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Lim J.,National University of Singapore | Griva K.,National University of Singapore | Chionh H.L.,Khoo Teck Puat Hospital | Yap P.,Khoo Teck Puat Hospital | Yap P.,Geriatric Center
Alzheimer Disease and Associated Disorders

This cross-sectional study used the stress and coping paradigm to examine the factors associated with negative and positive adjustment outcomes among Asian family caregivers of persons with dementia (PWD) in Singapore. One hundred seven family caregivers completed measures assessing patient illness characteristics, general coping styles of caregivers, specific dementia management strategies, religion and spirituality, and caregiver adjustment outcomes of burden and gain. Multiple regressions revealed that behavioral problems in the PWD, dementia severity, and the use of behavioral disengagement and criticism as coping strategies were significant predictors of burden accounting for 48% of the explained variance [F(4,99)=23.12, P<0.001]. The only significant predictor of gain was the use of encouragement as a specific dementia management strategy, explaining 18% of variance [F(3,102)=7.39, P<0.001]. Religion and spirituality predicted gain indirectly through the use of encouragement. Coping strategies had an independent effect on caregiver outcomes above and beyond PWD illness characteristics and caregiver characteristics. Hence, caregiver interventions should target coping strategies to improve outcomes of caregiving for dementia. Findings also support the need to examine religion and spirituality in future studies of caregiver adjustment outcomes and to explore the factors not measured in this study that might explain gain. Copyright © 2011 by Lippincott Williams &Wilkins. Source

Hempenius L.,University of Groningen | Slaets J.P.J.,University of Groningen | Boelens M.A.M.,University of Groningen | Van Asselt D.Z.B.,Geriatric Center | And 3 more authors.
Journal of Geriatric Oncology

With the aging of the population, the interest in clinical trials concerning frail elderly patients has increased. Evidence-based practice for the elderly patient is difficult because elderly patients, especially the frail, are often excluded from clinical trials. To facilitate the participation of frail elderly patients in clinical trials, investigators should be more aware of possible barriers when setting up research. While conducting a trial entitled 'A randomized controlled trial of geriatric liaison intervention in frail surgical oncology patients' (LIFE) the main problem was low inclusion rates. This was due to: 1) limited physical and cognitive reserve of frail elderly patients making participation and extra visits to the hospital a burden for patients; 2) difficulty with understanding written information and information given by telephone; and 3) insufficient awareness of the study by health care professionals. To increase inclusion rates, follow-up measurements were taken at a home visit. To overcome barriers to understanding written information and information given over the phone, patients were informed face to face and questionnaires were filled in an interview format. To increase awareness, posters, pencil and sweets with the logo of the study were distributed and the study protocol was repeatedly explained to new staff. Moreover, it was checked if possible eligible patients coming to the hospital were indeed screened for participation. The mentioned measures, increased inclusion rates but also caused an increased time investment and consequently extra financial resources for staff costs. © 2012 Elsevier Ltd. Source

Obeid R.,Saarland University | Kirsch S.H.,Saarland University | Kasoha M.,Saarland University | Eckert R.,Geriatric Center | Herrmann W.,Saarland University
Metabolism: Clinical and Experimental

Folate deficiency can cause age-related disease. Folic acid (FA) has been used in studies aiming at disease prevention. Recently, unmetabolized FA in plasma raised public health concerns; but numerous studies used FA for disease prevention. Concentrations of the folate forms FA, 5-methyltetrahydrofolate (5-MTHF), and tetrahydrofolate (THF) were measured before and after 3-week placebo or FA 5 mg, vitamin B6 40 mg, and cyanocobalamin 2 mg per day administrated to 74 older adults (median age, 82 years). Concentrations of 5-MTHF and total homocysteine (tHcy) (r = -0.392) and S-adenosylmethionine (r = 0.329) were correlated at baseline. Twenty-six percent of the elderly subjects had unmetabolized FA in plasma at the start, and concentrations of FA were increased after 3 weeks of FA treatment (median FA = 0.08 nmol/L at baseline and 15.3 nmol/L at the end of the treatment in the vitamin group). Folic acid caused a 10- and a 5-fold increase in 5-MTHF and THF, respectively, and lowered tHcy (median tHcy = 17.2 μmol/L at baseline vs 9.0 μmol/L after treatment). Concentrations of unmetabolized FA were positively related to those of 5-MTHF and THF. People showed wide variations in folate forms at baseline, but these were reduced after FA treatment. Folic acid given to older adults is mostly converted to THF and 5-MTHF and lowered concentrations of tHcy, but caused a substantial increase in unmetabolized FA in the plasma. © 2011 Elsevier Inc. Source

