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Current Challenges in Home Nutrition Services for Frail Older Adults in Japan—A Qualitative Research Study from the Point of View of Care Managers  [PDF]
Yoshihisa Hirakawa,Takaya Kimata,Kazumasa Uemura
Healthcare , 2013, DOI: 10.3390/healthcare1010053
Abstract: Preventive care for frail older adults includes providing tailor-made diet information suited to their health conditions. The present study aims to explore the current situation and challenges of home nutrition advice for Japanese frail older adults using qualitative data from a ten-person group discussion among care managers. As the results of our analysis, nine themes were identified: (1) Homebound older adults develop poor eating habits; meals turn into a lonely and unpleasant experience; (2) With age, people’s eating and drinking patterns tend to deteriorate; (3) Many older adults and their family know little about food management according to condition and medication; (4) Many older adults do not understand the importance of maintaining a proper diet; (5) Many homebound older adults do not worry about oral hygiene and swallowing ability; (6) Some older adults are at high risk for food safety problems; (7) Only a limited range of boil-in-the-bag meal options are available for older adults; (8) Many older adults feel unduly confident in their own nutrition management skills; and (9) For many family caregivers, nutrition management is a burden. We conclude that the provision of tailor-made information by skilled dietitians and high-quality home-delivered meal service are essential for the successful nutrition management of the older adults.
Challenges and Solutions for Care of Frail Older Adults
Young, H
Online Journal of Issues in Nursing , 2003,
Abstract: Frail older adults are at risk for negative outcomes and are the most significant consumers of health resources across both acute and community settings. Both formal systems and families are involved in this care of frail elders. This article reviews health care issues for frail older adults and addresses the impact of frailty on the future health care system. It also presents challenges for future care, creative solutions that are currently being tested and explored, and suggestions for future nursing priorities. Challenges in the care of frail elders include: the organization and sustainability of the continuum of services, resource allocation, and cultural competence in service delivery. Creative solutions include intensive case management programs, targeting at risk older adults, partnerships with families, enhanced use of telemedicine and assistive technology, and promoting healthy aging. Nurses have the potential to improve elder health across settings through clinical practice, education, leadership, and research.
A Need to Study the Immune Status of Frail Older Adults
Steven C Castle, Koichi Uyemura, Tamas Fulop, Katsuiku Hirokawa, Takashi Makinodan
Immunity & Ageing , 2006, DOI: 10.1186/1742-4933-3-1
Abstract: In contrast, much is known of the immune status of the healthy older adult subpopulation, for this subpopulation has been investigated extensively over the past three decades. Thus, it is known that T cell-dependent immune functions decline with age [2], and associated with the decline are structural changes in T cells [3]. However, a review of more than 200 scientific articles that evaluated healthy older adults, who were selected on a set of rigorous criteria as defined by the SENEIUR Protocol [4], showed that the magnitude of decline in T cell-dependent immune functions with age is modest [5], relative to that of the aging mouse model [6]. More recently, Sehl and Yates [7] analyzed changes in various physiologic functions with age from 469 studies involving more than 54,000 healthy and frail older adults. The expansive review included 43 immunologic studies of 372 individuals. They found that the mean annual rate of decline with age in immune functions is greater than that of other physiologic functions that were assessed. The authors concluded that the deterioration in immune function in older adults is due not only to aging, but also the presence of chronic disease. This review also underscores the need to evaluate the immune status of frail older adults with chronic diseases.Recently, the influence of chronic disease on T cell immunity as been investigated [8], using the Cumulative Illness Rating Scale (CIRS) [9]. CIRS is an instrument that measures disease burden in individuals with various chronic diseases, but with no evidence of acute deterioration or infection. The CIRS instrument was originally developed in 1968 and is acknowledged as a user-friendly, comprehensive review of medical problems of 14 organ systems [9]. It is based on a 0 to 4 rating of each organ system. The scale has been validated in older adults living in long-term care facilities and congregate apartments in the community and has demonstrated better validity in predicting healthcare out
Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)
Maaike M Muntinga, Emiel O Hoogendijk, Karen M van Leeuwen, Hein PJ van Hout, Jos WR Twisk, Henriette E van der Horst, Giel N Nijpels, Aaltje PD Jansen
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-19
Abstract: In a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. Participants: 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. Intervention: Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. Evaluation: We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the “intention-to-treat” principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional status, care needs and QALYs. We will investigate the level of implementation, barriers and facilitators to successful implementation and the extent to which the intervention manages to achieve the transition necessary to overcome challenges in elderly care.This is one of the first studies assessing the effectiveness, cost-effectiveness and implementation process of the chronic care model for frail community-dwelling older adults.The Netherlands National Trial Register NTR2160.
