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Encyclopedia of Statistics in Behavioral Science

Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data

Prevalence and comorbidity of common mental disorders in primary care

Introduction 
Loneliness is a common, emotionally distressing experience and is associated with adverse physical and mental health and an unhealthy lifestyle. Nevertheless, little is known about the prevalence of loneliness in different age groups in Switzerland. Furthermore, the existing evidence about age and gender as potential effect modifiers of the associations between loneliness, physical and mental health and lifestyle characteristics warrants further investigation. Thus, the aim of the study was to examine the prevalence of loneliness among adults in Switzerland and to assess the associations of loneliness with several physical and mental health and behavioral factors, as well as to assess the modifying effect of sex and age.


Methods 
Data from 20,007 participants of the cross-sectional population-based Swiss Health Survey 2012 (SHS) were analyzed. Logistic regression analyses were used to assess associations of loneliness with physical and mental health or lifestyle characteristics (e.g. diabetes, depression, physical activity). Wald tests were used to test for interactions.


Results 
Loneliness was distributed in a slight U-shaped form from 15 to 75+ year olds, with 64.1% of participants who had never felt lonely. Lonely individuals were more often affected by physical and mental health problems, such as self-reported chronic diseases (Odds ratio [OR] 1.41, 95% confidence interval [CI] 1.30–1.54), high cholesterol levels (OR 1.31, 95% CI 1.18–1.45), diabetes (OR 1.40, 95% CI 1.16–1.67), moderate and high psychological distress (OR 3.74, 95% CI 3.37–4.16), depression (OR 2.78, 95% CI 2.22–3.48) and impaired self-perceived health (OR 1.94, 95% CI 1.74–2.16). Loneliness was significantly associated with most lifestyle factors (e.g. smoking; OR 1.13, 95% 1.05–1.23). Age, but not sex, moderated loneliness’ association with several variables.


Conclusion 
Loneliness is associated with poorer physical and mental health and unhealthy lifestyle, modified by age, but not by sex. Our findings illustrate the importance of considering loneliness for physical and mental health and lifestyle factors, not only in older and younger, but also in middle-aged adults. Longitudinal studies are needed in Switzerland to elucidate the causal relationships of these associations.

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Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey.

// Didier Remond 1, 2 , Danit R. Shahar 3 , Doreen Gille 4 , Paula Pinto 5, 6 , Josefa Kachal 7 , Marie-Agnes Peyron 1, 2 , Claudia Nunes Dos Santos 6, 8 , Barbara Walther 4 , Alessandra Bordoni 9 , Didier Dupont 10 , Lidia Tomas-Cobos 11 , Guy Vergeres 4 1 UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France 2 Clermont Universite, Universite d’Auvergne, Unite de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France 3 Department of Public Health, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel 4 Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland 5 Escola Superior Agraria, Insituto Politecnico de Santarem, 2001-904 Santarem, Portugal 6 Instituto de Tecnologia Quimica e Biologica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal 7 Israeli Ministry of Health, 93591 Jerusalem, Israel 8 Instituto de Biologia Experimental e Tecnologica, 2780-157 Oeiras, Portugal 9 Department of Agri-Food Sciences and Technologies, University of Bologna, 47521 Cesena, Italy 10 UMR 1253, Science et Technologie du Lait & de l’Œuf, INRA, 35000 Rennes, France 11 ainia Centro Tecnologico, E46980 Paterna (Valencia), Spain Correspondence to: Guy Vergeres, e-mail: guy.vergeres@agroscope.admin.ch Keywords: malnutrition, gastrointestinal tract, aging, dietary solutions, gerotarget Received: May 06, 2015      Accepted: May 13, 2015      Published: May 27, 2015 ABSTRACT Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.

https://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=download&path%5B%5D=4030&path%5B%5D=10573

Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition.