Kimyagarov S.,Geriatric Center

BACKGROUND: The reduction of skeletal muscle mass and strength, that occurs with aging (sarcopenia), leads to disability in the elderly population. OBJECTIVES: To investigate the prevalence of sarcopenia among older disabled nursing home residents and to examine the relationship between skeletal muscle mass (SMM) and routine data of nutritional, functional status and body composition estimations. PARTICIPANTS: Sixty three men and women aged 63 to 99 years old (mean +/- SD = 84.7 +/- 7.1) suffering from advanced dementia (89.8%), who have undergone evaluations and are considered disabled according to their functional status (FIM = 27-32 +/- 7.2-7.9%). MEASUREMENTS: The whole SMM and body composition (FFM, FM) were assessed by daily urinary creatinine excretion and the results were compared to routine data on nutritional, functional status, body composition, functional status indexes and muscle strength (MMT). RESULTS: Prevalence of sarcopenia was 87.5% and 41.0% for men and women, respectively. Significant differences were found in both gender groups in all indexes of body composition and SMM: prevalence of underweight was 15.4% in women vs 33.3% in men. Absolute levels of FFM and SMM in men were significantly higher, but relative to height2 were reduced among men compared to women. No correlation was found between SMM and routine data of nutritional status, but it highly correlates with values of functional status and body composition. CONCLUSION: Sarcopenia in elderly nursing home residents is one of the important parameters of disability and its prevalence in men is twice as high in comparison to women. The routine nutritional status assessments are limited to estimation of skeletal muscle mass. The method of measuring SMM, based on daily creatinine excretion, is simple but well correlated with body composition and functional status data. Source

Herrmann W.,Saarland University | Kirsch S.H.,Saarland University | Kruse V.,Saarland University | Eckert R.,Geriatric Center | And 3 more authors.
Clinical Chemistry and Laboratory Medicine

Background: Vitamin D and vitamin B deficiency are common in elderly subjects and are important risk factors for osteoporosis and age-related diseases. Supplementation with these vitamins is a promising preventative strategy. The objective of this study was to evaluate the effects of vitamins D3 and B supplementation on bone turnover and metabolism in elderly people. Methods: Healthy subjects (n = 93; > 54 years) were randomly assigned to receive either daily vitamin D3 (1200 IU), folic acid (0.5 mg), vitamin B12 (0.5 mg), vitamin B6 (50 mg), and calcium carbonate (456 mg) (group A) or only vitamin D3 plus calcium carbonate (group B) in a double blind trial. We measured at baseline and after 6 and 12 months of supplementation vitamins, metabolites, and bone turnover markers. Results: At baseline mean plasma 25-hydroxy vitamin D [25(OH)D] was low (40 or 30 nmol/L) and parathormone was high (63.7 or 77.9 pg/mL). 25(OH)D and parathormone correlated inversely. S-Adenosyl homocysteine and S-adenosyl methionine correlated with bone alkaline phosphatase, sclerostin, and parathormone. One year vitamin D3 or D3 and B supplementation increased plasma 25(OH)D by median 87.6% (group A) and 133.3% (group B). Parathormone was lowered by median 28.3% (A) and 41.2% (B), bone alkaline phosphatase decreased by 2.8% (A) and 16.2% (B), osteocalin by 37.5% (A) and 49.4% (B), and tartrate-resistant-acid-phosphatase 5b by 6.1% (A) and 36.0% (B). Median total homocysteine (tHcy) was high at baseline (group A: 12.6, group B: 12.3 μ mol/L) and decreased by B vitamins (group A) to 8.9 μ mol/L (29.4%). tHcy lowering had no additional effect on bone turnover. Conclusions: One year vitamin D3 supplementation with or without B vitamins decreased the bone turnover significantly. Vitamin D3 lowered parathormone. The additional application of B vitamins did not further improve bone turnover. The marked tHcy lowering by B vitamins may modulate the osteoporotic risk. Source

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