Search

Background. Although weight change in older persons has proven prognostic significance, it is not known whether monthly weights obtained by the clinical staff in long-term care institutions are reliable enough to be useful in identifying at-risk residents. The objective of this study was to determine whether an association exists between mortality risk and the intraresident variation in weight in long-term care institutions. Methods. For this study, 900 nursing home residents with a recently identified nutritional problem from 96 long-term care facilities in 8 states were randomly selected. At study entry, nutritional, health status, and demographic data were extracted from the nursing home chart or the Minimum Data Set. Weights obtained by the nursing home staff were recorded at baseline and during each of the subsequent 6 months. Cox proportional hazards regression analysis was used to assess relationships between weight parameters and mortality risk during the 7 months of observation. Results. During the study, 435 (48%) participants had at least 1 monthly weight that differed from the previous month's weight by [greater than or equal to]5%; 163 (18%) participants had this magnitude of a 1-month weight change more than once. By controlling for the linear trend (i.e., slope) of each residents' weight change between the first to the as weight the average month-to-month residual variability in the resident's weights was calculated. This residual variability or 'average random fluctuation' in weight from 1 month to the next was [greater than or equal to]2% in 229 (25%) participants and [greater than or equal to]3% in 82 (9%) participants. Despite the large random fluctuation in the residents' weights weight loss was au important prognostic indicator. Those who lost [greater than or equal to]5% in any month had a 10-fold increased risk for death compared with those who gained weight (adjusted relative risk, 10.6; 95% confidence interval, 3.2 to 35.5). The average random fluctuation in weight was associated with an increased risk for death only at the upper 10th percentile for the population. Conclusions. Many nutritionally compromised elderly nursing home residents experience significant bidirectional fluctuations in their weight from month to month. How much of this variability is due to measurement error is not known. However, a weight loss of [greater than or equal to]5% in any month has important prognostic implications.

Background. The importance of undernutrition as a determinant of postdischarge mortality among hospitalized elderly people remains controversial. The purpose of this study was to investigate this issue. Methods. The study included 660 elderly patients (85% white, 98% men, average age 73 [+ or -] 6 years) discharged from a university-affiliated Department of Veterans Affairs Hospital, who were followed for 1 year. Associations between patient characteristics at hospital discharge and mortality were identified utilizing Cox Proportional Hazards Regression analysis. Results. In the year following hospital discharge, 85 subjects (13%) died. After adjusting for illness severity (Acute Physiology and Chronic Health Evaluation II score) and functional status (Katz Index of Activities of Daily Living score), a body mass index (BMI) [less than or equal to] 20 kg/[m.sup.2] was strongly associated with mortality (adjusted relative risk, [95% confidence interval] 1.83 [1.17-2.85]), as was more than 10% weight loss in the prior year (2.31 [1.35-3.94]), and weight as percent of usual weight (WPU) [less than or equal to] 85% (1.78 [1.14-2.77]). Albumin [less than or equal to] 30 g/l was only weakly associated with mortality (1.10 [0.67-1.81]). When all of the putative nutrition variables were included in a multivariable analysis with the two control variables, only BMI followed by WPU [less than or equal to] 85% entered the model. Utilizing this model, the predicted probabilities of death at 1 year were calculated for the study subjects and for a hypothetical group of patients who were identical to the study subjects except they were assigned a BMI of 28 kg/[m.sup.2] and their WPU was 100%. Compared to 24% of the actual subjects, only 7% of the hypothetical well-nourished patients would have been classified as being at high risk for mortality (a 71% relative reduction). Conclusions. Older patients who have evidence of chronic body mass depletion are at significantly increased risk of mortality within the year following hospital discharge.

Purpose: To evaluate the effectiveness of an evidence‐based 12‐week Tai Chi course designed to improve balance and physical function in a population of older veterans. Methods: Community dwelling veterans of all ages with gait and balance problems were invited to participate in the Tai Chi program. Participants completed the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale‐International (FES‐I) at baseline and again at the end of the program. Descriptive statistics were used to summarize study participants' characteristics. The change from baseline to the end of the 12‐week program was calculated for each of the three primary outcome variables (BBS, TUG, FES‐I). Results: Twenty‐two veterans, aged 58 years and above, with perceived gait and/or balance issues were enrolled in the program with completion by 11 veterans. Veterans who completed their final assessments showed the BBS, improved significantly (p = 0.004) from baseline to the 12‐week assessment. The TUG scores improved by a median of 1.3 s (p = 0.022). There was not a significant change in the FES‐I. Conclusions: Preliminary findings provide evidence of the effectiveness of a 12‐week Tai Chi program to improve functional outcomes for older veterans with mild to moderate gait and balance problems. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this nurse‐led project was to increase the number of interprofessional Tai Chi instructors for veterans through a 5‐week (32 hours) training of trainers (ToT) course led by a Tai Chi master trainer. Methods: This project was designed to evaluate the effectiveness of using the ToT model to increase the availability of Tai Chi to veterans. To understand how well the ToT course met learners' needs, a two‐phase course evaluation was conducted. Results: Fifteen interprofessional employees enrolled in and completed the course. Most learners were white (67%) females (67%) with a median age of 50 years. All agreed that the training provided the skills, materials, and confidence to lead Tai Chi classes. Most (93%) indicated experiencing positive health benefits from the training and none experienced any negative effects. The 3‐month follow‐up evaluation indicated that 10 (67%) were teaching veterans in individual or group classes with two others assisting. Twelve instructors taught more than 150 veterans. Conclusions: Overall, learners evaluated this ToT course positively and indicated their needs were met and felt prepared to teach Tai Chi despite being inexperienced. The course was a success with 80% of new instructors teaching or coteaching Tai Chi to veterans. [ABSTRACT FROM AUTHOR]

Background/objective: Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD.Methods: A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73±6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention).Results: At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445).Conclusion: Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE's results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database--steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs' estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, [ABSTRACT FROM AUTHOR]

Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments. [ABSTRACT FROM AUTHOR]

Investigates undernutrition and risk of mortality in elderly patients within a year of hospital discharge. Assessment criteria used in older hospitalized patients for being undernourished at the time of their hospital discharge; Characteristics the patients; Weight loss indicators which are evaluated to determine whether the amount and duration of weight loss are related to one-year mortality risk.

Our work identifies subjects based on their height and the distance between their joints. Using a depth sensing camera, we obtained the position of a person's joints in 3D space relative to each other. The distances between adjacent joints and height of a subject's head are used to create a vector of eight features for an individual to use for identification. Using modified KNN, full and partial feature sets were used to identify subjects. Additionally, our classifier can be utilized to assess ambulation (such as walking's velocity and distance) of subject, when identified.

The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE's results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database-steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs' estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, -8.1 to 8.7 kcal) with limits of agreement of -79.5 kcal to 80.1 kcal. Compared to the traditional method, energy intake assessments could be completed using the multi-component method in less than a third of the time. These results indicate the multi-component method is an accurate, reliable, and efficient method of obtaining energy intake assessments for hospitalized patients., Competing Interests: The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments.