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    Selected Abstracts

    Providing Nutrition Supplements to Institutionalized Seniors with Probable Alzheimer's Disease Is Least Beneficial to Those with Low Body Weight Status

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004
    Karen W. H. Young MSc
    Objectives: To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer's disease (AD) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention. Design: Randomized, crossover, nonblinded clinical trial. Setting: A fully accredited geriatric teaching facility affiliated with the University of Toronto's Medical School with a home for the aged. Participants: Thirty-four institutionalized seniors with probable AD who ate independently. Intervention: Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake. Measurements: Investigator-weighed food intake, body weight, cognitive function (Severe Impairment Battery and Global Deterioration Scale), behavioral disturbances (Neuropsychiatric Inventory,Nursing Home Version), and behavioral function (London Psychogeriatric Rating Scale). Results: Relative to habitual intake, group mean analyses showed increased 24-hour energy, protein, and carbohydrate intake during the supplement phase, but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake, and 24-hour energy intake was enhanced in only 21 of 31 subjects. Compensation at lunch was more likely in subjects with lower body mass indices, increased aberrant motor behavior, poorer attention, and increased mental disorganization/confusion. Conclusion: Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention,those with low body weight status. Those likely to benefit include those with higher body mass indices, less aberrant motor problems, less mental disorganization, and increased attention. [source]

    Neuropsychiatric symptoms and quality of life in patients in the final phase of dementia

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2009
    Raymond T.C.M. Koopmans
    Abstract Objectives To assess neuropsychiatric symptoms and quality of life in a group of patients in the final phase of dementia. Methods All patients with dementia (n,=,216) residing on dementia special care units of two Dutch nursing homes were included in the study provided they met the criteria for the final phase of dementia. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory Nursing Home version (NPI-NH) and the Cohen Mansfield Agitation Inventory (CMAI). Quality of life was assessed with the QUALIDEM Results Of the 216 dementia patients 39 met the criteria for the final phase of dementia. The patients showed a specific pattern of behaviours with a high prevalence of apathy, agitation and behaviours that were mainly observed during morning care such as making strange noises, grabbing, performing repetitious mannerism, spitting, hitting, screaming and pushing. Overall quality of life of these patients in the final phase of dementia was moderate. Conclusion In this small sample, patients in the final phase of dementia show specific behavioural problems, that mainly should be addressed with psychosocial interventions. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Energy-Containing Nutritional Supplements Can Affect Usual Energy Intake Postsupplementation in Institutionalized Seniors with Probable Alzheimer's Disease

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2006
    Matthew D. Parrott BSc
    OBJECTIVES: To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index (BMI) and cognitive and behavioral measures on this response. DESIGN: Secondary analysis of a previously published randomized, crossover, nonblinded clinical trial. SETTING: A fully accredited geriatric care facility affiliated with the University of Toronto. PARTICIPANTS: Thirty institutionalized seniors with probable Alzheimer's disease (AD) who ate independently. MEASUREMENTS: Investigator-weighed food intake, body weight, cognitive (Severe Impairment Battery; Global Deterioration Scale) and behavioral (Neuropsychiatric Inventory,Nursing Home version; London Psychogeriatric Rating Scale) assessments. RESULTS: Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8% of that increase postsupplementation, although stopping the supplement was associated with decreased habitual energy intake in low-BMI individuals who reduced their daily intakes during supplementation in response to the extra calories. Cognitive/behavioral tests were not reliable predictors of postsupplement intake. CONCLUSION: Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes resulting from 3 weeks of supplementation. This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden, but only for those individuals who are most likely to respond favorably. These data indicate that nutritional supplements and diet plans should be carefully prescribed in low-BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake. [source]

    Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale,

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2007
    K. Jongenelis
    Abstract Objective To construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients. Methods The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n,=,410), the Mini Mental State Examination (n,=,410) and a diagnostic interview (SCAN; n,=,333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, items that were identified as unsuitable were removed using the data of the Assess project (n,=,77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specitivity, area under ROC and positive and negative predictive values), the newly constructed shortened GDS was validated in the AGED data set (n,=,333), using DSM-IV diagnosis for depression as measured by the SCAN as ,gold standard'. Results The eight-item GDS that resulted from stage 1 showed good internal consistency in both the Assess data set (,,=,0.86) and the AGED dataset (,,=,0.80). In the AGED dataset, high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. Conclusion The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2007
    Sytse U. Zuidema
    Abstract Objective To estimate the prevalence of neuropsychiatric symptoms of dementia patients in Dutch nursing homes. Methods Cross-sectional study in a large sample of 1322 demented patients living in 59 dementia special care units (SCUs) in The Netherlands. Symptoms were observed by licensed vocational nurses during regular care-giving in a 2-week observational period prior to assessment. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory- Nursing home version (NPI-NH; frequency X severity score , 4) and the Cohen-Mansfield Agitation Inventory (CMAI; symptoms occurring at least once a week). Results More than 80% of these patients suffered from at least one clinically significant symptom, as defined with the NPI-NH frequency X severity score , 4. Measured with the NPH-NH agitation/aggression, apathy and irritability were the most frequently observed behaviors, with prevalences of 30,35%. Using the CMAI, 85% of the patients showed at least one symptom of agitation, of which general restlessness was observed most frequently (44%). Other frequently observed symptoms with prevalence rates of 30% were cursing or verbal aggression, constant request for attention, negativism, repetitious sentences, mannerisms, pacing, and complaining. Physically aggressive symptoms such as hitting, kicking, biting occurred less often (less than 13%). Conclusions Prevalence rates of neuropsychiatric symptoms in Dutch nursing home patients with dementia residing in SCUs are high, especially agitation and apathy. Insight into the prevalence rates of individual symptoms in patients with dementia has important practical consequences for the accurate planning of staff allotment and stresses the need for patient oriented care. Copyright © 2006 John Wiley & Sons, Ltd. [source]