Effectiveness of an exercise program on postural control in frail older adults  [cached]
Alfieri FM,Riberto M,Abril-Carreres A,Boldó-Alcaine M
Clinical Interventions in Aging , 2012,
Abstract: Fábio Marcon Alfieri,1,2 Marcelo Riberto,3 àngels Abril-Carreres,4 Maria Boldó-Alcaine,4 Elisabet Rusca-Castellet,4 Roser Garreta-Figuera,4 Linamara Rizzo Battistella51S o Paulo Adventist University Center, S o Paulo, Brazil; 2Institute of Physical and Rehabilitation Medicine Hospital of Clinics, University of S o Paulo, Brazil; 3School of Medicine in Ribeir o Preto, University of S o Paulo, Brazil; 4University Hospital Mútua Terrassa Department of Rehabilitation, University of Barcelona, Barcelona, Spain; 5School of Medicine, Institute of Physical Medicine and Rehabilitation, Clinics Hospital of University of S o Paulo, S o Paulo, BrazilBackground: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults.Method: Twenty-six older adults (76.7 ± 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mútua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System . These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%.Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open.Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.Keywords: balance, aging, intervention, falls
Effectiveness of an exercise program on postural control in frail older adults
Alfieri FM, Riberto M, Abril-Carreres A, Boldó-Alcaine M, Rusca-Castellet E, Garreta-Figuera R, Battistella LR
Clinical Interventions in Aging , 2012, DOI: http://dx.doi.org/10.2147/CIA.S36027
Abstract: tiveness of an exercise program on postural control in frail older adults Original Research (1525) Total Article Views Authors: Alfieri FM, Riberto M, Abril-Carreres A, Boldó-Alcaine M, Rusca-Castellet E, Garreta-Figuera R, Battistella LR Published Date December 2012 Volume 2012:7 Pages 593 - 598 DOI: http://dx.doi.org/10.2147/CIA.S36027 Received: 17 July 2012 Accepted: 10 October 2012 Published: 18 December 2012 Fábio Marcon Alfieri,1,2 Marcelo Riberto,3 àngels Abril-Carreres,4 Maria Boldó-Alcaine,4 Elisabet Rusca-Castellet,4 Roser Garreta-Figuera,4 Linamara Rizzo Battistella5 1S o Paulo Adventist University Center, S o Paulo, Brazil; 2Institute of Physical and Rehabilitation Medicine Hospital of Clinics, University of S o Paulo, Brazil; 3School of Medicine in Ribeir o Preto, University of S o Paulo, Brazil; 4University Hospital Mútua Terrassa Department of Rehabilitation, University of Barcelona, Barcelona, Spain; 5School of Medicine, Institute of Physical Medicine and Rehabilitation, Clinics Hospital of University of S o Paulo, S o Paulo, Brazil Background: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method: Twenty-six older adults (76.7 ± 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mútua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System . These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.
Delayed postural control during self-generated perturbations in the frail older adults
Kubicki A, Bonnetblanc F, Petrement G, Ballay Y, Mourey F
Clinical Interventions in Aging , 2012, DOI: http://dx.doi.org/10.2147/CIA.S28352
Abstract: yed postural control during self-generated perturbations in the frail older adults Original Research (3564) Total Article Views Authors: Kubicki A, Bonnetblanc F, Petrement G, Ballay Y, Mourey F Published Date February 2012 Volume 2012:7 Pages 65 - 75 DOI: http://dx.doi.org/10.2147/CIA.S28352 Received: 17 November 2011 Accepted: 18 January 2012 Published: 29 February 2012 Alexandre Kubicki1–3, Fran ois Bonnetblanc1,2, Geoffroy Petrement3, Yves Ballay1,2, France Mourey2,4 1UFR STAPS, Université de Bourgogne, Dijon, France; 2Motricité et Plasticité, Institut National de la Santé et de la Recherche Médicale (INSERM), Dijon, France; 3SARL Fovea Interactive, Campus Industriel – Espace Entreprises, Chalon sur Sa ne, France; 4UFR Médecine, Université de Bourgogne, Dijon, France Purpose: The aim of this study was to investigate the coordination between posture and movement in pathological aging (frailty) in comparison with normal aging, with the hypothesis that in pathological aging, postural control evolves towards a more reactive mode for which the perturbation induced by the movement is not anticipated and leads to delayed and late postural adjustments. Methods: Elderly subjects performed rapid focal arm-raising movements towards a target, from an upright standing position in two stimuli conditions: simple reaction time and choice reaction time (CRT). Hand and center of pressure (CoP) kinematics were compared between a control group and a frail group of the same age. Results: In frail individuals, the entire movement was impaired and slowed down. In addition, postural adjustments that classically precede and accompany the focal arm movement were delayed and reduced, especially in the CRT condition in which the motor prediction is more limited. Finally, a correlation between the time to CoP maximal velocity and the timed up-and-go score was observed. Conclusion: In these patients, it was concluded that the control of the CoP displacement evolved from a proactive mode in which the perturbation associated with the arm movement is anticipated toward a more reactive mode in which the perturbation is compensated by late and delayed adjustments.
