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01/2017 journal articles

Editorials

ABOUT CARE WEEKLY

A.S. Khachaturian

Care Weekly 2017;1:2

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CITATION:
A.S. Khachaturian (2017): About Care Weekly. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.1

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CARE SERVICES WORKFORCE DEVELOPMENT SPECIAL TOPIC SECTION

Care Weekly 2017;1:3

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CITATION:
A.S. Khachaturian (2017): Care Services Workforce Development Special Topic Section. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.2

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WEIGHT LOSS IS A MAJOR CAUSE OF FRAILTY

B. Fougère, J.E. Morley

Care Weekly 2017;1:4-6

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CITATION:
B. Fougère ; J.E. Morley (2017): Weight Loss is a Major Cause of Frailty. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.3

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Featured Articles

GENDER AND AGE DIFFERENCES IN LEVELS, TYPES AND LOCATIONS OF PHYSICAL ACTIVITY AMONG OLDER ADULTS LIVING IN CAR-DEPENDENT NEIGHBORHOODS

W. Li, E. Procter-Gray, L. Churchill, S.E. Crouter, K. Kane, J. Tian, P.D. Franklin, J.K. Ockene, J. Gurwitz

Care Weekly 2017;1:7-13

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Background: A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults. Objectives: To examine gender and age differences in levels, types and locations of physical activity. Design: Cross-sectional observation. Setting: Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA. Participants: 111 men and 103 women aged 65 years and older. Measurements: From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days. Results: Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching. Conclusion: Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

CITATION:
W. LI ; E. PROCTER-GRAY ; L. CHURCHILL ; S.E. CROUTER ; K. KANE ; J. TIAN ; P.D. FRANKLIN ; J.K. OCKENE ; J. GURWITZ (2017): Gender and Age Differences in Levels, Types and Locations of Physical Activity among Older Adults Living in Car-Dependent Neighborhoods . The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.4

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ORAL HEALTH AND THE FRAIL ELDERLY

L. Rapp, S. Sourdet, B. Vellas, M.H. Lacoste-Ferré

Care Weekly 2017;1:14-20

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Introduction: The relationships between oral health conditions and frailty have rarely been explored. A systematic review of frailty components and oral health concluded that differences in study population endpoint criteria and study design cannot establish a relationship between frailty and oral health. Objective: This study aims to describe the distribution of the OHAT (Oral Health Assessment Tool) score in a population of frail subjects and to assess associated parameters (age, socio-economic status, living conditions, education level, nutritional habits, cognitive functioning, autonomy). Design: Cross-sectional observational study among patients referred to the Geriatric Frailty Clinic. Measurements: 1314 patients participated in different standardized tests to evaluate their health status, cognitive and affective functioning, adaptation to usual daily activities, nutritional status, and oral health status. Results: The risk of oral health deterioration was higher with the appearance of frailty: the OHAT increased significantly with the Fried Frailty Score (p<0.001). Physical performance and oral health were correlated (p<0.001). The OHAT score and the MNA (Mini Nutritional Assessment) score were significantly correlated: oral status seemed better for malnourished subjects (p<0.001). Dementia significantly increased the risk of an unhealthy oral status (p<0.001). There was no significant correlation between oral status and depression, just a trend. Conclusion: This pilot study establishes a relationship between the OHAT and Fried Frailty Criteria in a population of frail elderly. It must be expanded to follow the distribution of the different items composing the OHAT score (items assessing lips; tongue; gums and tissues; saliva; natural teeth; dentures; oral cleanliness; and dental pain) with different parameters (age, socio-economic status, living conditions, educational level, medical history, drug treatment, nutritional habits, cognitive functioning, disabilities and handicaps).

