MANY OLDER EMERGENCY DEPARTMENT PATIENTS ARE MALNOURISHED

MANY OLDER EMERGENCY DEPARTMENT PATIENTS ARE MALNOURISHED

More than half of emergency department patients 65 and older were either malnourished or at risk for malnutrition, study finds

From the FMS Global News Desk of Jeanne Hambleton Released: 13-Aug-2014    Citations     Annals of Emergency Medicine   Source  University of North Carolina School of Medicine

 

Newswise — More than half of emergency department patients age 65 and older who were seen at UNC Hospitals during an 8-week period were either malnourished or at risk for malnutrition.

In addition, more than half of the malnourished patients had not previously been diagnosed, according to a new study by researchers at the University of North Carolina at Chapel Hill. The study was published online August 13 by the journal Annals of Emergency Medicine.

“Malnutrition is known to be a common problem among older adults. What is surprising in our study is that most of the malnourished patients had never been told that they were malnourished,” said Timothy F. Platts-Mills, MD, MSc, assistant professor of emergency medicine in the UNC School of Medicine and senior author of the study.

“Our findings suggest that identifying malnutrition among older emergency department patients and connecting these patients with a food program or other services may be an inexpensive way to help these patients,” Platts-Mills said.

“Older adults make more than 20 million visits to U.S. emergency departments each year. Our results add to a growing body of evidence that more needs to be done to develop the capacity of emergency departments to address the underlying conditions that impact health for older adults, particularly for those with limited resources.”

The study included 138 adults age 65 and older who sought treatment in the emergency department at UNC Hospitals during an 8-week period. All were patients with no cognitive impairments, who were not critically ill and did not live in a nursing home or skilled nursing facility.

The nutritional status of each was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), a 6-item tool that combines body mass index and the patient’s answers to questions about weight loss, decline in food intake, recent stress or disease, mobility and neuropsychological disorders. The results produce a score from 0 to 14. Malnutrition is defined as a score of 7 or lower while at risk for malnutrition is defined as a score from 8 to 11.

Sixteen percent were found to be malnourished and most of these (77 percent) said they had not previously been diagnosed as malnourished. Sixty percent were found to be either malnourished or at risk for malnutrition.

There were no significant differences in the prevalence of malnutrition between men and women, across levels of education or between those living in urban versus rural areas. However, the prevalence of malnutrition was higher among patients who reported having depressive symptoms, difficulty eating (due to dental pain, ill-fitting dentures, etc.) or difficulty buying groceries (due to lack of transportation, lack of money, etc.).

First author of the study is Greg F. Pereira, BSPH, a recent graduate of the UNC Department of Nutrition. Co-authors are Wesley C. Holland, Mark A. Weaver, PhD, research assistant professor in the UNC Gillings School of Global Public Health; and Cynthia M. Bulik, PhD, distinguished professor of psychiatry in UNC School of Medicine and nutrition in the UNC Gillings School of Global Public Health.

 

SENIORS FACE BARRIERS TO CRITICAL DENTAL CARE

From the FMS Global News Desk of Jeanne Hambleton Released: 26-Aug-2014 Citations American Journal of Health Behavior – Source: Health Behavior News Service                          By Sharyn Alden, HBNS Contributing Writer

KEY POINTS

* Nearly half of seniors referred for follow-up care after a dental exam did not receive needed treatment.
* The most commonly cited barriers to follow-up dental care were financial constraints, a lack of transportation and needing help making appointments.

Newswise — Research has shown that poor oral health can have a negative impact on seniors’ overall health and well-being, but for many, there are significant barriers to visiting a dentist, finds a new report in the American Journal of Health Behavior.

Lead study author Theresa Montini, Ph.D., assistant medical professor at the Sophie Davis School of Biomedical Education at the City College of New York and her colleagues provided oral dental exams to 184 older adult volunteers. The average age of the study volunteers was 75 years old.

The researchers found that 89 percent of the participants, who frequented eight senior centers in New York City, needed some form of dental treatment with an average of two cavities per person. Six weeks following their initial dental exams, 52 percent had sought dental treatment but 48 percent had not been able to access dental services. Seniors who had not received follow-up treatment had significantly fewer teeth and were more likely to have been referred for new dentures or to repair old ones.

Three months after their initial dental exam, those who did not get subsequent dental care cited three primary barriers — 60 percent noted financial issues, 31 percent said transportation was a problem and 20 percent needed someone to help make the appointment and find a dentist.

The authors note that their findings have several implications for policymakers, such as considering adding dental benefits to Medicare coverage and/or expanding Medicaid dental coverage.

Matt Salo, executive director of the National Association of Medicaid Direction agrees, noting the study clearly identifies unmet needs of older Americans who would benefit from more reliable, accessible and affordable dental care.

“The primary barrier to accessing dental care for older adults appears to be a complete lack of attention — a lack of any kind of benefit from the Medicare program,” he said.

“Not all seniors are eligible for Medicaid and obviously Medicaid benefits vary, but this would not be an issue if Medicare provided basic [dental] benefits for the population it serves.”

Salo noted that one important barrier that is not addressed is having an adequate and responsive dental workforce.

