Nutritional Situation, Functionality and Mortality in Nursing Home Residents : Results of a 12-Month Follow-Up Study

The influence of the nutritional status on quality of life, functionality, morbidity and mortality in elderly people has been shown in several studies. Elderly people, especially with functional and cognitive deficits, are at high risk of malnutrition, a status of an insufficient intake of macronutrients and micronutrients. Prevalence of malnutrition has been investigated in several studies and depends on the observed setting and the used assessment. Consequently, prevalence rates ranged between 5 and 85%. Several methods for the determination of nutritional status or the risk of malnutrition are available; the present thesis focuses on different assessment of nutritional situation, and its influence on functionality and mortality in an observational longitudinal study. Therefore the first aim of this thesis was to test the agreement of MNA, approached by either using a one-on-one interview with residents of two Nuremberg nursing homes compared to the assessment by nursing staff. We identified a fair agreement and a different value of applicability with the two methods. Applicability was higher in the approach of the nursing staff. Additionally, a predictive value of the screening tool could be shown, as residents with a nutritional status identified as “poor” died more often within a one-year follow-up than residents identified as “well-nourished”. Second aim was the description of specific nutrient blood markers of the nursing home residents as another indicator of nutritional status. This included the monitoring within one year and the analysis of its association to functionality and mortality. Longitudinal data on nursing home residents in this regard are not yet available. The highest deficiency prevalence was observed for vitamin D, retinol and albumin. Within one year, status of vitamin D and retinol decreased significantly. Vitamin D, retinol and folate status were associated with functional parameters; vitamin D status was significantly associated with survival. Beside the high prevalence of malnutrition in the elderly, a growing amount of obesity was revealed, including the above 65-year-olds. The discussion on the influence of obesity on functional parameters in the aged has been contradictory. Data on nursing home residents in this regard are scarce anyway. In several studies in different settings, the lowest mortality has been shown to be in overweight and obese elderly. Consequently, the third aim of the present thesis was to investigate the association of obesity, defined as BMI above 30 kg/m2, with functionality and mortality in obese nursing home residents. Obese residents showed the highest levels of the observed functional parameters and the lowest mortality in comparison to residents with low and normal BMI.In vielen Studien wurde der Einfluss des Ernährungszustandes auf die Lebens-qualität, Funktionalität, Morbidität und Mortalität bei älteren Menschen bereits gezeigt. Menschen ab 65 Jahren mit funktionellen und kognitiven Defiziten unterliegen einem besonderen Risiko für das Vorliegen einer Mangelernährung. Als Mangelernährung wird ein Defizit an Makro- und/oder Mikronährstoffen bezeichnet. Die Prävalenz von Mangelernährung wurde bereits in vielen Studien untersucht und ist abhängig von dem untersuchten Kollektiv und der verwendeten Methode zur Erfassung der Mangelernährung. Folglich schwankte die ermittelte Prävalenz zwischen 5 und 85%. Der Ernährungszustand kann mit Hilfe verschiedenster Methoden erfasst werden; im Fokus der folgenden Dissertation standen verschiedene Methoden zur Erfassung der Ernährungssituation und ihr Einfluss auf Funktionsparameter sowie Mortalität. Folglich war das erste Ziel der vorliegenden Dissertation der systematische Vergleich zweier auf unterschiedlicher Erhebungsmethoden ermittelter MNA Ergebnisse. Ein Bogen wurde mit dem Pflegeheimbewohner selbst in Form eines Interviews ausgefüllt, ein weiterer MNA wurde mittels der Einschätzung des zuständigen Pflegepersonals komplettiert. Die Anwendbarkeit durch das Pflegepersonal war größer. Es ergab sich nur eine ausreichende Übereinstimmung zwischen den beiden Erhebungsmethoden. Es konnte ein prognostischer Wert dieses Instrumentes gezeigt werden, da mehr mangelernährte Bewohner im Beobachtungszeitraum von einem Jahr verstarben als Probanden, die mittels MNA als normal ernährt eingestuft wurden. Studien, die den Nährstoffspiegel von älteren Menschen longitudinal beobachten, existieren bisher kaum. Zweites Ziel der vorliegenden Arbeit war daher spezifische Blutmarker als Indikatoren des Ernährungszustandes bei den Pflegeheimbewohnern zu beschreiben, über ein Jahr zu beobachten und die Höhe der Blutwerte in Beziehung zu funktionellen Parametern und der Mortalität zu setzen. Die höchste Prävalenz an erniedrigten Spiegeln zeigte sich beim Vitamin D, Retinol und Albumin. Durchschnittlich sank der Retinol- und Vitamin D-Spiegel innerhalb eines Jahres signifikant ab. Die Vitamin D-, Retinol und Folatspiegel zeigten positive Assoziationen zu funktionellen Parametern; der Vitamin D-Spiegel zusätzlich zum Überleben der Pflegeheimbewohner. Neben der Problematik der großen Anzahl mangelernährter älterer Menschen, zeigt sich eine stetig wachsende Prävalenz adipöser über 65-Jähriger. Der Einfluss von Übergewicht auf funktionelle Parameter bei zuhause Lebenden zeigte bisher divergente Ergebnisse, entsprechende Daten für Bewohner von Pflegeheimen liegen kaum vor. Entsprechend war das letztes Ziel der vorliegenden Arbeit die Analyse des Zusammenhanges zwischen Adipositas, definiert durch einen BMI von >30 kg/m2, der Funktionalität und der Mortalität. Adipöse Bewohner zeigten ein größeres funktionelles Potential und eine höhere Überlebensrate als Bewohner im normalen und untergewichtigen BMI Bereich

