THE RELATIONSHIP BETWEEN MARKERS OF MALNUTRITION AND MUSCLE WASTING WITH FRAILTY AND PHYSICAL FUNCTION IN OLDER CARE HOME RESIDENTS

Background: Older care homes residents may suffer from malnutrition and muscle wasting within a background of varying degrees of frailty, comorbidity and disability. Hence, malnutrition is complicated by co-presence of sarcopenia, cachexia and inactivity-induced muscle atrophy. Objectives: (1) to assess the prevalence of malnutrition in care home residents using different methodologies. (2) To examine the relationship between measurements of nutritional status and muscle mass with frailty and physical function; Design: initial pilot study. Setting: care homes for older people. Participants: 73 participants, 46 female and 27 male; Intervention: observational study. Measurements: height (m), weight (kg), body mass index (BMI) (kg), bioelectrical impedance assessment (BIA) of fat free mass index (FFMI) (kg/m2), mid upper arm muscle circumference (MUAMC) (cm), Edmonton Frailty Scale (EFS) and Barthel Index (BI). Results: There was a relatively high prevalence of malnutrition depending on measure used. MNA-SF 0-7 score was 30% for females and 28% males. Low MUAMC was found in 41% females and 53% males; low BIA FFMI in 37% females and 52% males. Good correlation (P<0.001) was found for most measures including against EFS and BI for MNA-SF and MUAMC. Conclusions: Malnutrition prevalence was relatively high. MNA-SF and MUAMC correlated well with functional status and frailty EFS measures. FFMI by BIA correlated well with MNA-SF and MUAMC. This range of practical techniques should be explored further for determining malnutrition risk and muscle wasting in relation to functionality and frailty in care home residents.

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Assessment of fracture risk tools in care home residents: a multi-centre observational pilot study

European Geriatric Medicine ◽

10.1007/s41999-020-00383-2 ◽

2020 ◽

Author(s):

F. Ihama ◽

A. Pandyan ◽

C. Roffe

Keyword(s):

Pilot Study ◽

Care Home ◽

Fragility Fractures ◽

Care Homes ◽

Regression Analyses ◽

Observational Cohort ◽

Comorbidity Index ◽

Participant Outcomes ◽

Study Setting

Abstract Background Fragility fractures are common in care home residents but established tools have not been tested in this population. Aim:To identify the most practicable tool for use. Methods Design Multicentre prospective observational cohort pilot study. Setting: 18 care homes in Boston, UK. Assessments: fragility risk score at baseline with FRAX, QFractureScore, Garvan nomogram, body mass index and TUGT for each participant. Outcomes: falls, fractures, combined falls & fractures. Follow-up; 12 months. Results 217/618 (35%) residents in the 18 care homes were enrolled. 147 (68%) had mental capacity,70 (32%) did not. There were 325 falls and 10 fractures in participants during the study. At the same time there were 1671 falls and 103 fractures in residents not participating in the study. Multiple regression analyses showed that only age had a statistically significant association with falls (χ2(1) = 5.7775, p = 0.0162), fractures (χ2(1) = 4.7269, p = 0.0297) and combined falls & fractures (χ2(1) = 4.7269, p = 0.0297). C-statistics were: falls; FRAX 0.544, BMI 0.610, QFractureScore 0.554, Garvan nomogram 0.579, TUGT 0.656, fractures; FRAX 0.655, BMI 0.708, QFractureScore 0.736, Garvan nomogram 0.712, TUGT 0.590, combined falls and fractures, c-statistics were same as for fractures. Fifty-four participants (25%) died during follow-up. Charlson comorbidity index predicted mortality, R2 = 0.021 (p = 0.034). Conclusions QFractureScore, BMI and Garvan nomogram were good predictors of fractures and combined falls and fractures Only age had statistically significant association with the outcomes. No tool was good predictor of falls.

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The Relationship between Selected Body Composition Components and Cardiopulmonary Resuscitation Parameters in Nurses: An Observational Simulation Study

Journal of Clinical Medicine ◽

10.3390/jcm11010049 ◽

2021 ◽

Vol 11 (1) ◽

pp. 49

Author(s):

Paweł Więch ◽

Marek Muster ◽

Łukasz Godek ◽

Izabela Sałacińska ◽

Edyta Guty ◽

...

Keyword(s):

Body Composition ◽

Cardiopulmonary Resuscitation ◽

Simulation Study ◽

Medical Staff ◽

Bioelectrical Impedance ◽

Face Mask ◽

The Body ◽

Fat Free Mass ◽

Physical Parameters ◽

The Relationship

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.

