‘Water, water everywhere’; dehydration in the older population

Janet Gordon & Marie Henson both work for Birmingham Community Healthcare NHS Foundation Trust. Janet Gordon is a dietitian working in Nutrition Support and is team leader for the adult Nutrition Support Team which is part of Birmingham Community Nutrition. At the time of the study Marie Henson was a Community Nurse team leader in the Kings Heath area of Birmingham, which is where the study took place. This study was presented as a poster at BAPEN Conference 2016 and was published here.

The prevalence of dehydration in older people in the UK has not been widely studied. The UK DRIE Study found 20% of residents in UK long term care were dehydrated. The prevalence in those living at home has not been determined. Dehydration in older people is linked to associated morbidities such as increased falls, confusion, and infections and is a frequent cause of hospitalisation. Clear signs of early dehydration in older people are yet to be determined, but there is a need to identify those at risk of dehydration and intervene early. Systems for recognising those with inadequate fluid intakes, and helping them to drink more, are already in place in many UK hospitals where a red jug scheme identifies those requiring assistance to drink.

“Doc, I read on the Internet that probiotics might help me. Is it true?”

Patrick Alexander Wachholz  is a Geriatrician, Research associate at Botucatu Medical School, São Paulo State University (UNESP). His paper Effectiveness of probiotics on the occurrence of infections in older people: systematic review and meta-analysis was recently published in Age and Ageing journal.

In 2001, an international Joint Expert Consultation of sci­entists working on behalf of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.

Probiotics are intended to have health benefits, and in some countries we can find a huge variety of products sold as probiotics including foods (such as yogurt and fermented milk), dietary supplements, and products that aren’t used orally, such as skin or vaginal creams.

Spring Speakers Series: Why worry about mouthcare?

Sam Shah discusses the HEE supported project exploring hydration, nutrition and mouthcare in hospital and community care settings. The project involves training staff and raising awareness to improve the quality of care, to help avoid admission and to support discharge. The insights from this project will be shared at the  BGS Spring Meeting in Gateshead on the 28th April at 9:30-11:00.

We are all accustomed to brushing our own teeth and cleaning our mouths, it’s entrenched in the daily routines of most people. Most of us are able to eat and drink ourselves and we understand the link between what we eat and our how our bodies respond. A big challenge in the care of frail older people, and those in high needs settings, is ensuring their hydration, nutrition and mouthcare needs are supported.

Nutrition in geriatric medicine in context

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

Do you reach for protein to nibble within minutes of finishing a session at the Gym?  Many do. Protein bars, pots of creatine and drugs you can get at the Gym are all very well but they’re wasted on fit young things. What we really need to do is keep the best stuff for older people, especially our patients. So, OK, we have to justify the cost – there needs to be some evidence. On the plus side however our patients are not pulled aside by WADA or the other anti-doping bodies so they could get away with anabolics or even the odd transfusion. On the minus side maybe the anabolics don’t work! But good nutrition does!

Oral health; the gateway to hydration, nutrition, and medication

Yasmin Allen @missdiplom and Nikki Patel @NikkiPatel_

Yasmin is currently working as a clinical fellow in leadership and management in the HEE, her work includes promoting collaboration between health care professionals and the dental team, unscheduled dental care and improving oral health for older people in community and hospital settings. Yasmin also works clinically in the out of hours emergency dental care service on weekends.

Nikki is a community dental officer who looks after the oral health of dependant elderly or medically compromised individuals. She is currently pursuing her Fellowship in Clinical Leadership at Health Education England in London, where she is involved with projects and strategies to overall improve the oral health of the population and develop new and improved ways of working.