Assembling evidence for identifying reservoirs of infection

Many pathogens persist in multihost systems, making the identification of infection reservoirs crucial for devising effective interventions. Here, we present a conceptual framework for classifying patterns of incidence and prevalence, and review recent scientific advances that allow us to study and manage reservoirs simultaneously. We argue that interventions can have a crucial role in enriching our mechanistic understanding of how reservoirs function and should be embedded as quasi-experimental studies in adaptive management frameworks. Single approaches to the study of reservoirs are unlikely to generate conclusive insights whereas the formal integration of data and methodologies, involving interventions, pathogen genetics, and contemporary surveillance techniques, promises to open up new opportunities to advance understanding of complex multihost systems

Induced topological changes in DNA complexes: influence of DNA sequences and small molecule structures

Heterocyclic diamidines are compounds with antiparasitic properties that target the minor groove of kinetoplast DNA. The mechanism of action of these compounds is unknown, but topological changes to DNA structures are likely to be involved. In this study, we have developed a polyacrylamide gel electrophoresis-based screening method to determine topological effects of heterocyclic diamidines on four minor groove target sequences: AAAAA, TTTAA, AAATT and ATATA. The AAAAA and AAATT sequences have the largest intrinsic bend, whereas the TTTAA and ATATA sequences are relatively straight. The changes caused by binding of the compounds are sequence dependent, but generally the topological effects on AAAAA and AAATT are similar as are the effects on TTTAA and ATATA. A total of 13 compounds with a variety of structural differences were evaluated for topological changes to DNA. All compounds decrease the mobility of the ATATA sequence that is consistent with decreased minor groove width and bending of the relatively straight DNA into the minor groove. Similar, but generally smaller, effects are seen with TTTAA. The intrinsically bent AAAAA and AAATT sequences, which have more narrow minor grooves, have smaller mobility changes on binding that are consistent with increased or decreased bending depending on compound structure

Impact of Simian Immunodeficiency Virus Infection on Chimpanzee Population Dynamics

Like human immunodeficiency virus type 1 (HIV-1), simian immunodeficiency virus of chimpanzees (SIVcpz) can cause CD4+ T cell loss and premature death. Here, we used molecular surveillance tools and mathematical modeling to estimate the impact of SIVcpz infection on chimpanzee population dynamics. Habituated (Mitumba and Kasekela) and non-habituated (Kalande) chimpanzees were studied in Gombe National Park, Tanzania. Ape population sizes were determined from demographic records (Mitumba and Kasekela) or individual sightings and genotyping (Kalande), while SIVcpz prevalence rates were monitored using non-invasive methods. Between 2002–2009, the Mitumba and Kasekela communities experienced mean annual growth rates of 1.9% and 2.4%, respectively, while Kalande chimpanzees suffered a significant decline, with a mean growth rate of −6.5% to −7.4%, depending on population estimates. A rapid decline in Kalande was first noted in the 1990s and originally attributed to poaching and reduced food sources. However, between 2002–2009, we found a mean SIVcpz prevalence in Kalande of 46.1%, which was almost four times higher than the prevalence in Mitumba (12.7%) and Kasekela (12.1%). To explore whether SIVcpz contributed to the Kalande decline, we used empirically determined SIVcpz transmission probabilities as well as chimpanzee mortality, mating and migration data to model the effect of viral pathogenicity on chimpanzee population growth. Deterministic calculations indicated that a prevalence of greater than 3.4% would result in negative growth and eventual population extinction, even using conservative mortality estimates. However, stochastic models revealed that in representative populations, SIVcpz, and not its host species, frequently went extinct. High SIVcpz transmission probability and excess mortality reduced population persistence, while intercommunity migration often rescued infected communities, even when immigrating females had a chance of being SIVcpz infected. Together, these results suggest that the decline of the Kalande community was caused, at least in part, by high levels of SIVcpz infection. However, population extinction is not an inevitable consequence of SIVcpz infection, but depends on additional variables, such as migration, that promote survival. These findings are consistent with the uneven distribution of SIVcpz throughout central Africa and explain how chimpanzees in Gombe and elsewhere can be at equipoise with this pathogen

