Summary of Articles From the Journal of the American Geriatrics Society: January 2011, Volume 59
Reviewed, prepared, and submitted by Thomas T. Yoshikawa, MD, Editor-in-Chief, Journal of the American Geriatrics Society Title: Individualized Nutritional Intervention During and After Hospitalization: The Nutritional Intervention Study Clinical Trial Authors: Feldblum I, German L, Castel H, et al Summary: Undernutrition or malnutrition in hospitalized patients is a well-known and observed occurrence, particularly in frail and very old adults. Nutritional supplementation in older persons appears to lower mortality in undernourished individuals. This randomized, controlled study examined the impact of individualized nutritional support from a dietitian in the hospital and three home visits post discharge compared to standard care or meeting a dietitian once in the hospital. A total of 259 participants were randomized with 66 (84.6%) in intervention group and 102 (56.3%) in control group completing the study. After 6 months, there was lower mortality and moderate improvement in nutritional status (using Mini Nutritional Assessment scores) in patients receiving individualized nutritional treatment during and after hospitalization. Moreover, only 9.7% of the intervention group compared to 22.9% of the control group had serum albumin of less than 3.5 g/dL. Comments: Although there was a substantial dropout rate in the control group, there were no significant differences in demographic , nutritional, functional, or laboratory characteristics in those who remained or withdrew from the study. Functional decline occurred significantly in both groups, indicating that nutritional intervention does not favorably impact function. However, in my view, frail and very old adults tend to eat less protein as part of their regular diet (often due to restrictions imposed by underlying health conditions), which impacts muscle integrity and strength. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________ Title: Depressive Symptoms and Incidence of Mild Cognitive Impairment and Probable Dementia in Elderly Women: The Women’s Health Initiative Memory Study Authors: Goveas JS, Espeland MA, Woods NE, et al Summary: Several studies have shown an association between late-life depressive symptoms and subsequent occurrence of mild cognitive impairment (MCI) or dementia. However, it is uncertain whether the depressive symptoms are a cause or effect of cognitive decline. In this study, of 6376 women in the Women’s Health Initiative Memory Study aged 65 to 79 who were free of MCI and dementia at enrollment, completed a 6-item Center for Epidemiological Studies Depression Scale and the 2-item National Institute of Mental Health’s Diagnostic Interview Schedule, and attended at least 1 follow-up visit were analyzed. Mean follow-up was 5.4 years (range 1-8 years). Depressive disorder at baseline was associated with a greater risk of incident MCI (hazard ratio (HR) of 1.98), probable dementia (HR of 2.03) and MCI or probable dementia (HR of 1.92). Assignment to hormone therapy or baseline cognitive function status did not change these relationships. Comments: Certainly, if these findings are confirmed by others, the identification of depressive symptoms or depression may be an early manifestation of cognitive decline. Of course, these findings have potential implications for screening for depression as early as possible, as well as whether treatment of depression alters subsequent development of cognitive impairment. Our geriatric teaching of ruling out depression as a “false cause” of dementia may now have to be reconsidered. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________ Title: Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons Authors: Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society Summary: The Guideline for Prevention Falls in Older Persons was published in May 2001. Through a combined effort and collaboration between the American Geriatrics Society and British Geriatrics Society, the earlier guideline was updated by evaluating evidence and analyses that have been published or became available since the initial 2001 guideline was released. Changes have been recommended in both Assessments and Interventions. Readers are highly recommended in carefully reviewing the new guidelines by reading this January 2011 issue of JAGS or going to the AGS website: www.americangeriatrics.org Comments: This is a well-written summary of the current approach to the identification and management of falls in older adults. I would highly recommend it. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society.