Introduction: The clinical and epidemiological data show that proper nutrition plays an important role in maintaining health and combating the danger of developing some chronic diseases in the elderly population. Nutrition is an important factor in many physiological and pathological changes that accompany the aging process. More than 50% of elderly patients are suffering from malnutrition which is information that concerns. Due to various factors, older people are potentially vulnerable groups at risk of malnutrition. Loneliness, isolation from society and neglect of parents by children is a big problem to many people in old age. Objective: To determine differences in nutritional status of elderly people living alone compared to those who live in family surroundings. Subject and methods: The study was conducted in the municipality of Tuzla in 2009.-2010, in outpatient family medicine Simin Han. The survey covered a total of 200 elderly subjects (age> 65 years). Subject group consisted of 45% of people living alone, and 55% control group consisted of elderly patients who live in traditional family surroundings. Questionnaires used in this study are General geriatric assessment questionnaire and Mini nutritional status. Results: The average age (} SD) was 75.4 } 6.2 years in subject group, while the same in the control group was 74.9 }5.6 years. In subject group significantly more patients are on the verge of poverty. There are significant differences in the classification of financial status, according to the groups (p =0.043). Members of subject groups have significantly lower BMI categories (p = 0.03) compared with the control group. In our study, people who live alone are at increased risk of malnutrition (p =0030), have reduced the number of daily meals, significantly lower daily intake of protein, fruits and vegetables in the diet in relation to persons living in a family environment. Significantly more patients with loss of appetite live alone. According to the existence of self-reported food problems significantly more people are in subject group. There is a difference value score “Small assessment of nutrition” between the two groups (p = 0.001). About 22% of the total number of respondents said they have not so good health status compared to others. Conclusions: Loneliness is a significant predictor of anorexia nervosa, the risk of malnutrition and malnutrition. Results indicate that it is necessary to work on improving the status and protection of elderly.

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The effect of loneliness on malnutrition in elderly population.

Objectives: The objective of this study is to evaluate the incidence and clinical presentation of hypertensive crises in the Emergency medical services of the Community Health Centre “Dr. Mustafa Sehovic” Tuzla in relation to age, sex, duration and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestations. Methods: The study was conducted between November 2009 and April 2010 and included 180 subjects of both sexes, aged 30-80 with a diagnosis of arterial hypertension. All subjects were divided into two groups: a control group, which consisted of subjects without hypertensive crisis (95 subjects) and an experimental group that consisted of subjects with hypertensive crisis (85 subjects). Results: The study results indicate that female subjects were significantly over- represented compared to men (60% vs. 40 %, p=0.007). The average age of the male subjects was 55.83±11.06 years, while the female subjects’ average age was 59.41±11.97 years. The incidence of hypertensive crisis was 47.22%, with hypertensive urgency significantly more represented than emergency (16.47% vs. 83.53%, p<0.0001). The majority of subjects in the experimental group (28.23%) belonged to the age group of 60-69 years of age: 26.76% urgency and 35.71% emergency. The most common accompanying symptoms in hypertensive subjects were headache (75%), chest pain (48.33%), vertigo (44.44%), shortness of breath (38.88%) and nausea (33.89%). The most common symptoms in subjects with hypertensive crisis were headache (74.11%), chest pain and shortness of breath (62.35%), vertigo (49.41%), and nausea and vomiting (41.17%). Conclusions: Chest pain, shortness of breath, nausea and vomiting were significantly over-represented in subjects with hypertensive crisis (p<0.005). Clinical manifestations of hypertensive emergencies in almost all subjects included acute coronary syndrome, and only one subject had acute pulmonary edema.

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Clinical presentation of hypertensive crises in emergency medical services.

The 1992-1995 conflict in Bosnia and Herzegovina resulted in more than 250 000 deaths and over two million refugees and internally displaced people. The trauma of ethnic cleansing, violence, and disrupted lives caused psychological and social breakdown in the adults and children who lived through it (1,2). These psychological disorders continue to be aggravated by interethnic tensions, as well as the political and economic instability in the country. Current and past adverse situations can have a lasting negative effect on the mental health of the people, often resulting in depression, anxiety, and somatization (3,4). Other social problems, such as alcoholism or eating disorders, can also result from trauma that has not been addressed in a timely or adequate manner (5).

Little is known about the prevalence of such mental and social disturbances in the general population in Bosnia and Herzegovina today. A few studies on mental health have been conducted by local researchers inside Bosnia and Herzegovina. This can be partly explained by the fact that they were also affected by the war and its consequences, and choose not to study mental health. One study on posttraumatic stress disorder among family physicians found that among 133 physicians who completed the questionnaire, 80% had experienced a traumatic event during the war, and 18% of them met the criteria for PTSD (6). A second study on anxiety and depression among nurses after the conflict determined that 45% of nurses in Srebrenik and 67% in Tuzla had anxiety, while 39% of the nurses in Srebrenik and 55% in Tuzla had depression (7).

Perhaps the prime reason for the dearth of studies by local primary care researchers is the lack of research experience. Due to current primary care reform program in Bosnia and Herzegovina, newly-trained family medicine specialists are learning about and participating in research.

