Biomedical subjects

M Unosson

Publications and source records attributed to M Unosson.

32 records · Page 2Linked to original sources

PubMed2000

Nutritional state and functional capacity among elderly Swedish people with acute hip fracture.

The objective of this study was to describe characteristics in a group of elderly men and women with hip fracture, regarding presumed risk factors, such as nutritional state and functional capacity. A total of 142 men and women aged 75 years or more were consecutively included on admittance to the hospital. Anthropometry and body composition were measured 4-6 days after the fracture. Data on functional status, activities of daily living and living arrangements at the time of the fracture were collected. The women and men had a body mass index (BMI) of 22.3 +/- 3.7 kg/m2 and 21.7 +/- 2.1 kg/m2, respectively. Of the whole group, 71% had a BMI < 24 kg/m2 and 25% a BMI < 20.0 kg/m2. Forty-five percent of the patients needed daily home help, and a majority of them were mentally impaired (p < 0.0001). Women with a trochanteric hip fracture were shorter, had lower body weight, lower lean body mass and lower arm muscle circumference (AMC) than the cervical fracture group (p < 0.05). Fewer women with a trochanteric fracture and fewer women with mental impairment took walks outside before the fracture, (p = 0.023 and p = 0.002, respectively). Characteristics found in the group were low BMI, low muscle mass as indicated by low lean body mass and mental impairment. It seems important to evaluate such factors when developing post-operative care plans aimed at avoiding further deterioration. Extra frail sub-groups of patients, such as people who are mentally impaired, women with trochanteric fracture and women with high dependency concerning ADL functions were identified.

Activities of Daily Living↗

PubMed1999

The relationship between nutritional status and physical activity, ulcer history and ulcer-related problems in patients with leg and foot ulcers.

The nutritional status in patients with leg and foot ulcers is assessed in relation to sociodemographic data, mobility, physical activity, ulcer history, and ulcer-related problems from the patients' point of view. The patients (20 men and 50 women, mean age 79 years) were living in their own homes and treatment was given in primary health care. The Mini Nutritional Assessment (MNA) was used to assess nutritional status. Interviews were conducted to collect data on patients' mobility, physical activity, ulcer history and ulcer-related problems. According to the MNA, 32 patients were classified as being at risk of malnutrition and two were malnourished. Patients classified as at risk of malnutrition or malnourishment were usually living alone and were more dependent on aids for mobility and on home-help services than the well-nourished patients (p < 0.05). There were no significant differences between the well-nourished patients and those classified as at risk of malnutrition or malnourished in the number and the duration of open ulcers. This study shows that risk of malnutrition was common in this elderly population of 70 patients with leg and foot ulcers. Comprehensive patient care should include nutritional assessment and preventive actions to restore the nutritional status before malnutrition is manifest.

Activities of Daily Living↗

PubMed1999

Malnutrition in elderly people newly admitted to a community resident home.

The purpose of this study was to assess nutritional status in elderly people, newly admitted to a community resident home, and to describe the characteristics of residents with protein-energy malnutrition (PEM). The participants were 261 people, 65 to 103 years of age (M= 84.8+/-7.1 in women, 82.5+/-6.4 in men) who during one year entered special types of housing for the elderly in a municipality in the south of Sweden. During the first two weeks after admission nutritional status was assessed using weight index, triceps skinfold thickness, arm muscle circumference, serum albumin and transthyretin. Demographic and sociomedical data and eating-related factors were collected by using structured interviews and studying residents records. PEM was found in 29% of the residents who entered municipal care from their own homes, 33% among those moving within municipal care and 43% of the residents who entered from hospital care. Pressure sores or leg ulcers, psychological stress or acute disease in the previous 3 months, reduced fluid intake, deteriorated appetite, reduced mobility, need of help during meals and gastrointestinal symptoms were factors associated with PEM.

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PubMed1997

Nutritional intake and physical activity in leg ulcer patients.

The aim of the study was to describe the nutritional intake, meal patterns, physical activity and need for help in nine women living in their own homes and being treated for venous leg ulcers. Food habits were identified by use of interviews and food diaries completed by the women during a period of seven days. The intake of energy and nutrients from 304 eating events during seven days was calculated and meal patterns were evaluated using a qualitative system for meal classification. Physical activity and the degree of need were identified with the help of interviews. The intakes of energy and key nutrients for wound healing, such as protein, vitamin C and zinc, were not optimal according to the Swedish nutrition recommendations, although food habits were well organized. Most of the women had hardly any physical activities and the need of help and support varied, from daily visits to visits every second week.

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PubMed1996

Interrater variability and validity in subjective nutritional assessment of elderly patients.

The subjective Global Assessment technique was evaluated with regard to its reliability and validity in a Swedish elderly population. Ninety patients, 70 years of age or older, and newly admitted to the geriatric clinic, participated in the study. The nutritional state was assessed subjectively by two independent observers using the Subjective Global Assessment form, and objectively, using a combination of anthropometry and serum-protein analysis. The subjectively assessed malnutrition rate was about 20% higher than that assessed objectively. The agreement level between the two observers was 77.8%, Kappa 0.56 (< 0.001), and the levels between the subjective and objective assessments were 57.8% (Kappa = 0.17) and 73.3% (Kappa = 0.46), respectively. The experienced observer identified 85.2% of those who were defined as malnourished using the objective criteria and the less experienced observer, 66.6%. Furthermore, a regression analysis indicated weight index as the main significant objective factor influencing the subjective assessment. The subjective technique could be regarded as reliable from a clinical and preventive perspective since the agreement between the two rates was just under 80%. It seems also to be valid since the subnormalities in the selected criteria showed a similar pattern. The necessity of being well trained in order to manage nutritional status assessment, for both clinical and research purposes, is obvious.

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PubMed1994

Feeding dependence and nutritional status after acute stroke.

BACKGROUND AND PURPOSE: We assessed the nutritional status of patients with acute stroke and evaluated it in relation to the patients' dependence on assistance with feeding. METHODS: Fifty patients aged 70 years or older, admitted from their homes, were included. Weight index, triceps skinfold thickness, arm muscle circumference, serum proteins, delayed hypersensitivity, body composition measured by bioelectric impedance, and functional condition were determined on admission and 2 and 9 weeks after admission. Food and fluid consumption were also recorded. RESULTS: On admission, four patients were regarded as protein-energy malnourished. Those who required assistance with feeding after admission (n = 18, 36%) had lower serum albumin (P < .05), lower body cell mass (P < .01), and were more anergic than the independent patients (P < .01) on admission. The mean food consumption was 72% of the food served without significant difference between dependent and independent patients. Nine weeks after the onset of stroke symptoms, the patients who were dependent on assisted feeding showed a decrease in body cell mass. The loss of body cell mass was related to their activity and feeding dependence. CONCLUSIONS: Low serum albumin and anergy commonly occur in elderly patients with acute stroke, and they occur more prevalently among those with a severely impaired functional condition. During the recovery period, the patients use body fat to compensate for energy needs, and immobility leads to loss of body cell mass.

Activities of Daily Living↗

PubMed1992

Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale.

Elderly long-term care patients (n = 501) were randomly allocated to receive dietary supplementation (400 kcal/day) in addition to a normal hospital diet, or normal hospital diet only, for 26 weeks. The patients' functional condition was assessed by a modified Norton scale comprising mental condition, activity, mobility, food intake, fluid intake, incontinence and general physical state. Nutritional status was assessed by anthropometry, serum protein analysis and delayed hypersensitivity skin tests. Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group, and in mobility and general physical condition in the control group. After 8 weeks the supplemented group showed a significantly higher level of activity (p < 0.05) compared to the control group. We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function.

Journal Article↗

PubMed1991

The development and healing of pressure sores related to the nutritional state.

The aims of the study were to investigate the relationship between nutritional state and the development of pressure sores and to test the hypothesis that supplementary nutritional support might prevent pressure sore development and improve healing. Newly admitted long-term care patients hospitalised for more than 3 weeks were included and randomised into an experimental and a control group. The nutritional state was evaluated using serum protein analyses, anthropometry and the delayed hypersensitivity skin test. Further, the patients' condition was assessed weekly using a modified Norton scale. The experimental group received extra nutritional support. Significantly more patients with protein-energy malnutrition had, or developed, pressure sores. Regression analyses indicated albumin, mobility, activity and food intake as predictors for pressure sores. Patients who received extra nutritional support tended to develop fewer pressure sores and to heal existing pressure sores to a greater extent than the control group, although this did not reach statistical significance.

Journal Article↗

PubMed1991

Demographical, sociomedical and physical characteristics in relation to malnutrition in geriatric patients.

The purpose of this study was to describe and compare demographical, sociomedical and physical characteristics between protein-energy malnourished and non-malnourished geriatric patients on admission. According to the International Statistical Classification of Diseases, 104 malnourished patients were age-, gender- and diagnosis-matched with 104 non-malnourished patients. Data were collected from patients' medical records. The patient's condition was assessed by a modified Norton scale on admission. No differences were seen in marital status, type of dwelling, previous need for help service, residence before admission, and dependence on assistance with ADL function. The malnourished patients had a greater consumption of diuretics (47%; P less than 0.05) and a lower consumption of analgesics (29%; P less than 0.05) than the non-malnourished patients (33% and 42% respectively). In the malnourished group, impaired conditions in activity (83%; P less than 0.05), and general physical condition (78%; P less than 0.01) were observed compared to the non-malnourished group (69% and 60% respectively). The malnourished patients had less sufficient food intake (41% vs 21%; P less than 0.01) and fluid intake (25% vs 10%; P less than 0.01) than non-malnourished patients. This study indicates that demographical characteristics and primary ADL-functions are of minor importance for the development of protein-energy malnutrition in geriatric patients. Observation of the patients' physical condition and drug consumption seemed more important on admission.

