Purpose Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory respo... more Purpose Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory response. We investigated predictability of NLR for early adverse outcome after surgery for hip fracture in elderly population. Methods We reviewed a total of 971 elderly patients with hip fracture who underwent emergency surgery between January 2017 and July 2020 in the Department of Orthopaedics Surgery at the Wollongong Hospital. After considering exclusion criteria, data from a total of 834 patients included in our study. Socio-demographic data, NLR in admission, updated Charlson comorbidity index (uCCI), biochemical markers, mortality rate and 15 short term post-operative complications were collected to determine predictability of NLR for post-operative complications and mortality. Results After hip surgery, Hospital in-patient case fatality rate was 3.7% (31). In addition, 63.1% (511) of the patients had at least one complication or more. Logistic regression demonstrated that raised NLR...
Background Despite clinical guidelines that recommend routine nutrition screening of older patien... more Background Despite clinical guidelines that recommend routine nutrition screening of older patients, this does not generally occur in the Australian general practice setting. This study aimed to identify perceived barriers and opportunities to implementing nutrition screening of older people in general practice. Methods Twenty-five in-depth individual interviews were conducted with general practitioners, general practice registrars and practice nurses. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Observations were performed to identify opportunities to conduct nutrition screening within general practice workflow. Results The primary identified barrier to screening related to time constraints, which was further validated by the observational component of the study. The main opportunity for screening was seen to be within the existing Australian Government Medicare Benefits Schedule Primary Care Item, \u27Health assessment for people aged 75 years an...
Background: Older patients’ views regarding undergoing nutrition screening within General Practic... more Background: Older patients’ views regarding undergoing nutrition screening within General Practice settings have not been evaluated to date. Objectives: To identify perceptions of older patients related to their experiences of having a nutrition screening process performed using the Mini Nutritional Assessment Short Form (MNA-SF®), accompanied by a clinical care pathway. Methods: Patients aged ≥75 years were invited to attend repeat screening between 6 months and one year following a first screening (n=143). Patients who were identified to be malnourished or at risk at baseline (n=44) were invited to participate in an individual interview to identify their perceptions of the MNA-SF® and the applicability of a nutrition resource kit that had been provided to them. Results: Nutritional status improved in the group identified to be malnourished/at risk at baseline (p= 0.01). Interviews indicated that the MNA-SF® process was well-received but that patients did not perceive themselves as...
Background: Frailty assessment is a critical approach in assessing the health status of older peo... more Background: Frailty assessment is a critical approach in assessing the health status of older people. The clinical tools deployed by geriatricians to assess frailty can be grouped into two categories; using a questionnaire-based method or analyzing the physical performance of the subject. In performance analysis, the time taken by a subject to complete a physical task such as walking over a specific distance, typically three meters, is measured. The questionnaire-based method is subjective, and the time-based performance analysis does not necessarily identify the kinematic characteristics of motion and their root causes. However, kinematic characteristics are crucial in measuring the degree of frailty. Results: The studies reviewed in this paper indicate that the quantitative analysis of activity of daily living, balance and gait are significant methods for assessing frailty in older people. Kinematic parameters (such as gait speed) and sensor-derived parameters are also strong markers of frailty. Seventeen gait parameters are found to be sensitive for discriminating various frailty levels. Gait velocity is the most significant parameter. Short term monitoring of daily activities is a more significant method for frailty assessment than is long term monitoring and can be implemented easily using clinical tests such as sit to stand or stand to sit. The risk of fall can be considered an outcome of frailty. Conclusion: Frailty is a multi-dimensional phenomenon that is defined by various domains; physical, social, psychological and environmental. The physical domain has proven to be essential in the objective determination of the degree of frailty in older people. The deployment of inertial sensor in clinical tests is an effective method for the objective assessment of frailty.
