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PubMed2002

The effects of body mass index on peak seat-interface pressure of institutionalized elderly.

OBJECTIVE: To determine if body mass index (BMI) influenced seat-interface pressure in a population of institutionalized elderly. DESIGN: A cross-sectional comparison of peak seat-interface pressure in 4 groups of institutionalized elderly was compared with BMI scores defined as either thin (<20 kg/m(2)), desirable range (20-24.9 kg/m(2)), grade I obesity (25-29.9 kg/m(2)), or grade II obesity (30-40 kg/m(2)). SETTING: Several small nursing homes and a university in a small urban community. PARTICIPANTS: A convenience sample of 75 individuals (age range, 65-95 y) living in 1 of 3 skilled nursing facilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Novel Pliance seat pressure-mapping system was used to collect seat-interface pressure data. Each participant was asked to sit in the wheelchair for up to 10 minutes while the seat-interface pressures were recorded. Body weight and height of each participant were obtained from the medical chart; these characteristics were then used to calculate a BMI for each participant. RESULTS: A 1-way analysis of variance on the peak seat-interface pressures revealed significant differences between the 4 groups (P<.05). Post hoc comparisons showed differences in peak seat-interface pressure between the thin and desirable range groups (P<.05), the thin and grade I obesity group (P<.05), and the thin and grade II obesity groups (P<.05). Differences in peak seat-interface pressure decreased as BMI increased. CONCLUSIONS: The results are consistent with the results of a previous study of individuals with spinal cord injuries. In the current study, peak seat-interface pressure was highest in the thin elderly group, which had the lowest BMI levels of any of the 4 groups. Differences in the peak seat-interface pressures were less as BMI increased.

Aged↗

PubMed1989

The pathophysiology of urinary incontinence among institutionalized elderly persons.

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ("uninhibited bladder") accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.

Aged↗

PubMed1989

Selenium and vitamin E status of healthy and institutionalized elderly subjects: analysis of plasma, erythrocytes and platelets.

Levels of selenium in whole blood, plasma, erythrocytes and platelets, glutathione peroxidase (EC 1.11.1.9; GSH-Px) activity in erythrocytes and platelets and vitamin E, low-density-lipoprotein (LDL)-cholesterol and vitamin E: LDL cholesterol in plasma were measured in seventy-five healthy subjects aged less than 65 years and twenty-eight healthy and twenty-three institutionalized elderly people aged greater than 65 years. Healthy elderly subjects had significantly lower levels of Se in whole blood and plasma when compared with younger subjects. Other measurements of Se status were not significantly different. In the healthy subjects plasma levels of vitamin E and LDL-cholesterol increased with age to 60 years and decreased above 80 years. Vitamin E: LDL cholesterol values were not affected by age. Measurements of Se and vitamin E status in the institutionalized elderly compared with the healthy elderly were all reduced with the exception of platelet Se levels and erythrocyte GSH-Px activity. Ageing per se had minimal effect on Se and vitamin E status but intercurrent illness and decreased food intake can lead to reduced levels in the elderly.

Adult↗

PubMed1990

Thiamine status of healthy and institutionalized elderly subjects: analysis of dietary intake and biochemical indices.

Thiamine status was assessed in healthy young and elderly subjects and institutionalized elderly patients by measuring dietary intake, erythrocyte levels of thiamine and the activity of the thiamine-dependent enzyme, erythrocyte transketolase, with and without the addition of excess thiamine pyrophosphate (the TPP effect). Healthy elderly subjects had a reduced intake of thiamine compared with the younger subjects but erythrocyte levels of thiamine and the TPP effect were comparable, suggesting adequate thiamine status. The institutionalized elderly patients had a low intake of thiamine compared with the healthy elderly as well as abnormal biochemical indices suggestive of suboptimal thiamine status. Thiamine deficiency does not appear to be a problem in healthy elderly people but those in institutions are at risk of deficiency which might adversely affect their clinical state.

Adult↗

PubMed1988

Dietary intakes and biochemical indicators of nutritional status in an elderly, institutionalized population.