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Relationship between BMI and adiposity among different ethnic groups in 2-year-old New Zealand children

British Journal Of Nutrition ◽

10.1017/s000711451800380x ◽

2019 ◽

Vol 121 (6) ◽

pp. 670-677 ◽

Cited By ~ 2

Author(s):

Mariam J. Buksh ◽

Joanne E. Hegarty ◽

Rebecca Griffith ◽

Jane M. Alsweiler ◽

Chris J. McKinlay ◽

...

Keyword(s):

Body Composition ◽

Body Size ◽

New Zealand ◽

Ethnic Groups ◽

Bioelectrical Impedance ◽

Overweight And Obesity ◽

Fat Free Mass ◽

Indian Children ◽

The Relationship ◽

Size At Birth

AbstractAge- and sex-based BMI cut-offs are used to define overweight and obesity, but the relationship between BMI and body composition has not been very well studied in children or compared between children of different ethnic groups. Body size and composition in childhood are also influenced by size at birth. Our aim was to compare body size and composition at 2 years in children with different ethnicity and size at birth. We prospectively followed a multi-ethnic cohort of 300 children born with risk factors for neonatal hypoglycaemia (infants of diabetics, large or small at birth or late preterm) to 2 years corrected age. Complete data on weight, height and head circumference and body composition using bioelectrical impedance 24±1 months corrected age were available in 209 children. At birth, compared with European children, Chinese, Indian and other ethnicity children were lighter, and Indian children had smaller head circumferences, but birth lengths were similar in all ethnic groups. At 2 years, Pacific children were heavier and had higher BMI z scores, and Indian children had smaller head circumferences and lower BMI z scores than those from other ethnic groups. However, fat mass and fat-free mass indices were similar in all groups. At median BMI, fat mass:fat-free mass ratio was 23 % lower in Pacific than in Indian children (0·22 v. 0·27, P=0·03). BMI is not a good indicator of adiposity in this multi-ethnic cohort of 2-year-old New Zealand children.

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Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr09190 ◽

2021 ◽

Vol 9 (19) ◽

pp. 1-188

Author(s):

Ann-Marie Towers ◽

Nick Smith ◽

Stephen Allan ◽

Florin Vadean ◽

Grace Collins ◽

...

Keyword(s):

Quality Of Life ◽

Mixed Methods ◽

Social Care ◽

Care Home ◽

Self Report ◽

Care Homes ◽

Mixed Methods Approach ◽

Related Quality ◽

The Relationship

Background Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design This was a mixed-methods study. Setting The setting was care homes for older adults in England. Participants Care home residents participated. Results Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations No care homes rated as inadequate were recruited to the study. Conclusions The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

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Behavioral components of pro-healthy lifestyle and bioelectrical impedance body composition in Polish young adults: Preliminary results

Polish Annals of Medicine ◽

10.29089/2021.21.00208 ◽

2021 ◽

Author(s):

Michał Skrzypek ◽

Maciej Pokarowski ◽

Kornela Partycka-Pietrzyk ◽

Olga Poźniak ◽

Michał Kędra

Keyword(s):

Young Adults ◽

Body Composition ◽

Waist Circumference ◽

Health Behaviors ◽

Healthy Lifestyle ◽

Bioelectrical Impedance ◽

Fat Free Mass ◽

Nutritional Knowledge ◽

Anthropometric Indices ◽

The Relationship

Introduction: Adverse health behaviors changes are reported during emerging adulthood, inter alia the reduced level of physical activity (PA), worse diet quality etc. There are only very few studies concerned with the relationship between health behaviors and body composition in healthy young adults. Aim: The aim was to investigate the relationship between behavioral components of prohealthy lifestyle and body composition assessed by bioelectrical impedance (BIA) in the cohort of Polish young adults. Material and methods: A cross-sectional observational study of health behaviors, anthropometric indices and BIA body composition was conducted in Polish young adults (n = 92) aged 18–24 (mean 19.33, SD 0.915), 71 females. Behavioral variables included: general health behaviors, PA, eating behaviors and nutritional knowledge. Body composition was analyzed by means of the BIA phase-sensitive 8-electrode medical SECA mBCA 525 device. Results and discussion: A higher level of PA was associated with a lower volume of visceral adipose tissue in females (r = –0.27; P < 0.05). In the males, the intensification of unhealthy diet was negatively correlated with the muscle mass (r = 0.65; P < 0.01), and the higher level of nutritional knowledge resulted in a smaller waist circumference (r = –0.45; P < 0.05). Behavioral components of pro-healthy lifestyle were not significant predictors of body composition/anthropometric indices such as waist circumference, fat mass index, fat free mass index and body mass index. Conclusions: The reported studies provide an important insight into the sex-specific correlations between the behavioral components of the pro-healthy lifestyle and body composition in healthy young adults.