Medical & Biological Engineering & Computing, 2018
OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscu... more OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscular function. We tested the effect of vitamin K2 supplementation on postural sway, falls, healthcare costs, and indices of physical function in older people at risk of falls. DESIGN: Parallel-group double-blind randomized placebocontrolled trial. SETTING: Fourteen primary care practices in Scotland, UK. PARTICIPANTS: A total of 95 community-dwelling participants aged 65 and older with at least two falls, or one injurious fall, in the previous year. INTERVENTION: Once/day placebo, 200 μg or 400 μg of oral vitamin K2 for 1 year. MEASUREMENTS: The primary outcome was anteroposterior sway measured using sway plates at 12 months, adjusted for baseline. Secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Timed Up & Go Test, quality of life, health and social care costs, falls, and adverse events. RESULTS: Mean participant age was 75 (standard deviation [SD] = 7) years. Overall, 58 of 95 (61%) were female; 77 of 95 (81%) attended the 12-month visit. No significant effect of either vitamin K2 dose was seen on the primary outcome of anteroposterior sway (200 μg vs placebo: −.19 cm [95% confidence interval [CI] −.68 to .30; P = .44]; 400 μg vs placebo: .17 cm [95% CI −.33 to .66; P = .50]; or 400 μg vs 200 μg: .36 cm [95% CI −.11 to .83; P = .14]). Adjusted falls rates were similar in each group. No significant treatment effects were seen for other measures of sway or secondary outcomes. Costs were higher in both vitamin K2 arms than in the placebo arm. CONCLUSION: Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls.
AimTo investigate the relationship between nutritional status, functional ability and frailty in ... more AimTo investigate the relationship between nutritional status, functional ability and frailty in older adults participating in a 12‐week Transitional Aged Care Service program.MethodsA retrospective analysis of a clinical cohort of older adults aged 65+ years after hospital discharge. At entry into the program and at completion, nutritional status was measured using the Mini Nutritional Assessment (MNA), frailty status was measured using the Groningen Frailty Indicator and functional ability was measured using the Modified Barthel Index (MBI). Demographic data were obtained from electronic medical records.ResultsBaseline data were available for 115 participants (mean age = 81.7 (SD =7.9) years; 20.9% classified as malnourished and 89.6% as frail). A positive association was found between nutritional status and frailty (r = 0.298; P = 0.001), and frailty and functional ability (r = 0.204; P = 0.029). Multiple regression analysis, accounting for the cofounders of baseline MNA, MBI, ag...
Reduced toe flexor strength is an independent predictor of falls in older people. However it is u... more Reduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people. After baseline testing, 85 men and women (age range 60-90years) were randomized to either a supervised, progressive resistance training (n=43) or a home-based exercise (n=42) group for 12weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time. Average class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-...
Background: General Practitioners (GPs) are responsible for primary prescribing decisions in most... more Background: General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to discontinue other physicians' prescriptions, resulting in further polypharmacy. Therefore it is relevant to ascertain and synthesise the GP views from multiple settings to understand the processes that might promote appropriate deprescribing medications in the elderly. The aims of this study were to 1) compare and contrast behavioural factors influencing the deprescribing practices of GPs providing care for ACF residents in two separate countries, 2) review health policy and ACF systems in each setting for their potential impact on the prescribing of medications for an older person in residential care of the elderly, and 3) based on these findings, provide recommendations for future ACF deprescribing initiatives. Methods: A review and critical synthesis of qualitative data from two interview studies of knowledge, attitudes, and behavioural practices held by GPs towards medication management and deprescribing for residents of ACFs in Australia and Sweden was conducted. A review of policies and health care infrastructure was also carried out to describe the system of residential aged care in the both countries. Results: Our study has identified that deprescribing by GPs in ACFs is a complex process and that there are numerous barriers to medication reduction for aged care residents in both countries, both with similarities and differences. The factors affecting deprescribing behaviour were identified and divided into: intentions, skills and abilities and environmental factors. Conclusions: In this study we show that the GPs' behaviour of deprescribing in two different countries is much dependent on the larger health care system. There is a need for more education to both GPs and ACF staff as well as better cooperation between the different health care systems and appropriate monetary incentives for elderly care to achieve better conditions for deprescribing practice.
Aim To determine if a model of home-based dietetic care improves dietary intake and weight status... more Aim To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. Methods The Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment (MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status. Results Mean body weight improved significantly (P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) (P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index (BMI) < 23 kg/m 2) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight (BMI 23-27 kg/m 2) (1.4 ± 0.3 g/kg) or overweight (BMI>27 kg/m 2) (1.1 ± 0.3 g/kg) peers (P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day). Conclusions Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community.