What do geriatric rehabilitation patients and experts consider relevant? Requirements for a digitalised e-coach for sustainable improvement of nutrition and physical activity in older adults – a qualitative focus group study

Background!#!During geriatric rehabilitation, attempts are made to increase the patients' health and functional capacity. In order to maintain these improvements in the medium- and long-term, behavioural changes regarding mobility and nutrition are also targeted, but these are often not sustainable. International studies show positive effects on the sustainability of the improvement of physical activity behaviour in healthy seniors through the use of electronic devices and software applications. Comparable approaches that include nutrition topics or combine them and were additionally developed for geriatric rehabilitation patients (≥70 years) to date are not known. The aim of this study was to identify what geriatric rehabilitation patients require from an electronic coaching system (e-coach) to support them in improving their nutritional and physical activity behaviour, and what content and features physiotherapists and dieticians consider relevant.!##!Method!#!Focus group interviews (09-11/2019) were conducted in a geriatric rehabilitation centre in Germany with patients aged 70 years and older, relatives and experts (physiotherapists and nutritionists). The focus groups were recorded, transcribed verbatim and analysed using content analysis.!##!Results!#!Three focus groups with patients and relatives (n = 17, 65% female, 16 (94%) in age category 70-99 years) and one focus group with experts (2 dieticians and 1 physiotherapist) were conducted. Relevant contents and feedback elements for nutrition and physical activity in old age were identified. The patients' comments show that an e-coach must offer obvious benefits for the older persons and promote motivation in order to be used. The willingness to change nutrition and physical activity behaviour and the previous experiences in these areas are very heterogeneous, therefore content should be adaptable to different requirements.!##!Conclusion!#!Experts and patients identified quite similar contents, barriers and facilitators for a nutrition and physical activity e-coach. The e-coach needs to be able to address different points of behaviour change, enable adaptations to the individual patient and convince the older person that using it will help them to improve their nutrition and physical activity. It is also important that the e-coach is easy to use and can be easily integrated into the patient's everyday life after rehabilitation

Detecting Impending Malnutrition of (Pre-) Frail Older Adults in Domestic Smart Home Environments

Malnutrition is a well-known risk factor for deteriorated physical function, disability and loss in independence in older adults. An unintended loss in body weight of more than 5% in 3 months is one indicator for malnutrition. In this study we examined the relationship between meal preparation time, hand grip strength, and body weight in order to map impending nutritional problems using ambient sensors. Data were collected in the domestic environments of 20 (pre-) frail older adults aged 85.75 y (Standard Deviation: 5.19 y) over 10-months of observation. Collecting included physical function and nutritional status of the participants and meal preparation time by a combination of motion and power sensor events. Analysis was done by rank correlation of hand grip strength, body weight, and meal preparation time. Ten participants aged 85.1 years (Standard Deviation: 4.6 y) were included. The results show a significant correlation (≥0.99) of the meal preparation time with the hand grip strength. This result validated the meal preparation time as a suitable measure for analysing the correlation between meal preparation time and body weight, and a significant correlation (≥0.99) found. Hence the meal preparation time could be used as an indicator for malnutrition. However, causalities have to be conducted by further clinical studies

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up

Estimation of the HIV basic reproduction number in rural south west Uganda: 1991-2008.

BACKGROUND: The basic reproduction number, [Formula: see text], is one of the many measures of the epidemic potential of an infection in a population. We estimate HIV [Formula: see text] over 18 years in a rural population in Uganda, examine method-specific differences in estimated [Formula: see text], and estimate behavioural changes that would reduce [Formula: see text] below one. METHODS: Data on HIV natural history and infectiousness were collated from literature. Data on new sexual partner count were available from a rural clinical cohort in Uganda over 1991-2008. [Formula: see text] was estimated using six methods. Behavioural changes required to reduce [Formula: see text] below one were calculated. RESULTS: Reported number of new partners per year was 0 to 16 (women) and 0 to 80 (men). When proportionate sexual mixing was assumed, the different methods yielded comparable [Formula: see text] estimates. Assuming totally assortative mixing led to increased [Formula: see text] estimates in the high sexual activity class while all estimates in the low-activity class were below one. Using the "effective" partner change rate introduced by Anderson and colleagues resulted in [Formula: see text] estimates all above one except in the lowest sexual activity class. [Formula: see text] could be reduced below one if: (a) medium risk individuals reduce their partner acquisition rate by 70% and higher risk individuals reduce their partner acquisition rate by 93%, or (b) higher risk individuals reduce the partner acquisition rate by 95%. CONCLUSIONS: The estimated [Formula: see text] depended strongly on the method used. Ignoring variation in sexual activity leads to an underestimation of [Formula: see text]. Relying on behaviour change alone to eradicate HIV may require unrealistically large reductions in risk behaviour, even though for a small proportion of the population. To control HIV, complementary prevention strategies such as male circumcision and HIV treatment services need rapid scale up