Depression Significantly Impacted by Serum 25-Hydroxyvitamin D [25(OH)D] Levels in Older Adults Living in Long-Term Care Communities

Abstract Insufficient serum 25-hydroxyvitamin D (25(OH)D) concentrations are associated with increased respiratory tract infections, influenza, and other infectious diseases. As the world deals with the COVID-19 pandemic, the interest of adequate serum levels to reduce the risk of infection has surfaced. This study determined if the number of infections per year are associated with serum 25(OH)D concentrations in long-term care (LTC). Participants (≥ 65 years) in a cross-sectional study were recruited across five LTC communities in Texas. Medical records were used to collect a one-year medical history using double-blind protocols. Blood draws were collected to measure serum 25(OH)D concentrations. Medical records were used to classify infections based upon documentation of signs and symptoms of infection concurrent with either a physician’s note or antibiotic/antiviral medication prescription. Race, BMI, sex, age, and liver and renal disease diagnoses were used as confounders. Of the 177 participants (89% Caucasian, 63% female, mean age 83 years) 69% had ≥1 infection over year and 55% had insufficient serum 25(OH)D concentrations <30 mg/mL (mean 32.6 ng/mL). Linear regression did not show a significant association between serum 25(OH)D concentrations and number of infections (β 0.003; 95% CI -0.014, 0.018; p=0.760). Additionally, insufficient serum concentration did not increase the odds of having an infection (OR 1.02; 95% CI 0.05, -19.34; p=0.987). This study did not show a significant association between infection rates and serum 25(OH)D concentrations. However, further research is needed to determine if vitamin D supplementation could be an effective therapeutic intervention to reduce infection rates, including COVID-19.

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Prevalence of Insufficient Serum 25-hydroxyvitamin D (25(OH)D) Greater Among Medicaid Residents Living in Long-Term Care Communities (P01-011-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-011-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ronna Robbins ◽

Nalini Ranjit ◽

Sara Sweitzer ◽

Maragaret Briley

Keyword(s):

Logistic Regression ◽

Serum Level ◽

Medical Records ◽

Long Term Care ◽

Serum Levels ◽

Term Care ◽

Hydroxyvitamin D ◽

Payer Source ◽

25 Hydroxyvitamin D

Abstract Objectives Evaluate the association between insufficient 25-hydroxyvitamin D [25(OH)D] serum levels and healthcare payer source of older adults living in long-term care (LTC) communities. Methods Residents (age >65 yo) of five LTC communities in Central, Texas were recruited to participated in the multi-site, cross-sectional study. A one-year medical history was abstracted from medical records using double-blinded data abstraction and entry protocols. Medical history included but not limited to: diagnosis, medications, history of supplementation, BMI, mini-nutritional assessment, diet order, total mood assessments, hospitalizations and number of infections. Data on payer source and other demographics were also obtained via medical records. Blood draws were collected to measure serum 25(OH)D levels. Logistic regression models were uses to assess the association between insufficient25(OH)Dserum levels (defined as <30 ng/ml) and healthcare payer source. Total vitamin D supplemented per day along with amount provided in meals, body mass index, race, gender, age, years living in community, and diagnosis of liver and renal disease were used as confounders. Results The 174 participants (89% Caucasian, mean age 83 yo) included 63% females. Payer source was distributed as follows: 55% private pay, 8.6% Medicare, 35% Medicaid, and 1% insurance. Fifty-five % had insufficient25(OH)D serum levels (mean serum level = 32.6 ng/ml; mean supplementation rate of 1138 IU per/d). Insufficient serum levels were seen in 48% of participants with private pay (mean serum level = 36 mg/ml) and 58% with Medicaid (mean serum level = 30.5 ng/ml). Adjusted logistic regression showed that payer source was a significant determinant of insufficient25(OH)D serum levels. Medicaid residents had significantly greater odds of having insufficient 25(OH)D serum levels (adjusted odd ratio (OR) 3.26; CL: 1.25, 8.48; P = 0.015) than private pay participants. Conclusions Practitioners working in LTC can use these results to ensure equity in the provision of medical nutritional therapy across Medicaid residents and private pay residents. Funding Sources Funding for study was provided through the private funds of research team.