The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse... more The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. 'Deprescribing' - the withdrawal of an inappropriate medication with goal of managing polypharmacy and improving outcomes - may improve the quality of life of LTCF residents. The RELEASE study sought to explore perceptions of medication use and the concept of deprescribing in LTCFs. Focus groups and interviews were conducted with General Practitioners (GPs), pharmacists, nursing staff, residents and their relatives within three LTCFs in the Illawarra-Shoalhaven region of NSW, Australia. Audiotapes were transcribed verbatim and, using the Integrative Model of Behaviour Prediction as a framework, thematic analysis of transcripts was conducted using QSR NVivo 10. Participants acknowledged the burden of too many medications (time to administer, ph...
People at the age of 65 and above are drastically at the risk of falling. Falls among elderly may... more People at the age of 65 and above are drastically at the risk of falling. Falls among elderly may occur because of many physical factors such as natural deterioration of motor function or other disease related problems such as stroke, Parkinson's or Alzheimer's disease. The methods reported in the literature to assess the risk of falling in older people are often subjective, qualitative, retrospective and inaccurate. An objective, quantifiable approach to assess the risk of falling in elderly by analysing body movement using inertial sensors is conducted. Initial results of the experimental work and analysis carried out on three subjects, one older person with impaired balance and two younger people with normal balance are reported. The sensors are mounted on the subjects' chests and they are asked to conduct balance tests. The results of the data analysis indicate that the elderly subject has disturbed and involuntary chest movements. This demonstrates the potential of the method to assess balance and the risk of fall in older people. Index Terms-balance assessment for older people, fall risk assessment between the elderly, gait and posture analysis
rich cherry juice for 12 weeks improves memory Consumption of anthocyanin-rich cherry juice for 1... more rich cherry juice for 12 weeks improves memory Consumption of anthocyanin-rich cherry juice for 12 weeks improves memory and cognition in older adults with mild-to-moderate dementia and cognition in older adults with mild-to-moderate dementia
Journal of Nutrition & Intermediary Metabolism, 2014
Results: Eighty three participants completed the intervention (HP-D ¼ 34, HP-S ¼ 26, TP ¼ 23). St... more Results: Eighty three participants completed the intervention (HP-D ¼ 34, HP-S ¼ 26, TP ¼ 23). Strength increased in all treatment groups, but the increase was significantly less in HP-S compared with HP-D and TP (p ¼ 0.006; HP-S, 63.0 ± 23.8%; HP-D, 92.1 ± 40.8%; TP, 92.3 ± 35.4%). There was no difference between HP-D and TP (p ¼ 0.99). Lean body mass increased and fat mass decreased (p ¼ 0.006), with no differential effect between any treatments (p ¼ 0.06). Conclusions: Increased intake of soy protein attenuated gains in muscle strength compared with increased intake of dairy protein or a typical protein intake. Funding source(s): Dairy Health & Nutrition Consortium.
Despite clinical guidelines that recommend routine nutrition screening of older patients, this do... more Despite clinical guidelines that recommend routine nutrition screening of older patients, this does not generally occur in the Australian general practice setting. This study aimed to identify perceived barriers and opportunities to implementing nutrition screening of older people in general practice. Twenty-five in-depth individual interviews were conducted with general practitioners, general practice registrars and practice nurses. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Observations were performed to identify opportunities to conduct nutrition screening within general practice workflow. The primary identified barrier to screening related to time constraints, which was further validated by the observational component of the study. The main opportunity for screening was seen to be within the existing Australian Government Medicare Benefits Schedule Primary Care Item, 'Health assessment for people aged 75 years and older'. Incorporatio...