Delayed postural control during self-generated perturbations in the frail older adults  [cached]
Kubicki A,Bonnetblanc F,Petrement G,Ballay Y
Clinical Interventions in Aging , 2012,
Abstract: Alexandre Kubicki1–3, Fran ois Bonnetblanc1,2, Geoffroy Petrement3, Yves Ballay1,2, France Mourey2,41UFR STAPS, Université de Bourgogne, Dijon, France; 2Motricité et Plasticité, Institut National de la Santé et de la Recherche Médicale (INSERM), Dijon, France; 3SARL Fovea Interactive, Campus Industriel – Espace Entreprises, Chalon sur Sa ne, France; 4UFR Médecine, Université de Bourgogne, Dijon, FrancePurpose: The aim of this study was to investigate the coordination between posture and movement in pathological aging (frailty) in comparison with normal aging, with the hypothesis that in pathological aging, postural control evolves towards a more reactive mode for which the perturbation induced by the movement is not anticipated and leads to delayed and late postural adjustments.Methods: Elderly subjects performed rapid focal arm-raising movements towards a target, from an upright standing position in two stimuli conditions: simple reaction time and choice reaction time (CRT). Hand and center of pressure (CoP) kinematics were compared between a control group and a frail group of the same age.Results: In frail individuals, the entire movement was impaired and slowed down. In addition, postural adjustments that classically precede and accompany the focal arm movement were delayed and reduced, especially in the CRT condition in which the motor prediction is more limited. Finally, a correlation between the time to CoP maximal velocity and the timed up-and-go score was observed.Conclusion: In these patients, it was concluded that the control of the CoP displacement evolved from a proactive mode in which the perturbation associated with the arm movement is anticipated toward a more reactive mode in which the perturbation is compensated by late and delayed adjustments.Keywords: frailty, anticipatory postural adjustments, backward disequilibrium
Frailty Prevalence and Characteristics in Older Patients with Type 2 Diabetes  [PDF]
Takahisa Tanikawa, Sayuri Sable-Morita, Haruhiko Tokuda, Hidenori Arai
Journal of Diabetes Mellitus (JDM) , 2019, DOI: 10.4236/jdm.2019.92004
Abstract: Background: Older diabetic patients are more likely to be frail than those who do not have diabetes. Frailty is an important risk factor for both mortality and disability in older patients with type 2 diabetes. However, the mechanism of frailty in diabetes mellitus is not fully understood. Aims: The aim of this study was to identify the prevalence of frailty and associated factors in older patients with type 2 diabetes in Japan. Methods: A cross-sectional study was conducted with a total of 178 outpatients who were over 65 years old with type 2 diabetes. We used the Obu Study Health Promotion for the Elderly definition of frailty to divided subjects into a non-frail and a frail group. We investigated the association between frailty and various patient characteristics. Results: In the study, 21.4% of the older patients with type 2 diabetes were considered frail. There were no significant differences in the duration of diabetes, BMI, proportion of microvascular complications, or HbA1c values between the frail and non-frail group. However, serum albumin and IGF-1 levels were lower in the frail group than the non-frail group as were the Mini-Mental State Examination scores. The frail group had a higher number of medications than the non-frail group. In a multivariable analysis, frailty was positively associated with the number of medications and, lower levels of both serum albumin and IGF-1. Conclusion: Our study suggests that diabetes accelerates the aging process and frailty is associated with low albumin, polypharmacy and low levels of IGF-1.
Study on Comparison of Citizens’ Environmental Awareness Among Four Cities in China and Japan  [cached]
Yingchao LIN,Masahiko FUJII,Peng WANG
Management Science and Engineering , 2011, DOI: 10.3968/j.mse.1913035x20110503.315
Abstract: This study aims to compare governmental activities and citizens’ consciousness in environmental protection in China and Japan. The citizens’ environmental awareness and the relevant acts were examined by designing and distributing questionnaires to citizens in urban and rural cities in China and Japan. The results demonstrate that there are more differences between the two countries than between urban and rural cities inside the same country. Chinese people pay more attention to local severe problems, and require more garbage classification while Japanese people are relatively satisfied with the current environmental situations. Past trends of the accessible environment could positively affect citizens’ perspectives for the environment in the future. Key words: Environmental awareness; Citizen; China; Japan; Social survey
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