusion There is an increase in urinary iron and zinc clearance with aging. The values reported in this manuscript may be used as references in future studies

Perspectives for treating Alzheimer's disease: a review on promising pharmacological substances

ABSTRACT CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. Alzheimer's disease (AD) is one of the most common causes of dementia and has high prevalence among the elderly. It is known that there is no drug capable of interfering with the course of the disease. Research on treatments for AD has been marked by the appearance of new drugs and their abandonment. This study aimed to describe drugs that have been studied with regard to treating AD and which are capable of influencing the course of the disease. DESIGN AND SETTING: Narrative review on original articles published worldwide. METHODS: A systematized search was conducted in the PubMed/MEDLINE, Cochrane Library/Cochrane and SciELO/Bireme databases. The descriptors "Molecular Mechanisms of Pharmacological Action" and "Drug Therapy" were each combined with the descriptor "Alzheimer disease". All of these can be found in MeSH and DeCS. These descriptors were used alone or in combination, and a filter specifying publication between January 2009 and October 2015 in English, Spanish or Portuguese was set. RESULTS: 6,888 articles were found, of which 37 were included in this review; 70.3% of the articles selected were of good quality with low or unclear risk of bias. 86 drugs were considered promising for AD treatment and these were classified into 20 pharmacological categories. CONCLUSION: There are no drugs capable of influencing the course of AD such that treatments are safe and effective. However, immunomodulators stood out as promising, given their effectiveness and quality in the articles analyzed

Estudo da composição corporal de idosas ativas pelos métodos óxido de deutério e antropométrico

Com o envelhecimento, ocorrem alterações na composição corporal, observando­-se uma redução da massa magra (MM) e um aumento progressivo da massa gorda (MG). O objetivo deste estudo foi descrever a composição corporal de mulheres idosas ativas, pelos métodos de antropometria e óxido de deutério e verificar a concordância do método antropométrico com o método óxido de deutério, considerado como referência nesse estudo. Participaram do estudo 22 idosas independentes, com faixa etária entre 65 a 75 anos. O peso corporal foi avaliado usando balança digital e a altura usando um estadiômetro em barra vertical. Para identificar o nível de atividade física foi usado o questionário internacional de atividade física (IPAQ, versão longa). A composição corporal foi avaliada pela antropometria pelas equações de Jackson et al. e Durnin e Womersley e pelo método de óxido de deutério (2H2O). Para análise estatística, usaram-se o coeficiente de concordância de Lin e o gráfico de Bland e Altman. A média de idade foi 69,3±3,6 anos, o peso 67,2±10,6Kg, a altura 1,55±0,04m e o índice de massa corporal 27,9±5,0 kg/m2. Os coeficientes de concordância obtidos pelas equações de Jackson et al. e Durnin e Womersley comparados ao deutério foram: %GC 0,72 e 0,71; MG 0,90 e 0,91; e MM 0,46 e 0,57. As equações utilizadas neste estudo apresentaram boa concordância com o deutério, sendo que, a equação de Durnin e Womer­sley apresentou melhores resultados para avaliar a composição corporal de idosas ativas