AimTo evaluate the use of Nutrition as Medication (NAM) as a dietary intervention strategy in a s... more AimTo evaluate the use of Nutrition as Medication (NAM) as a dietary intervention strategy in a sample of malnourished renal and geriatric hospital inpatients.MethodsIn the study period of 1 July to 30 August 2009, patients admitted to the acute renal or geriatric wards of a large general hospital and assessed as malnourished or at risk of malnutrition and suitable to commence NAM were eligible for inclusion in this pilot clinical cohort study. Medication charts of the study patients were audited and opportunistic observations of patients receiving NAM were conducted. Comparisons of receival and refusal rates of NAM between chart audits and observations were made. Environmental influences on administration, delivery and consumption were noted.ResultsEighteen patients were included in the study. Audits of their medication charts indicated 943 doses of NAM were prescribed in the study period. The receival rate of NAM was 66.4% and refusal rate was 8.9%. Forty‐eight incident observatio...
Qualitative study of patients and health-care professionals' views on the Qualitative study of pa... more Qualitative study of patients and health-care professionals' views on the Qualitative study of patients and health-care professionals' views on the efficacy of the nutrition as medication oral nutrition supplement program efficacy of the nutrition as medication oral nutrition supplement program
Malnutrition is common in older people and is associated with a number of adverse outcomes. We re... more Malnutrition is common in older people and is associated with a number of adverse outcomes. We review the evidence for the effectiveness of nutritional supplementation for older people in the community, in institutional care and following discharge from hospital. Studies in these settings are scarce, often include only small numbers of participants and are of variable quality. The interventions used are heterogeneous and difficult to directly compare. Oral nutritional supplements (sip feeds), dietary fortification, educational programmes, exercise, flavour enhancement and meal setting have all been studied. Evidence for use of oral nutritional supplements as sip feeds in undernourished community-dwelling and institutionalized older people and in those discharged from hospital is currently insufficient to recommend routine use. Flavour enhancement and more sociable meal environments may be beneficial. Further, more methodologically robust research is needed to clarify the effect of these interventions.
A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes ... more A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes and mortality within 12 months
BackgroundNutrition screening in older adults is not routinely performed in Australian primary ca... more BackgroundNutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group.MethodsNine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling.Individual in-depth interviews, open-ended questionnaires and an 11-item knowledge questionnaire were completed three months following ...
Purpose Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory respo... more Purpose Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory response. We investigated predictability of NLR for early adverse outcome after surgery for hip fracture in elderly population. Methods We reviewed a total of 971 elderly patients with hip fracture who underwent emergency surgery between January 2017 and July 2020 in the Department of Orthopaedics Surgery at the Wollongong Hospital. After considering exclusion criteria, data from a total of 834 patients included in our study. Socio-demographic data, NLR in admission, updated Charlson comorbidity index (uCCI), biochemical markers, mortality rate and 15 short term post-operative complications were collected to determine predictability of NLR for post-operative complications and mortality. Results After hip surgery, Hospital in-patient case fatality rate was 3.7% (31). In addition, 63.1% (511) of the patients had at least one complication or more. Logistic regression demonstrated that raised NLR...
Background Despite clinical guidelines that recommend routine nutrition screening of older patien... more Background Despite clinical guidelines that recommend routine nutrition screening of older patients, this does not generally occur in the Australian general practice setting. This study aimed to identify perceived barriers and opportunities to implementing nutrition screening of older people in general practice. Methods Twenty-five in-depth individual interviews were conducted with general practitioners, general practice registrars and practice nurses. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Observations were performed to identify opportunities to conduct nutrition screening within general practice workflow. Results The primary identified barrier to screening related to time constraints, which was further validated by the observational component of the study. The main opportunity for screening was seen to be within the existing Australian Government Medicare Benefits Schedule Primary Care Item, \u27Health assessment for people aged 75 years an...
Background: Older patients’ views regarding undergoing nutrition screening within General Practic... more Background: Older patients’ views regarding undergoing nutrition screening within General Practice settings have not been evaluated to date. Objectives: To identify perceptions of older patients related to their experiences of having a nutrition screening process performed using the Mini Nutritional Assessment Short Form (MNA-SF®), accompanied by a clinical care pathway. Methods: Patients aged ≥75 years were invited to attend repeat screening between 6 months and one year following a first screening (n=143). Patients who were identified to be malnourished or at risk at baseline (n=44) were invited to participate in an individual interview to identify their perceptions of the MNA-SF® and the applicability of a nutrition resource kit that had been provided to them. Results: Nutritional status improved in the group identified to be malnourished/at risk at baseline (p= 0.01). Interviews indicated that the MNA-SF® process was well-received but that patients did not perceive themselves as...