 

Cast your mind back to when you opened your eyes this morning. Then think of how your mouth felt at that time; I bet it was dry, uncomfortable, had a horrible taste and you most likely felt some plaque roughening the surfaces of your teeth. Now think about how your mouth would feel if you hadn’t brushed your teeth after waking up. Or you didn’t brush them for a week after, or even a few weeks after. Your mouth and teeth will now almost certainly feel dirty, odorous, uncomfortable and in turn it may affect your confidence and well being. This is what happens to dependant elderly people far too regularly than we would like to admit. These are the people whose personal care, including their hair care, foot care, nails care and continence care is being delivered as part of their overall support. Yet there is often one part of personal care which is frequently overlooked- the mouth.

Frequent consumption of fruit and vegetables inversely associated with sarcopenia

Yunhwan Lee is a professor and Jinhee Kim is a research fellow in the Department of Preventive Medicine and Public Health of Ajou University School of Medicine, and the Institute on Aging of Ajou University Medical Center in the Republic of Korea. His paper was recently published in Age and Ageing journal.

Sarcopenia, the gradual loss of muscle mass with age, is now widely recognised as a major health problem in late life. Older people with sarcopenia are prone to suffering from frailty, falls, and disability that negatively affects their quality of life. Because there is currently no effective treatment for sarcopenia, it is important to identify risk factors that have a modifiable influence on the condition.

To Feed or Not to Feed? This is only half the question

Dr Eleni Tsiompanou is a specialist in nutritional medicine at the Health-Being Institute. She blogs at www.blog.healthbeing.co.uk and Tweets at @DrEleni   

For some time I have been intrigued by patients who, thought to be dying, were put on the Liverpool Care Pathway (LCP) but instead of dying improved. Such cases of unexpected recovery, reported in the Daily Mail, were of patients on the LCP who had had their treatment, feeding and hydration withdrawn. In two recent articles, in Clinical Medicine and BMJ online, I argue that there is more to these stories than meets the eye.

You don’t need to be thin to be frail

Dr Katie Sheehan is a Vancouver based physiotherapist and a recent research fellow at The Irish Longitudinal Study on Ageing. You can see her platform presentation at 11.45 on Friday 21st at the BGS Scientific Meeting.

Frailty is often thought of as a wasting disorder and, as such, is frequently considered a consequence of ageing incurred by those older adults who present as underweight.  The Fried model of frailty includes reduced gait velocity, low physical activity levels, weakness, exhaustion and weight loss. But frailty isn’t the sole preserve of the thin. As people get older, muscle mass is replaced by fat and physical function deteriorates. This phenomenon offers a particular difficulty for obese older adults who have too low a muscle mass relative to their body size. This mismatch represents a substantial barrier to physical function and may help to explain the recently reported cross sectional ‘U’ shaped relationship between Body Mass Index (BMI) and frailty. This correlation suggests that those who are underweight (body mass index (BMI) < 18.5 kg.m²) and those who are obese (BMI ≥ 30 kg.m²) are more likely to present as frail.

Francis cannot define compassionate care but we can still practise it

 Iain Wilkinson is an ST6 in the London Deanery and wrote the letter below for publication in the BGS newsletter

The second Francis report into the failings at Mid Staffordshire hospital will have stirred up feelings in a number of the readers of this newsletter. For me, I am actually quite anxious about the report. I see a number of things that happened at North Staffs that happen in every hospital I have worked in. The report shines a spotlight onto a number of areas of our practice as geriatricians and on-call general medical doctors, as highlighted by David Oliver’s excellent review (March 2013). Much of this is “structural” in nature (i.e.. training etc.). There are however some areas that are key to the way we work. 

Chronic disease begins in childhood

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

Research is increasingly suggesting that old age is influenced by conditions and events in early life, a concept supported by data from The Irish Longitudinal Study on Ageing, TILDA, which has studied 8,500 people aged 50 and over for the past ten years. Opening a special session on the last morning of the conference, its principal investigator Prof Rose-Anne Kenny of Trinity College Dublin, described the process. Participants were given an initial comprehensive assessment which included physical health, cognition, psychology, behaviour, family background and use of health care. They were then revisited every two years providing a rich set of data involving almost one in every 140 people in Ireland.