A dietary and biochemical assessment of the nutritional status of 260 elderly men and women, 60-101 y (average 80.5 y), was conducted in 15 long-term-care facilities in the Boston area. Subjects were free of clinically apparent terminal or wasting illness. Nutrient intakes were comparable to those in a simultaneously studied free-living population as were most biochemical markers of nutrient status. Although no specific nutrient deficiencies were identified, blood levels of vitamin A and retinol-binding protein in males and of zinc in both sexes were lower in this institutionalized group than in the free-living subjects. Hematologic indices, albumin, prealbumin, and transferrin levels were also lower than in noninstitutionalized elderly populations. These differences may reflect the greater prevalence of chronic diseases and medication use in a long-term-care population. However, there is no evidence that institutionalization in itself leads to impairment of nutritional status.

Aged↗

PubMed1988

Fatty acid composition of serum lipids and its relation to diet in an elderly institutionalized population.

This study was conducted to determine the nutritional status with respect to fatty acids of 53 institutionalized elderly subjects (group A). Seven-day food records and biochemical determinations were used. The same protocol was applied to 25 healthy young adults (group B). The 1981 French Recommended Dietary Allowances were used to assess adequacy of intake. Total fat intake was found to be too high in both groups. Higher intakes of animal fats and saturated fatty acids and lower intakes of polyunsaturated fatty acids and linoleic acid were documented in group A than in group B. Elderly subjects exhibited decreased 18:2 omega 6 and 20:4 omega 6 in serum phospholipids and triglycerides. Other indicators of essential fatty acid status in group A differed from group B in the direction of deficiency (double-bond index [DBI], 0.93 +/- 0.01 vs 1.13 +/- 0.04, p less than 0.001; total omega 6, 25.07 +/- 0.46% vs 32.49 +/- 0.89%, p less than 0.001). These findings indicate that institutionalized elderly people are deficient in circulating essential fatty acids, which appears to be caused by both diet and metabolism.

Adult↗

PubMed1996

Protozoal colonization of the intestinal tract in institutionalized Romanian children.

To determine the prevalence of intestinal parasitic infections in 92 Romanian children institutionalized at Colentina Hospital (Bucharest, Romania) and at the Dystrophic Center (Vidra, Romania), medical charts were reviewed and complete physical examinations were performed. The nutritional status of each child was evaluated, and their sera were tested for the presence of antibodies to human immunodeficiency virus (HIV) and Cryptosporidium. Fecal samples were collected in 10% formalin and examined by an immunofluorescent assay and by trichrome staining for intestinal parasites. At least one protozoan was identified in 77% of the fecal specimens examined. Giardia lamblia (72% of cases), Cryptosporidium parvum (12%), and Entamoeba coli (4%) were the only parasites identified. Stepwise logistic regression revealed that the only factors predictive of giardia colonization were normal nutritional status (P < .01) and HIV seropositivity (P < .02), while cryptosporidium colonization was only associated with where the children lived (P < .01). Seventy-three percent of the children had IgA and/or IgG antibodies to Cryptosporidium in their sera. The presence of these antibodies was strongly associated with the severity of symptoms present in the HIV-infected children (P < .01). Protozoal colonization of the intestinal tract is common in institutionalized Romanian children and may play a role in causing morbidity and mortality in this high-risk group of children.

AIDS-Related Opportunistic Infections↗

PubMed1983

Primary measures of music audiation scores in an institutionalized elderly population.

The purpose of this study was to determine whether persons at various age levels in an institutionalized elderly population vary significantly in their musical aptitudes as indicated by their scores on the Primary Measures of Music Audiation test. (Gordon, 1979). Age was not related to either tonal subtest, rhythm subtest, or composite test scores. In addition, this study attempted to determine which of the following variables were related to or predictive of PMMA scores: (a) musical experience and training, along with current musical activity levels; (b) frequency of music listening; (c) general morale; (d) sex; (e) care home classification; (f) location of the care home; (g) duration of institutionalization; and (h) location for the majority of one's life. No attribute variables were found to be related to PMMA scores. This result differs from that found in a study of variables related to Musical Aptitude Profile (Gordon, 1965) scores in noninstitutionalized, Caucasian, elderly female subjects (Gibbons, Note 1).