Background: Frailty assessment is a critical approach in assessing the health status of older peo... more Background: Frailty assessment is a critical approach in assessing the health status of older people. The clinical tools deployed by geriatricians to assess frailty can be grouped into two categories; using a questionnaire-based method or analyzing the physical performance of the subject. In performance analysis, the time taken by a subject to complete a physical task such as walking over a specific distance, typically three meters, is measured. The questionnaire-based method is subjective, and the time-based performance analysis does not necessarily identify the kinematic characteristics of motion and their root causes. However, kinematic characteristics are crucial in measuring the degree of frailty. Results: The studies reviewed in this paper indicate that the quantitative analysis of activity of daily living, balance and gait are significant methods for assessing frailty in older people. Kinematic parameters (such as gait speed) and sensor-derived parameters are also strong markers of frailty. Seventeen gait parameters are found to be sensitive for discriminating various frailty levels. Gait velocity is the most significant parameter. Short term monitoring of daily activities is a more significant method for frailty assessment than is long term monitoring and can be implemented easily using clinical tests such as sit to stand or stand to sit. The risk of fall can be considered an outcome of frailty. Conclusion: Frailty is a multi-dimensional phenomenon that is defined by various domains; physical, social, psychological and environmental. The physical domain has proven to be essential in the objective determination of the degree of frailty in older people. The deployment of inertial sensor in clinical tests is an effective method for the objective assessment of frailty.
Medical & Biological Engineering & Computing, 2018
OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscu... more OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscular function. We tested the effect of vitamin K2 supplementation on postural sway, falls, healthcare costs, and indices of physical function in older people at risk of falls. DESIGN: Parallel-group double-blind randomized placebocontrolled trial. SETTING: Fourteen primary care practices in Scotland, UK. PARTICIPANTS: A total of 95 community-dwelling participants aged 65 and older with at least two falls, or one injurious fall, in the previous year. INTERVENTION: Once/day placebo, 200 μg or 400 μg of oral vitamin K2 for 1 year. MEASUREMENTS: The primary outcome was anteroposterior sway measured using sway plates at 12 months, adjusted for baseline. Secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Timed Up & Go Test, quality of life, health and social care costs, falls, and adverse events. RESULTS: Mean participant age was 75 (standard deviation [SD] = 7) years. Overall, 58 of 95 (61%) were female; 77 of 95 (81%) attended the 12-month visit. No significant effect of either vitamin K2 dose was seen on the primary outcome of anteroposterior sway (200 μg vs placebo: −.19 cm [95% confidence interval [CI] −.68 to .30; P = .44]; 400 μg vs placebo: .17 cm [95% CI −.33 to .66; P = .50]; or 400 μg vs 200 μg: .36 cm [95% CI −.11 to .83; P = .14]). Adjusted falls rates were similar in each group. No significant treatment effects were seen for other measures of sway or secondary outcomes. Costs were higher in both vitamin K2 arms than in the placebo arm. CONCLUSION: Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls.
AimTo investigate the relationship between nutritional status, functional ability and frailty in ... more AimTo investigate the relationship between nutritional status, functional ability and frailty in older adults participating in a 12‐week Transitional Aged Care Service program.MethodsA retrospective analysis of a clinical cohort of older adults aged 65+ years after hospital discharge. At entry into the program and at completion, nutritional status was measured using the Mini Nutritional Assessment (MNA), frailty status was measured using the Groningen Frailty Indicator and functional ability was measured using the Modified Barthel Index (MBI). Demographic data were obtained from electronic medical records.ResultsBaseline data were available for 115 participants (mean age = 81.7 (SD =7.9) years; 20.9% classified as malnourished and 89.6% as frail). A positive association was found between nutritional status and frailty (r = 0.298; P = 0.001), and frailty and functional ability (r = 0.204; P = 0.029). Multiple regression analysis, accounting for the cofounders of baseline MNA, MBI, ag...
