Prevalence and risk factors of sarcopenia among adults living in nursing homes

Objectives: Sarcopenia is a progressive loss of skeletal muscle and muscle function, with significant healthand disability consequences for older adults. We aimed to evaluate the prevalence and risk factors ofsarcopenia among older residential aged care adults using the European Working Group on Sarcopeniain Older People (EWGSOP) criteria.Study design: A cross-sectional study design that assessed older people (n = 102, mean age 84.5 ± 8.2 years)residing in 11 long-term nursing homes in Australia.Main outcome measurements: Sarcopenia was diagnosed from assessments of skeletal mass index bybioelectrical impedance analysis, muscle strength by handheld dynamometer, and physical performanceby the 2.4 m habitual walking speed test. Secondary variables where collected to inform a risk factoranalysis.Results: Forty one (40.2%) participants were diagnosed as sarcopenic, 38 (95%) of whom were categorizedas having severe sarcopenia. Univariate logistic regression found that body mass index (BMI) (Oddsratio (OR) = 0.86; 95% confidence interval (CI) 0.78–0.94), low physical performance (OR = 0.83; 95% CI0.69–1.00), nutritional status (OR = 0.19; 95% CI 0.05–0.68) and sitting time (OR = 1.18; 95% CI 1.00–1.39)were predictive of sarcopenia. With multivariate logistic regression, only low BMI (OR = 0.80; 95% CI0.65–0.97) remained predictive.Conclusions: The prevalence of sarcopenia among older residential aged care adults is very high. Inaddition, low BMI is a predictive of sarcopenia

Consequences of sarcopenia among nursing home residents at long-term follow-up.

The consequences of and transition into sarcopenia with long-term survival was investigated in the nursing home setting. Eligible residents from 11 nursing homes were followed-up 18-months after their assessment for sarcopenia using the European Working Group on Sarcopenia in Older People criteria, with other demographic, physical and cognitive health measures collected. Of the 102 older adults who consented at baseline, 22 had died and 58 agreed to participate at follow-up, 51.7% of whom had sarcopenia. Sarcopenia at baseline was associated with a depression (p < 0.001), but not mortality, hospitalization, falls or cognitive decline at follow-up. Age was the strongest predictor of mortality (p = 0.05) with the relative risk of death increasing 5.2% each year. The prevalence of sarcopenia is high and increases with long-term survival in end-of-life care. However, the risk of sarcopenia-related mortality is not as great as from increasing age alone

1940 Ruby Yearbook

A digitized copy of the 1940 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1042/thumbnail.jp

Attention deficits after incident stroke in the acute period: Frequency across types of attention and relationships to patient characteristics and functional outcomes

Background: Attention deficits are common post stroke and result in poorer functional outcomes. This study examined the frequency of attention deficits after incident stroke and their correlates. Method: Attention of 94 stroke survivors was assessed using the Bells test, Trails Making Test A/B, 2.4- and 2.0-second trials of the Paced Auditory Serial Addition Test (PASAT), and Integrated Auditory Visual Continuous Performance Test (IVA-CPT) within 3 weeks post stroke. Wider functioning was assessed using the Medical Short Form-36 (SF-36) Physical and Mental Component Summary scores (PCS and MCS), London Handicap Scale, Modified Rankin Scale, General Health Questionnaire-28, and Cognitive Failures Questionnaire (CFQ). Results: Most participants were impaired or very impaired on the IVA-CPT (z scores > 3 SDs below normative mean) but not other attention measures. Functional independence and cognitive screening test (Mini-Mental State Examination) performance were significantly related to IVA-CPT, Trails A/B, and Bells tests but not PASAT. Better performance across the Bells test was related to better SF-36 PCS, whereas Trails A and the PASAT were related to SF-36 MCS. Better CFQ naming was related to Trails B, whereas worse CFQ memory was related to better PASAT performance. Conclusion: Attention deficits are common post stroke, though frequency varies widely across the forms of attention assessed, with tests of neglect and speeded attention tasks being linked to quality of life. This variability of performance and linking to wider outcomes suggests the need for comprehensive assessment of attention and that attention is a viable target for rehabilitative efforts

General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

Melatonin in Youth: N-of-1 trials in a stimulant-treated ADHD Population (MYNAP): study protocol for a randomized controlled trial

Attention-deficit/hyperactivity disorder (ADHD) is a common neurological disorder affecting 5\ua0% of children worldwide. A prevalent problem for children with ADHD is initial insomnia. The gold standard treatment to manage ADHD symptoms is stimulant medications, which may exacerbate the severity of existing initial insomnia. Currently, no gold standard treatment option exists for initial insomnia for these children. Melatonin, a hormone and a popular natural health product, is commonly provided to children by parents and recommended by healthcare providers, but high quality pediatric evidence is lacking.This trial is a multicenter randomized triple-blind, placebo-controlled, parallel-group, randomized, controlled trial (RCT), in which each participant is offered an N-of-1 trial. An N-of-1 trial is a multiple-crossover, randomized, controlled trial conducted in a single individual. For the N-of-1 trial, each participant will undergo three pairs of treatment/placebo periods; each period is 1\ua0week in length. Half the participants will have melatonin in the first period, the other half will start with placebo, and this will make up the parallel-group RCT. The primary outcome will be mean difference in sleep onset latency as measured by sleep diaries. A comparison of treatment effects yielded by the RCT data versus the aggregated N-of-1 trial data will also be assessed.This trial will provide rigorous evidence for the effectiveness of melatonin in children with ADHD on stimulants who experience initial insomnia. Further, this study will provide the first prospectively planned head-to-head comparison of RCT data with pooled data from a series of N-of-1 trials. Aggregated N-of-1 trials may be a powerful tool to produce high quality clinical trial evidence.ClinicalTrials.gov, NCT02333149 . Registered on 16 December 2014. Australian New Zealand Clinical Trials Registry, ACTRN12614000542695 . Registered on 21 May 2014

The role of allied health in the management of complex conditions in a comprehensive primary care setting

Appropriate management of chronic and complex conditions requires the expertise of many professionals. The interaction between these professionals is not well understood. Ensuring appropriate interaction, particularly between general practitioners (GPs) and allied health professionals (AHPs) is essential to high quality care.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Prevalence and Risk Factors for Low Habitual Walking Speed in Nursing Home Residents: An Observational Study

Objective To quantify habitual walking speed and estimate the prevalence of low habitual walking speed