CITATION:
L. RAPP ; S. SOURDET ; B. VELLAS ; M.-H. LACOSTE-FERRE (2017): Oral Health and the Frail Elderly. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.5

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HEALTH PROMOTION AND PREVENTIVE CARE INTERVENTION FOR OLDER COMMUNITY-DWELLING PEOPLE: LONG-TERM EFFECTS OF A RANDOMISED CONTROLLED TRIAL (RCT) WITHIN THE LUCAS COHORT

L. Neumann, U. Dapp, W. Von Renteln-Kruse, C.E. Minder

Care Weekly 2017;1:21-30

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Objectives: An RCT of a health promotion and preventive care intervention was done in 2001-2002. Here, long-term analyses based on 12 years of follow-up of survival and of change in functional competence between intervention and control group are presented. Positive 1-year results (significantly higher use of preventive services and better health behaviour) were presented earlier. Design: Parallel group randomised controlled trial (RCT) with 878 participants in the intervention and 1,702 participants in the control group. Setting: The study took place in Hamburg, Germany and made use of health care structures and professionals of a geriatrics centre. Participants: Study participants were initially community-dwelling, aged 60 years and older and without B-ADL-restrictions, cognitive impairment, or need of nursing care, with sufficient command of the German language. Interventions: Health promotion and preventive care interventions relied on an extensive health questionnaire and the subsequent offer to participate in multi-topic personal reinforcement performed in small group sessions or at preventive home visits. Measurements: Primary outcome: Survival time; in some analyses, adjustments were made for gender, age and self-perceived health. Secondary outcome: Functional competence (LUCAS Functional Ability Index) based on responses to self-administered questionnaires at 1-year follow-up and 12 years after 1-year follow-up (2013/2014). Results: Mean time under observation was 10.3 years. 38.3% (987/2,580) of the participants died; intervention group (IG): 35.7% (313/878), control group (CG): 39.6% (674/1,702); HR=0.89; p=0.09. Functional competence at 1-year follow-up: IG: ROBUST 67.4% (391/580), FRAIL 11.9% (69/580) vs. CG: ROBUST 62.9% (861/1,368), FRAIL 14.8% (203/1,368); p=0.12. 12-years after 1-year follow-up: IG: ROBUST 50.0% (160/320), FRAIL 30.9% (99/320) vs. CG: ROBUST 48.9% (307/628), FRAIL 34.1% (214/628); p=0.56. Conclusions: Insignificant but consistent effects on survival and the dynamics of functional competence suggest effectivity of the complex intervention. We plan to take a closer look at the effect of each reinforcement separately.

CITATION:
L. NEUMANN ; U. DAPP ; W. VON RENTELN-KRUSE ; C.E. MINDER (2017): Health Promotion and Preventive Care Intervention for Older Community-Dwelling People: Long-Term Effects of a Randomised Controlled Trial (RCT) within the LUCAS Cohort. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.6

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THE MEALTIME AUDIT TOOL (MAT) – INTER-RATER RELIABILITY TESTING OF A NOVEL TOOL FOR THE MONITORING AND ASSESSMENT OF FOOD INTAKE BARRIERS IN ACUTE CARE HOSPITAL PATIENTS

J. McCulough, H. Marcus, H. Keller

Care Weekly 2017;1:31-40

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Objectives: Barriers to food intake (FI) exist in hospital that could exacerbate insufficient FI and malnutrition. The Mealtime Audit Tool (MAT) is a staff-administered clinical assessment tool to identify FI barriers for individual patients. Two studies were completed. The objectives of the first study were to test a draft version of the tool and characterize barriers to food intake in older adults in four diverse hospitals, while the second study aimed to demonstrate the inter-rater reliability of the revised MAT. Design: Multi-site, cross sectional. Setting: Four acute care hospitals in Canada. Participants: Study 1: 120 older (65+ years, adequate cognition) medical or surgical patients. Study 2: 90 medical or surgical patients. Measurements: In study 1, participants had barriers experienced at one mealtime assessed with MAT. Descriptive analyses characterized the prevalence of barriers across the hospitals. Revisions were made to the MAT based on recommendations from sites. A revised version was tested for inter-rater reliability in study 2. Intraclass correlation coefficient (ICC) was calculated for total MAT scores from 90 patient meals assessed by two raters. Kappa statistics were calculated for each of the 18 MAT items. Results: Mean (+/- standard deviation) number of barriers experienced in Study 1 was 2.93 +/- 1.58, and in Study 2 was 2.51 +/- 1.19. The revised MAT was reliable with an ICC of 0.68 (95%CI: 0.52-0.79). Ten of 16 items in which kappa could be calculated had at least fair agreement. Conclusion: MAT is sufficiently reliable when used by auditors with minimal training. Routinely auditing mealtimes with MAT could be useful in identifying and removing barriers to food intake for older hospitalized patients.