Activities of Daily Living↗

PubMed1990

Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study.

The present study was designed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients (n = 501). The patients were randomised into an experimental group which received nutritional supplementation (400 kcal) as well as a standard hospital diet, and a control group on hospital diet alone. The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry, serum protein analysis and a delayed hypersensitivity skin test. Protein energy malnutrition was defined as the presence of three or more abnormal parameters. 28.5% of patients showed evidence of malnutrition on admission. Hospitalisation itself resulted in a gradual deterioration in nutritional status. Nutritional supplementation generally improved nutritional state. Among those patients who were well nourished on admission, and subsequently receiving dietary supplementation, 8.3% fulfilled malnutrition criteria after 26 weeks, while 21.1% were considered malnourished in the control group (p < 0.05). The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation. In the initially well nourished group of more than 300 patients, the mortality rate was 8.6% in those given nutritional support compared to 18.6% in the control group (p < 0.02).

Journal Article↗

PubMed1990

The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population.

The nutritional state of 482 out of 501 newly admitted elderly patients was assessed by anthropometry, serum protein analyses and the delayed hypersensitivity skin test (DH) on admission and after 8 and 26 weeks. The mean age of the women was 81.3 +/- 7.7 and of the men 77.9 +/- 9.3. Protein-energy malnutrition (PEM) was initially defined as three or more subnormal criteria, one in each of the three categories of measurement. The data was then reanalysed excluding anergy and using the two other criteria only. The prevalence of PEM on the first assessment was 28.5% and was 10% higher when anergy was excluded as a criterion. PEM was more common in women and increased with age. The anergic patients had lower mean values in serum protein and anthropometry than those with normal reactivity. Anergic patients had a higher mortality rate and more pressure sores than the reactive group. Nutritional supplementation was associated with an increase in skin reactivity.

Journal Article↗

PubMed1989

The modified Norton scale and the nutritional state.

The Norton scale was devised in 1960 as an additive scale to facilitate the prediction and prevention of pressure sore development. The scale has been used both in the original version and in modified versions both in practice and as an instrument in nursing research. In a previous study the reliability had been analysed. The present investigation comprises 501 patients who were examined weekly by registered nurses with regard to the variables in a modified Norton scale and on admission with regard to the nutritional status. There are significant correlations between the variables establishing the modified Norton scale and the different criteria included in the nutritional assessment form.

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PubMedDate not supplied

Improvement of oral mucosa with mucin containing artificial saliva in geriatric patients.

In elderly individuals the saliva production is often decreased, leading to dry mucosal membranes and predisposition to local infections, as well as other oral problems. Eighty-five hospitalized geriatric patients, with a multitude of disabling diseases, participated in a double blind placebo-controlled study when mucin-containing artificial saliva and a placebo liquid was given. In the patients treated with the artificial saliva a considerable improvement in the condition of oral mucosa was seen. Also, in one quarter of the patients treated with the placebo liquid, the oral candida infection disappeared, possibly due to improved oral hygiene. It is reasonable to assume that general well-being increases when the condition of the oral mucosa improves. If factors causing dry mouth cannot be removed, i.e. due to diseases or ageing factors, treatment with artificial saliva could be of benefit, but the importance of good oral hygiene must not be overlooked.

Clinical Trial↗

PubMedDate not supplied

Smaller but energy and protein-enriched meals improve energy and nutrient intakes in elderly patients.

UNLABELLED: The purpose of the present study was to investigate if smaller but energy and protein enriched meals could improve energy and nutrient intakes in elderly geriatric patients. Ten patients, between 77 and 87 years of age were included in the study, performed at a Geriatric rehabilitation ward. The first week after inclusion, the patients were offered a three days' standard hospital menu and the second week, a three days' energy and protein-enriched menu. The consumption of food and the fluid intake were recorded using a pre-coded food record book during both the menus and analysed by the Swedish National Food Administration. The patients' energy requirements were calculated according to the Nordic Nutrition Recommendation for elderly subjects. When the standard hospital menu was offered, six patients had lower energy intake, -67 to -674 kcal/day, than the calculated energy requirements. The daily energy intake increased by 37 %, with the energy and protein-enriched menu compared with the standard hospital menu. Furthermore, the daily intake of protein, fat, carbohydrate, certain vitamins and minerals was significantly higher with the energy and protein-enriched menu compared with the standard hospital menu. CONCLUSION: This study showed that the intake of energy and nutrients increased with the energy and protein-enriched menu in elderly patients on a geriatric rehabilitation ward.

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