Funded by the Canadian International Development Agency, the Department of Family Medicine at Queen's University in Kingston has been working in Bosnia and Herzegovina since 1995 to establish an effective family medicine educational infrastructure. Activities include creating departments of family medicine in four of the five medical schools in Bosnia and Herzegovina with clinical training bases in family medicine teaching centers, establishing and implementing a residency (specialty) program in family medicine, introducing family medicine into the undergraduate curricula, and helping to establish a professional college of family doctors (8). To date, more than 280 specialists have been certified by examination; another 165 residents are in the process of their training in one of 20 family medicine teaching centers or satellite centers. To encourage continuing professional development following the years of specialization training, and to maintain a connection between community-based family physicians and the academic family medicine departments at the medical faculties, a Primary Care Research Network (PCRN) was recently formed. Many of these new family medicine specialists, through their involvement in the PCRN, have collaborated in this study to address the mental and social disturbances among their population.

The aim of this study was to determine the prevalence of mental and social disturbances, ie, rates of depression, anxiety, and somatization, as well as alcoholism and eating disturbances, among people over the age of 18 who attended primary care centers in Bosnia and Herzegovina. These disturbances were selected because of their inclusion in a validated questionnaire that could be administered by the physicians of the newly formed PCRN of Bosnia and Herzegovina.

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Prevalence of Mental and Social Disorders in Adults Attending Primary Care Centers in Bosnia and Herzegovina

Introduction Bosnia and Herzegovina has one of the highest unemployment rates in the Balkan region (43.2%), so unemployment is one of the most serious public concerns in our country. Aim To analyze the influence of unemployment on mental health of the working age population who attend primary care center. Material and methods The study was carried out in the municipality of Bosanska Krupa, which has the highest unemployment rate in the Federation of Bosnia and Herzegovina (56%), and included 510 randomly selected working age patients (aged 23-65 years). We used the General Health Questionnaire-28 (GHQ-28) to evaluate mental health of the working age population. Results There were significantly more women than men (53.5% vs. 46.5%; p=0.02). The mean age of participants was 51.04±12.84 years. The experimental group included 318 (62.35%) unemployed working age participants: 160 (50.3%) had been unemployed for more than 5 years and had had no work experience, while 158 (49.7%) unemployed participants had had a previous work experience of more than five years. The control group included 192 (37.65%) employed working age participants. Unemployment had a significant influence on mental health of the working age population. The unemployed participants had a significantly poorer mental health compared to the employed (p=0.0003). A predictor of impaired mental health was a job loss. A significantly greater mental health impairment occured in the group of unemployed participants with previous work experience of more than five years compared to the unemployed participants who had had no work experience (p=0.001) and employed (p=0.000). Conclusion Unemployment has a negative impact and leads to impaired mental health of the working age population in Bosnia and Herzegovina. A job loss has a predictive role. It indicates that social and health policies must be developed in order to improve well-being of the working age population.

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Influence of Unemployment on Mental Health of the Working Age Population.

Smoking causes decrease of HDL-cholesterol (HDL-C) levels and increase of total cholesterol, triglyceride and LDL-cholesterol (LDL-C) levels. Low HDL-C levels and high cholesterol and LDL-C levels are associated with a higher risk for cardiovascular diseases. The aim of this study was to examine the effect of smoking status on serum lipid and lipoproteins levels among patients in family medicine practice. This trial was designed to detect differences in serum total cholesterol, triglyceride, LDL-C and HDL-C levels between smokers and non-smokers. We had placed a limit of 300 patients for data collection. We excluded 195 patients who met excluding criteria (diagnosis of diabetes mellitus, renal and hepatic failure, hypothyroidism; using beta blockers, thiazide diuretics, hormonal replacement therapy and corticosteroids; more than light physical activity; alcohol consumption and obesity), so the sample size included 105 randomly selected patients from Family Medicine Teaching Center Tuzla, mean age 52.05 +/- 11.61 years. Main outcomes were smoking status in all participants and serum total cholesterol, triglyceride, LDL-C and HDL-C levels in smokers and non-smokers. Our results showed that smoking prevalence was 49.52%. Smokers had significantly higher serum total cholesterol (P=0.01), triglyceride (P=0.002) and LDL-C level (P=0.03) and significantly lower HDL-C level (P=0.003) comparing with nonsmokers. There was no significant difference in serum lipid and lipoprotein levels between ex-smokers and never smokers. These results suggest that cigarette smoking adversely affects serum lipid and lipoprotein levels which further increases the risk for cardiovascular morbidity and mortality.

Olivera Batic-Mujanovic

Papers

The effect of loneliness on malnutrition in elderly population.

Clinical presentation of hypertensive crises in emergency medical services.

Prevalence of Mental and Social Disorders in Adults Attending Primary Care Centers in Bosnia and Herzegovina

Influence of Unemployment on Mental Health of the Working Age Population.

Influence of smoking on serum lipid and lipoprotein levels among family medicine patients.