Aged↗

PubMed1989

Adaptive and maladaptive functioning of institutionalized and noninstitutionalized fragile X males.

The profile of adaptive strengths and weaknesses of 12 institutionalized and 15 noninstitutionalized fragile X males was examined using the Vineland Adaptive Behavior Scales. Fragile X males in both living settings demonstrated relative strengths in Daily Living Skills compared to functioning in the domains of Communication and Socialization. Within daily living skills, personal (e.g., grooming, toileting) and domestic (e.g., cooking, cleaning) skills were better developed than community skills (e.g., managing money, attending work). Both institutionalized and noninstitutionalized fragile X males showed high levels of maladaptive behavior characterized by attentional impairments; impulsivity; and defiant, oppositional "externalizing" behaviors. High levels of anxiety were also apparent. The institutional sample showed particular deficits in expressive and written communication but was more likely than the noninstitutional group to have individuals with levels of daily living skills above their mental ages. These findings have direct implications for intervention with fragile X males.

Activities of Daily Living↗

PubMed1993

Institutionalizing patient education programs.

Some of the best health promotion and education programs have been shortlived. This is such a common occurrence that eventually almost all nursing administrators experience the frustration of watching a good and promising program die prematurely. The authors compare and contrast two similar foot care and education programs based in Department of Veteran Affairs (VA) Medical Centers and discuss those components of planning and development that led to the long-term survival, or "institutionalization," of one of the programs. Elements of a checklist for assessing and promoting institutionalization are also presented.

Arizona↗

PubMedDate not supplied

Institutionalized racism and end-stage renal disease: is its impact real or illusionary?

Racism is the subjugation of one group (superior) over another (inferior) and may be divided into two categories: overt (gross) and covert. Covert racism (subconscious) is categorized as institutionalized racism. Although institutionalized racism is a more tolerant and restrained practice of this superior/inferior ethnic construct in which African Americans or other people of color are treated as inferiors, it has led to important health disparities between blacks and whites. One area where its mark is most indelible is in the treatment of end-stage renal disease (ESRD).

Black or African American↗

PubMed1992

Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings.

OBJECTIVE: To prospectively evaluate the incidence and impact of viral respiratory infection in the institutionalized elderly during a winter season. DESIGN: Prospective descriptive study, without intervention. METHOD: Patients with respiratory illnesses were evaluated by a directed history and physical examination. Nasopharyngeal secretions for viral culture were obtained, and acute and convalescent serum samples were obtained for analysis. Serologic evidence of infection with respiratory syncytial virus (RSV) and parainfluenza were determined by enzyme immunoassay (EIA), and influenza by hemagglutination-inhibition assay and EIA. SETTING: A 591-bed nursing home. PARTICIPANTS: Residents with signs or symptoms of acute respiratory illness (nasal congestion, pharyngitis, cough, wheezing, or respiratory difficulty) were eligible for study. RESULTS: A viral etiology was documented in 62 out of 149 illnesses (42%). RSV was the most common virus associated with illness; it was documented in 27% of respiratory illnesses, followed by rhinovirus (9%), parainfluenza (6%), and influenza (1%). RSV was associated with significantly more severe disease when compared with rhinovirus. Clustering of specific viral infections occurred, suggesting nosocomial transmission. CONCLUSIONS: Viruses are an important cause of acute respiratory infections in the institutionalized elderly during the winter months.

Acute Disease↗

PubMed1998

Urinary antibody level and survival in bacteriuric institutionalized older subjects.