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GPs’ experience of safeguarding in care homes: what do they see and what do they do?

British Journal of General Practice ◽

10.3399/bjgp20x711269 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711269

Author(s):

Elisabeth Alton ◽

Caroline White

Keyword(s):

Online Survey ◽

Qualitative Data ◽

Care Home ◽

Health Needs ◽

Care Homes ◽

Electronic Records ◽

Multiple Relationships ◽

Home Context ◽

Emerging Themes ◽

Multiple Health

BackgroundAbuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.AimTo explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.MethodAn online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.ResultsIn total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.ConclusionGP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.

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Is the relationship between increased knee muscle strength and improved physical function following exercise dependent on baseline physical function status?

Arthritis Research & Therapy ◽

10.1186/s13075-017-1477-8 ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 9

Author(s):

Michelle Hall ◽

Rana S. Hinman ◽

Martin van der Esch ◽

Marike van der Leeden ◽

Jessica Kasza ◽

...

Keyword(s):

Muscle Strength ◽

Physical Function ◽

Knee Muscle ◽

The Relationship ◽

Knee Muscle Strength

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Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽

10.1136/bmjopen-2020-045469 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045469

Author(s):

Rachel Stocker ◽

Siân Russell ◽

Jennifer Liddle ◽

Robert O Barker ◽

Adam Remmer ◽

...

Keyword(s):

Early Warning ◽

Healthcare Professionals ◽

Care Home ◽

Qualitative Interview ◽

Interview Study ◽

Care Homes ◽

Early Warning Score ◽

Service Utilisation ◽

Qualitative Interview Study ◽

National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

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Is area deprivation associated with greater impacts of COVID-19 in care homes across England? A preliminary analysis of COVID-19 outbreaks and deaths

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-215039 ◽

2021 ◽

pp. jech-2020-215039 ◽

Cited By ~ 2

Author(s):

Anders Malthe Bach-Mortensen ◽

Michelle Degli Esposti

Keyword(s):

Negative Binomial ◽

Care Home ◽

Negative Binomial Regression ◽

Population Characteristics ◽

Care Homes ◽

Future Research ◽

Area Deprivation ◽

Binomial Regression ◽

Index Of Multiple Deprivation

IntroductionThe COVID-19 pandemic has disproportionately impacted care homes and vulnerable populations, exacerbating existing health inequalities. However, the role of area deprivation in shaping the impacts of COVID-19 in care homes is poorly understood. We examine whether area deprivation is linked to higher rates of COVID-19 outbreaks and deaths among care home residents across upper tier local authorities in England (n=149).MethodsWe constructed a novel dataset from publicly available data. Using negative binomial regression models, we analysed the associations between area deprivation (Income Deprivation Affecting Older People Index (IDAOPI) and Index of Multiple Deprivation (IMD) extent) as the exposure and COVID-19 outbreaks, COVID-19-related deaths and all-cause deaths among care home residents as three separate outcomes—adjusting for population characteristics (size, age composition, ethnicity).ResultsCOVID-19 outbreaks in care homes did not vary by area deprivation. However, COVID-19-related deaths were more common in the most deprived quartiles of IDAOPI (incidence rate ratio (IRR): 1.23, 95% CI 1.04 to 1.47) and IMD extent (IRR: 1.16, 95% CI 1.00 to 1.34), compared with the least deprived quartiles.DiscussionThese findings suggest that area deprivation is a key risk factor in COVID-19 deaths among care home residents. Future research should look to replicate these results when more complete data become available.

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Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

BMC Geriatrics ◽

10.1186/s12877-021-02053-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fiona Marshall ◽

Adam Gordon ◽

John R. F. Gladman ◽

Simon Bishop

Keyword(s):

Central Government ◽

Resource Constraints ◽

Care Delivery ◽

Care Home ◽

Third Sector ◽

Care Homes ◽

Framework Analysis ◽

Local Networks ◽

Care Home Staff ◽

East Midlands

Abstract Background From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed. Methods Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals. Results Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care. Conclusions This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

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