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Efficacy of various prescribed vitamin D supplementation regimens on 25-hydroxyvitamin D serum levels in long-term care

Public Health Nutrition ◽

10.1017/s1368980021001609 ◽

2021 ◽

pp. 1-24

Author(s):

Ronna N Robbins ◽

Monica Serra ◽

Nalini Ranjit ◽

Deanna M Hoelscher ◽

Sara J Sweitzer ◽

...

Keyword(s):

Older Adults ◽

Vitamin D ◽

Long Term Care ◽

Serum Levels ◽

Vitamin D Supplementation ◽

Serum Concentrations ◽

Blood Draw ◽

Term Care ◽

Hydroxyvitamin D

ABSTRACT Objective: The aims of this study were to examine the efficacy among various vitamin D supplementation regimens on serum 25(OH)D concentrations and determine the minimal dose rate required to achieve sufficient serum concentrations (≥75 nmol/L) among older adults in long-term care (LTC). Design: A one-year medical history was abstracted from medical records, and a one-time blood draw to measure serum 25(OH)D concentrations was obtained. Individuals were stratified into vitamin D supplemented and non-supplemented groups. The supplemented group was further categorized into four treatment forms: single ingredient vitamin D2or3, multivitamin, calcium with vitamin D, or combination of the three, and by daily prescribed doses: 0-399, 400-799, 800-1999, 2000-3999, and >4000 IU/day. Setting: Five LTC communities in Austin, Texas. Participants: 173 older (≥65 years) adults. Results: Of the participants, 62% received a vitamin D supplement and 55% had insufficient (≤75 nmol/L) 25(OH)D serum concentrations. Individuals receiving single ingredient vitamin D2or3 supplementation received the highest daily vitamin D mean dose (2900 IU/d), while combination of forms was the most frequent treatment (44%) with the highest mean serum concentration (108 nmol/L). All supplementation doses were successful at reaching sufficient serum concentrations, except those <800 IU/d. Using a prediction model, it was observed that one IU/d of vitamin D supplementation resulted in a 0.008 nmol/L increase in serum 25(OH)D concentrations. Conclusion: Based on the predictive equation, results suggest that supplementation of 1500 IU/d of vitamin D2or3 or combination of vitamin D is most likely to achieve sufficient serum 25(OH)D concentrations in older adults in LTC.

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Author response for "The Effect Of Fall Biomechanics On Risk For Hip Fracture In Older Adults: A Cohort Study Of Video‐Captured Falls In Long‐Term Care"

10.1002/jbmr.4048/v2/response1 ◽

2020 ◽

Author(s):

Yijian Yang ◽

Vicki Komisar ◽

Nataliya Shishov ◽

Bryan Lo ◽

Alexandra MB Korall ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Hip Fracture ◽

Long Term Care ◽

Author Response ◽

Term Care

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Decision Making and Implementation of Aging-in-Place/Long Term Care Plans Among Older Adults

Case Medical Research ◽

10.31525/ct1-nct03960476 ◽

2019 ◽

Author(s):

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Aging In Place ◽

Term Care ◽

Care Plans

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Uitbraak COVID-19 in de verpleeghuiszorg

Tijdschrift voor Gerontologie en Geriatrie ◽

10.36613/tgg.1875-6832/2020.03.01 ◽

2020 ◽

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Long Term Care ◽

Informal Caregivers ◽

Rapid Review ◽

Daily Routine ◽

Term Care ◽

Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

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Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02049-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chan Mi Park ◽

Wonsock Kim ◽

Hye Chang Rhim ◽

Eun Sik Lee ◽

Jong Hun Kim ◽

...

Keyword(s):

Older Adults ◽

Primary Outcome ◽

Long Term Care ◽

Functional Decline ◽

Tube Feeding ◽

Term Care ◽

Pneumonia Severity ◽

Frailty Assessment ◽

Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

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Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

Journal of Holistic Nursing ◽

10.1177/08980101211025372 ◽

2021 ◽

pp. 089801012110253

Author(s):

Verónica G. Walker ◽

Elizabeth K. Walker

Keyword(s):

Older Adults ◽

Life Course ◽

Health Beliefs ◽

Long Term Care ◽

Life Course Theory ◽

Nursing Research ◽

Term Care ◽

Holistic Nursing ◽

Care Facilities

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

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