OBJECTIVE: In a previous study, elevated urine antibody levels in institutionalized subjects with asymptomatic bacteriuria were associated with decreased survival. This study was undertaken to confirm the previous observation in a prospective study in a larger cohort and to explore selected other variables that may be associated with survival. DESIGN: A prospective, 24-month, observational cohort study. SETTING: Three large nursing homes in Winnipeg, Manitoba. PARTICIPANTS: Permanent residents were identified by initial screening urine cultures and subjects with bacteriuria were enrolled. The median age of subjects was 76 years, 51% were women, and the median duration of residence before enrollment was 26 months. Subjects were highly functionally impaired. MEASUREMENTS: Monthly urine specimens were collected for culture, leukocyte count, and urine antibody. Serum specimens for antibody to uropathogens and IL6 were obtained at enrollment and every 6 months. Anthroporphometric tests of nutritional status and functional and mental status were also measured every 6 months. Residents were stratified as having elevated or not elevated urine antibody, based on the initial urine specimen. The mean urine antibody for all of each subject's specimens was also calculated, and subjects were stratified as low, intermediate, or elevated urine antibody. Outcomes measured included mortality, infection and antibiotic use, and functional, mental, and nutritional decline. RESULTS: Ninety-eight bacteriuric subjects were enrolled in the study; 34 (35%) had elevated urine antibody and 64 (65%) had not elevated urine antibody. The two groups did not differ in demographic features, co-morbidities, functional status, medication use, or infecting organisms. Survival was significantly (P < .001) poorer in the group with elevated urine antibody. At 24 months, 35% of subjects with an elevated urine antibody were alive compared with 75% with a low urine antibody level. This survival difference was consistent when the two groups were stratified by sex, institution, and presence of a chronic indwelling catheter. Subjects with elevated urine antibody had no evidence for accelerated functional or nutritional decline during the study period compared with the group with low urine antibody. These subjects did, however, have an increased incidence of episodes of symptomatic urinary infection and infections at non-urinary sites. CONCLUSIONS: Older, bacteriuric, institutionalized subjects with elevated urine antibody had decreased survival rates compared with subjects with lower urine antibody levels. There is no clinical evidence to support accelerated decline caused by chronic infection to explain this observation. Urine antibody may be a marker for immune dysregulation, which precedes death in older impaired subjects.

Aged↗

PubMedDate not supplied

Dental condition and weight loss in institutionalized demented patients.

This reports the results of a retrospective clinical study evaluating the role of dentures on weight maintenance in an institutionalized demented population. Records of 57 demented long-term (greater than 3 months) residents of the Department of Veterans Affairs Medical Center, Washington, DC, Nursing Home Care Unit were evaluated to determine body weight, mental acuity, independence in daily living, and dental condition. Fourteen (24%) of the patients possessed dentures, 19 (33%) were edentulous and functioned without dentures, while 24 patients (42%) were dentate. Overall mean weight change was -2.03 lbs +/- 0.81 lbs in 3 months. There was no significant difference in weight loss based on dental condition. There was, however, an apparent correlation of weight loss and mental acuity. Thus, it was concluded that dentures did not influence weight maintenance among institutionalized demented patients.

Activities of Daily Living↗

PubMed2001

One-year compliance and effects of amine and stannous fluoride on some salivary biochemical constituents and oral microbes in institutionalized elderly.

Due to old age and poor general health, the institutionalized elderly have often not been used as research subjects for the investigation of oral health protocols. Because the number of elderly is increasing, they are an important target group for the development of oral hygiene aids. This trial was designed to investigate whether the institutionalized elderly could successfully use an amine-fluoride- and stannous-fluoride-containing mouthwash and toothpaste during a 12-month period. A dental hygienist visited the subjects weekly, instructed them, and recorded their self-reported compliance. Plaque and saliva samples were taken at three-month intervals. Some salivary biochemical constituents reflecting mucosal integrity were analyzed. The carrier status of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Prevotella intermedia, and Prevotella nigrescens was studied by the polymerase chain-reaction method, and acidogenic bacteria and yeasts by dip-slide methods (Orion Diagnostica, Espoo, Finland). Of those 98 subjects originally included, 44 elderly (30 women and 14 men; mean age, 81.7 +/- 5.9 yrs) completed the trial. Their observations were positive or very positive regarding the use of mouthwash and toothpaste. The number of residents with P. gingivalis decreased statistically significantly throughout the trial, while the carrier status of the other periodontal bacteria and mutans streptococci remained on the same level. The number of subjects with high counts (> or = 10(5) cfu/mL) of yeasts decreased during the study: 26.2% at baseline, 9.1% one year later, respectively. Biochemical analyses of salivary immunoglobulins showed no effect on IgA and IgM levels, but IgG reduced significantly. Albumin and other salivary protein concentrations were found to have a decreasing tendency. Thus, the overall effect of the protocol was beneficial with regard to subjects' oral health as measured in this study. The residents were pleased to participate, but the number of drop-outs was very high, confirming the expected difficulties with the utilization of a group of frail elderly as research subjects.