Reduced toe flexor strength is an independent predictor of falls in older people. However it is u... more Reduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people. After baseline testing, 85 men and women (age range 60-90years) were randomized to either a supervised, progressive resistance training (n=43) or a home-based exercise (n=42) group for 12weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time. Average class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-...
Background: General Practitioners (GPs) are responsible for primary prescribing decisions in most... more Background: General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to discontinue other physicians' prescriptions, resulting in further polypharmacy. Therefore it is relevant to ascertain and synthesise the GP views from multiple settings to understand the processes that might promote appropriate deprescribing medications in the elderly. The aims of this study were to 1) compare and contrast behavioural factors influencing the deprescribing practices of GPs providing care for ACF residents in two separate countries, 2) review health policy and ACF systems in each setting for their potential impact on the prescribing of medications for an older person in residential care of the elderly, and 3) based on these findings, provide recommendations for future ACF deprescribing initiatives. Methods: A review and critical synthesis of qualitative data from two interview studies of knowledge, attitudes, and behavioural practices held by GPs towards medication management and deprescribing for residents of ACFs in Australia and Sweden was conducted. A review of policies and health care infrastructure was also carried out to describe the system of residential aged care in the both countries. Results: Our study has identified that deprescribing by GPs in ACFs is a complex process and that there are numerous barriers to medication reduction for aged care residents in both countries, both with similarities and differences. The factors affecting deprescribing behaviour were identified and divided into: intentions, skills and abilities and environmental factors. Conclusions: In this study we show that the GPs' behaviour of deprescribing in two different countries is much dependent on the larger health care system. There is a need for more education to both GPs and ACF staff as well as better cooperation between the different health care systems and appropriate monetary incentives for elderly care to achieve better conditions for deprescribing practice.
Aim To determine if a model of home-based dietetic care improves dietary intake and weight status... more Aim To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. Methods The Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment (MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status. Results Mean body weight improved significantly (P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) (P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index (BMI) < 23 kg/m 2) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight (BMI 23-27 kg/m 2) (1.4 ± 0.3 g/kg) or overweight (BMI>27 kg/m 2) (1.1 ± 0.3 g/kg) peers (P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day). Conclusions Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community.
The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse... more The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. 'Deprescribing' - the withdrawal of an inappropriate medication with goal of managing polypharmacy and improving outcomes - may improve the quality of life of LTCF residents. The RELEASE study sought to explore perceptions of medication use and the concept of deprescribing in LTCFs. Focus groups and interviews were conducted with General Practitioners (GPs), pharmacists, nursing staff, residents and their relatives within three LTCFs in the Illawarra-Shoalhaven region of NSW, Australia. Audiotapes were transcribed verbatim and, using the Integrative Model of Behaviour Prediction as a framework, thematic analysis of transcripts was conducted using QSR NVivo 10. Participants acknowledged the burden of too many medications (time to administer, ph...
People at the age of 65 and above are drastically at the risk of falling. Falls among elderly may... more People at the age of 65 and above are drastically at the risk of falling. Falls among elderly may occur because of many physical factors such as natural deterioration of motor function or other disease related problems such as stroke, Parkinson's or Alzheimer's disease. The methods reported in the literature to assess the risk of falling in older people are often subjective, qualitative, retrospective and inaccurate. An objective, quantifiable approach to assess the risk of falling in elderly by analysing body movement using inertial sensors is conducted. Initial results of the experimental work and analysis carried out on three subjects, one older person with impaired balance and two younger people with normal balance are reported. The sensors are mounted on the subjects' chests and they are asked to conduct balance tests. The results of the data analysis indicate that the elderly subject has disturbed and involuntary chest movements. This demonstrates the potential of the method to assess balance and the risk of fall in older people. Index Terms-balance assessment for older people, fall risk assessment between the elderly, gait and posture analysis
rich cherry juice for 12 weeks improves memory Consumption of anthocyanin-rich cherry juice for 1... more rich cherry juice for 12 weeks improves memory Consumption of anthocyanin-rich cherry juice for 12 weeks improves memory and cognition in older adults with mild-to-moderate dementia and cognition in older adults with mild-to-moderate dementia
Journal of Nutrition & Intermediary Metabolism, 2014
Results: Eighty three participants completed the intervention (HP-D ¼ 34, HP-S ¼ 26, TP ¼ 23). St... more Results: Eighty three participants completed the intervention (HP-D ¼ 34, HP-S ¼ 26, TP ¼ 23). Strength increased in all treatment groups, but the increase was significantly less in HP-S compared with HP-D and TP (p ¼ 0.006; HP-S, 63.0 ± 23.8%; HP-D, 92.1 ± 40.8%; TP, 92.3 ± 35.4%). There was no difference between HP-D and TP (p ¼ 0.99). Lean body mass increased and fat mass decreased (p ¼ 0.006), with no differential effect between any treatments (p ¼ 0.06). Conclusions: Increased intake of soy protein attenuated gains in muscle strength compared with increased intake of dairy protein or a typical protein intake. Funding source(s): Dairy Health & Nutrition Consortium.