“We have found that dentists do not always make accommodations for the unique challenges of the populations that Medicaid and Medicare serve,” he said.

“Not only are there not enough dentists, there are not enough dentists willing to work with low-income or challenging populations. Medicaid has struggled for decades to get dentists to participate, and the problems go much deeper than payment rates.”

 

HOME IS WHERE THE MICROBES ARE

Home Microbiome Project announces results of study on household microbes

From the FMS Global News Desk of Jeanne Hambleton Embargoed: 29-Aug-2014      Citations Science   Source : Argonne National Laboratory

 

Newswise — A person’s home is their castle, and they populate it with their own subjects: millions and millions of bacteria.

A study published today in Science provides a detailed analysis of the microbes that live in houses and apartments. The study was conducted by researchers from the U.S. Department of Energy’s Argonne National Laboratory and the University of Chicago.

The results shed light on the complicated interaction between humans and the microbes that live on and around us. Mounting evidence suggests that these microscopic, teeming communities play a role in human health and disease treatment and transmission.

“We know that certain bacteria can make it easier for mice to put on weight, for example, and that others influence brain development in young mice,” said Argonne microbiologist Jack Gilbert, who led the study.

“We want to know where these bacteria come from, and as people spend more and more time indoors, we wanted to map out the microbes that live in our homes and the likelihood that they will settle on us.

“They are essential for us to understand our health in the 21st century,” he said.
The Home Microbiome Project followed seven families, which included eighteen people, three dogs and one cat, over the course of six weeks. The participants in the study swabbed their hands, feet and noses daily to collect a sample of the microbial populations living in and on them. They also sampled surfaces in the house, including doorknobs, light switches, floors and countertops.

Then the samples came to Argonne, where researchers performed DNA analysis to characterize the different species of microbes in each sample.

“We wanted to know how much people affected the microbial community on a house’s surfaces and on each other,” Gilbert said.

They found that people substantially affected the microbial communities in a house — when three of the families moved, it took less than a day for the new house to look just like the old one, microbially speaking.

Regular physical contact between individuals also mattered—in one home where two of the three occupants were in a relationship with one another, the couple shared many more microbes. Married couples and their young children also shared most of their microbial community.

Within a household, hands were the most likely to have similar microbes, while noses showed more individual variation.

Adding pets changed the makeup as well, Gilbert said—they found more plant and soil bacteria in houses with indoor-outdoor dogs or cats.

In at least one case, the researchers tracked a potentially pathogenic strain of bacteria called Enterobacter, which first appeared on one person’s hands, then the kitchen counter, and then another person’s hands.

“This doesn not mean that the countertop was definitely the mode of transmission between the two humans, but it is certainly a smoking gun,” Gilbert said.

“It is also quite possible that we are routinely exposed to harmful bacteria—living on us and in our environment—but it only causes disease when our immune systems are otherwise disrupted.”

Home microbiome studies also could potentially serve as a forensic tool, Gilbert said. Given an unidentified sample from a floor in this study, he said, “we could easily predict which family it came from.”

The research also suggests that when a person (and their microbes) leaves a house, the microbial community shifts noticeably in a matter of days.

“You could theoretically predict whether a person has lived in this location, and how recently, with very good accuracy,” he said.

Researchers used Argonne’s Magellan cloud computing system to analyze the data; additional support came from the University of Chicago Research Computing Center.

The paper, “Longitudinal analysis of microbial interaction between humans and the indoor environment,” was published today in Science.

The study was funded by the Alfred P. Sloan Foundation. Additional funding also came from the National Institutes of Health, the Environmental Protection Agency, and the National Science Foundation.

Other Argonne researchers on the study included Argonne computational biologist Peter Larsen, postdoctoral researchers Daniel Smith, Kim Handley, and Nicole Scott, and contractors Sarah Owens and Jarrad Hampton-Marcell. University of Chicago graduate students Sean Gibbons and Simon Lax contributed to the paper, as well as collaborators from Washington University in St. Louis and the University of Colorado at Boulder.

The University of Chicago Medicine and Biological Sciences is one of the nation’s leading academic medical institutions. It comprises the Pritzker School of Medicine, a top medical school in the nation; the University of Chicago Biological Sciences Division; and the University of Chicago Medical Center, which recently opened the Center for Care and Discovery, a $700 million specialty medical facility. Twelve Nobel Prize winners in physiology or medicine have been affiliated with the University of Chicago Medicine.

Argonne National Laboratory seeks solutions to pressing national problems in science and technology. The nation’s first national laboratory, Argonne conducts leading-edge basic and applied scientific research in virtually every scientific discipline. Argonne researchers work closely with researchers from hundreds of companies, universities, and federal, state and municipal agencies to help them solve their specific problems, advance America’s scientific leadership and prepare the nation for a better future. With employees from more than 60 nations, Argonne is managed by UChicago Argonne, LLC for the U.S. Department of Energy’s Office of Science. For more visit http://www.anl.gov.

DOE’s Office of Science is the single largest supporter of basic research in the physical sciences in the United States, and is working to address some of the most pressing challenges of our time.

Back Friday. Jeanne

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