Aged↗

PubMed1995

Site-specific relative risk of fractures in the institutionalized elderly.

A 3-year prospective study was performed to evaluate the incidence of fractures in institutionalized elderly and associated risk factors. A total of 197 subjects (47 males and 150 females, mean age 81.5 +/- 8.0 years) were included in the study. The annual fracture incidence was 7.8%. All hip fractures occurred in female subjects (annual incidence = 3.7%). As expected, the incidence of fractures is higher in walking subjects. In walking subjects (n = 128) logistic regression analysis showed falls [adjusted relative risk (RR) = 3.3; 95% confidence interval (CI) = 1.3-8.4] and age (adjusted RR = 1.7; 95% CI = 1.1-2.3) to be variables independently and significantly associated with fractures, after adjusting for baseline bone mineral density (BMD) and sex. Hip fractures were associated with age (RR = 1.6; 95% CI = 1.1-2.3), and non-hip fractures with falls (RR = 4.1; 95% CI = 1.3-13.4). The importance of low BMD as a risk factor for fractures is reduced in the institutionalized elderly. However, other fracture-site-specific risk factors exert a greater influence.

Accidental Falls↗

PubMed2003

Adoption and institutionalization of the Child and Adolescent Trial for Cardiovascular Health (CATCH) in El Paso, Texas.

One goal of national health-promotion research is to disseminate and institutionalize experimentally tested programs in local communities. In 1997, the national Child and Adolescent Trial for Cardiovascular Health (CATCH) was chosen by the Paso del Norte Health Foundation as their first community-wide preventive health initiative for the El Paso, Texas/Juárez, México border region. With help from researchers at the University of Texas at Houston, evaluators from the University of Texas at El Paso, and the Region 19 Educational Services Center, CATCH was implemented in 18 Title I pilot schools. Known as the Coordinated Approach to Child Health 5 years later, the El Paso CATCH program has been embraced by the border community and reaches 108 elementary schools from New Mexico to West Central Texas. There are also plans to implement CATCH in Juárez. This article describes the institutionalization of CATCH in a predominately Hispanic, low income border region.

Adolescent↗

PubMed1976

Height and personality characteristics of 47, XYY males in a sample of tall non-institutionalized males.

A sample of 471 enlisted men 183 cm or taller serving in the US Navy, Coast Guard, and Marine Corps was screened for Y-chromosome aneuploidy by use of quinacrine fluorescence of peripheral blood smears. Two 47,XYY males were detected, resulting in a prevalence of 00425 or approximately 1 in 236. The prevalence of 47,XYY males (00331) in a number of samples of tall, non-institutionalized males is significantly higher than the incidence in newborn males (00061), indicating that 47,XYY males are disproportionately represented in tall male populations. The 47,XYY males had significantly higher scores than 46,XY males on the Schizophrenia, Schizophrenia+1K, and Prejudice scales of the Minnesota Multiphasic Personality Inventory and significantly lower scores on the Dominance scale. Since the probability that a randomly selected pair of subjects in the sample had four or more scale scores significantly different from the remainder of the group was greater than 05, it is possible that the differences between the 47,XYY and 46,XY males occurred by chance. On the other hand, one or more of these scales may measure personality dimensions on which non-institutionalized 47,XYY males may, in fact, differ from 46,XY males.

Adolescent↗