CITATION:
J. MCCULLOUGH ; H. MARCUS ; H. KELLER (2017): The Mealtime Audit Tool (MAT) – Inter-Rater Reliability Testing of a Novel Tool for the Monitoring and Assessment of Food Intake Barriers in Acute Care Hospital Patients. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.7

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QUALITY INDICATORS OF NUTRITIONAL CARE PRACTICE IN ELDERLY CARE

M. Skinnars Josefsson, M. Nydahl, I. Persson, Y. Mattsson Sydner

Care Weekly 2017;1:41-49

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Objectives: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Measurements: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents’ age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Results: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and ‘meal councils’. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Conclusion: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

CITATION:
M. SKINNARS JOSEFSSON ; M. NYDAHL ; I. PERSSON ; Y. MATTSSON SYDNER (2017): Quality Indicators of Nutritional Care Practice in Elderly Care. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.8

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FRAILTY AND FEAR FALLING: THE FISTAC STUDY

M. Esbri-Victor, I. Huedo-Rodenas, M. Lopez-Utiel, J.L. Navarro-Lopez, M. Martinez-Reig, J.A. Serra-Rexach, L. Romero-Rizos, P. Abizanda

Care Weekly 2017;1:50-55

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Objective: To analyze the association between frailty and Fear of Falling (FoF) in a cohort of older adults with previous falls. Design: Cross-sectional study (FISTAC). Setting: Falls Unit, Complejo Hospitalario Universitario of Albacete (Spain). Participants: 183 adults older than 69 years, from the Falls Unit, with a history of a previous fall in the last year. Measurements: FoF was assessed at baseline using the Falls Efficacy Scale International (FES-I) and three questions previously validated. Frailty was assessed with the frailty phenotype criteria. Age, gender, comorbidity, nutritional status, cognitive status and risk of depression were determined. Results: Mean age 78.4, 80.3% women. FoF was present in 140 (76.5%) participants with the three questions and 102 (55.7%) presented high concern of falling with the FES-I. 88.8% of frail older adults presented FoF compared to 62.4% of those who were not frail, and only 37.8% of non frail had a high concern of falling, compared to 77.2% of those who were frail measured with the FES-I. Frail participants had an adjusted risk of FoF that was 3.18 (95% CI 1.32 to 7.65) higher compared to those who were not frail assessed with the three questions and 3.93 (95% CI 1.85 to 8.36) higher concern of falling when using the FES-I scale. Only female sex and depression risk were also associated to FoF in the final adjusted models. Conclusion: Frailty is independently associated with the FoF syndrome in older faller subjects.

CITATION:
M. ESBRI-VICTOR ; I. HUEDO-RODENAS ; M. LOPEZ-UTIEL ; J.L. NAVARRO-LOPEZ ; M. MARTINEZ-REIG ; J.A. SERRA-REXACH ; L. ROMERO-RIZOS ; P. ABIZANDA (2017): Frailty and Fear Falling: The FISTAC Study. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.9

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Policy Report

POLICY REPORT: VULNERABLE YOUTH. EMPLOYMENT AND JOBTRAINING PROGRAMS

Care Weekly 2017;1:56-77

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CITATION:
Policy report (2017): Policy Report: Vulnerable Youth. Employment and JobTraining Programs*. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/cw.2017.10

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Research News

NEWS IN BRIEF

Care Weekly 2017;1:78

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