What do care home managers believe constitutes an ‘assessment for frailty’ of care home residents in North-West London? A survey

Background Frail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately. Research suggests that any interaction between an older person and a health or social care professional should include an assessment for frailty. Many older care home residents are frail when admitted, but we have little knowledge of whether or how this is assessed. The aim of this paper is to understand and establish the characteristics of the reported ‘assessments for frailty’ used in care homes with nursing (nursing homes) across North-West London. This will help understand what an ‘assessment for frailty’ of care home residents mean in practice in North-West London. Methods Telephone contact was made with every Care Quality Commission (CQC) (independent regulator of health and adult social care in England) regulated nursing home across North-West London [n = 87]. An online survey was sent to all that expressed interest [n = 73]. The survey was developed through conversations with healthcare professionals, based on literature and tested with academics and clinicians. Survey responses were analysed using descriptive statistics. The Mann-Whitney U test was used for statistical analyses. Results 24/73 nursing homes completed the survey (33%). Differences in the characteristics of reported ‘assessments for frailty’ across nursing homes were evident. Variation in high level domains assessed (physical, social, mental and environmental) was observed. Nurses were the most common professional group completing assessments for frailty, with documentation and storage being predominantly paper based. A statistically significant difference between the number of assessments used in corporate chain owned nursing homes (3.9) versus independently owned nursing homes (2.1) was observed (U = 21, p = .005). Conclusions Great variation existed in the characteristics of reported ‘assessments for frailty’ in nursing homes. Our study suggests that not all physical, social, mental and environmental domains of frailty are routinely assessed: it appears that frailty is still primarily viewed only in terms of physical health. The consequences of this could be severe for patients, staff and healthcare settings. Research illustrates that frailty is a broad, multifactorial health state and, as such, an overall ‘assessment for frailty’ should reflect this

Can indirect calorimetry combined to analysis of expired 13CO2 predict insulin resistance ? A preliminary study in healthy children

Introduction: Insulin resistance is increasingly found in the paediatric age group, resulting from elevated endogenous glucose production (hepatic glycogenolysis and gluconeogenesis) and/or altered glucose utilization (glucose oxidation and glycogen synthesis). These variables can be computed from the simultaneous use of indirect calorimetry and breath 13CO2 measurement, both non invasive methods. Objective: Predicting insulin resistance in targeted subjects requires to establish first the normal developmental pattern of glucose oxidation and glycogen turnover in school-aged children. Patients/Material and Methods: A beverage containing naturally enriched 13C maize glucose was given every hour during four hours, at a rate of 3 mg/kg/min, to 47 lean healthy subjects of both sexes, aged 12.4 ± 2.6 yrs (mean ± SD) of whom 11 aged 7-9 yrs (group 1, G1), 20 aged 10-13 yrs (G2) and 16 aged 14-17 yrs (G3). Energy expenditure (EE) and total glucose oxidation (TGO) were measured during the last two hours by indirect calorimetry. Exogenous glucose oxidation (EGO) was determined by the analysis of 13CO2 production in expired air. Glycogen degradation (GD) (mostly hepatic in resting conditions) was calculated as [TGO - EGO], and total glycogen synthesis (TGS) (liver and skeletal muscle) was calculated as [glucose intake - EGO]. Results: EE correlated negatively with age (r = -0.76, p < 0.001) as well as TGO (r = -0.66, p < 0.001) and GD (r = -0.59, p < 0.001), whereas EGO and TGS did not change signficantly. When expressed as age groups, EE decreased from 0.025 (G1) to 0.017 kcal/kg/min (G3) (p < 0.001). TGO fell from 4.61 (G1) to 4.25 (G2) and 2.93 mg/kg/min (G3) (p < 0.001 vs G1 and G2). Values for GD was 2.58, 2.30 and 1.23 mg/kg/min respectively (p = 0.004 for G3 vs G1 and p = 0.003 for G3 vs G2). Conclusions: 1) Indirect calorimetry coupled with breath 13CO2 measurement after oral glucose intake can easily be used in school-aged children. 2) This original non invasive procedure allows to assess glycogen degradation and synthesis simultaneously and, consequently, to describe the developmental pattern of whole body glycogen turnover in health and disease. 3) This pilot study shows significant changes in EE, TGO and GD with age in healthy subjects. These new data provide standardized values to be used in the evaluation of subjects at risk to develop anomalies of glucose metabolism

Assessment of hepatic glucose metabolism by indirect calorimetry in combination with a non-invasive technique using naturally enriched 13C glucose in healthy children and adolescents

The metabolic fate of hepatic glucose can be best studied using invasive techniques such as tracer infusions and frequent blood sampling which have been revealed to be impractical in the pediatric age group. The aim of this study was to develop a non-invasive method based on indirect calorimetry and expired 13CO2 monitoring in order to gain insight into the mechanisms leading to impaired glucose tolerance in children and teenagers. As a first step, net glucose oxidation (NGO) and energy expenditure (EE) were measured in 47 subjects (range 7.5-17.3 years) of whom 18 were prepubertal (P1), 11 in early puberty (P2-P3) and 18 in late puberty (P4-P5) after 3-hourly loads of 180 mg/kg of oral maize glucose containing naturally enriched 13C. Isotope analysis allowed to calculate exogenous and endogenous glucose oxidation (EXGO, ENGO) and, hence, to derive TGS and NGS, that is glycogen turnover. NGO and EE decreased significantly with pubertal progression, reflecting higher metabolism at younger ages, whereas EXGO remained constant. TGS did not change significantly whereas NGS showed a significant negative correlation with pubertal progression: this can be explained by the fact that glycogenolysis exceeded glycogen synthesis in this experimental setting. This non-invasive method appears to be a promising tool to study the fate of hepatic glucose and therefore glycogen turnover in children at risk of developing glucose intolerance and/or type 2 diabetes