Despite clinical guidelines that recommend routine nutrition screening of older patients, this do... more Despite clinical guidelines that recommend routine nutrition screening of older patients, this does not generally occur in the Australian general practice setting. This study aimed to identify perceived barriers and opportunities to implementing nutrition screening of older people in general practice. Twenty-five in-depth individual interviews were conducted with general practitioners, general practice registrars and practice nurses. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Observations were performed to identify opportunities to conduct nutrition screening within general practice workflow. The primary identified barrier to screening related to time constraints, which was further validated by the observational component of the study. The main opportunity for screening was seen to be within the existing Australian Government Medicare Benefits Schedule Primary Care Item, 'Health assessment for people aged 75 years and older'. Incorporatio...
AimTo evaluate the use of Nutrition as Medication (NAM) as a dietary intervention strategy in a s... more AimTo evaluate the use of Nutrition as Medication (NAM) as a dietary intervention strategy in a sample of malnourished renal and geriatric hospital inpatients.MethodsIn the study period of 1 July to 30 August 2009, patients admitted to the acute renal or geriatric wards of a large general hospital and assessed as malnourished or at risk of malnutrition and suitable to commence NAM were eligible for inclusion in this pilot clinical cohort study. Medication charts of the study patients were audited and opportunistic observations of patients receiving NAM were conducted. Comparisons of receival and refusal rates of NAM between chart audits and observations were made. Environmental influences on administration, delivery and consumption were noted.ResultsEighteen patients were included in the study. Audits of their medication charts indicated 943 doses of NAM were prescribed in the study period. The receival rate of NAM was 66.4% and refusal rate was 8.9%. Forty‐eight incident observatio...
Qualitative study of patients and health-care professionals' views on the Qualitative study of pa... more Qualitative study of patients and health-care professionals' views on the Qualitative study of patients and health-care professionals' views on the efficacy of the nutrition as medication oral nutrition supplement program efficacy of the nutrition as medication oral nutrition supplement program
Malnutrition is common in older people and is associated with a number of adverse outcomes. We re... more Malnutrition is common in older people and is associated with a number of adverse outcomes. We review the evidence for the effectiveness of nutritional supplementation for older people in the community, in institutional care and following discharge from hospital. Studies in these settings are scarce, often include only small numbers of participants and are of variable quality. The interventions used are heterogeneous and difficult to directly compare. Oral nutritional supplements (sip feeds), dietary fortification, educational programmes, exercise, flavour enhancement and meal setting have all been studied. Evidence for use of oral nutritional supplements as sip feeds in undernourished community-dwelling and institutionalized older people and in those discharged from hospital is currently insufficient to recommend routine use. Flavour enhancement and more sociable meal environments may be beneficial. Further, more methodologically robust research is needed to clarify the effect of these interventions.
A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes ... more A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes and mortality within 12 months
BackgroundNutrition screening in older adults is not routinely performed in Australian primary ca... more BackgroundNutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group.MethodsNine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling.Individual in-depth interviews, open-ended questionnaires and an 11-item knowledge questionnaire were completed three months following ...
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Papers by jan potter