Eating Disorders: End-of-Life Care for Persons With Advanced Alzheimer Disease: Design and Baseline Data From the ALFINE Study.

End-of-Life Care for Persons with Advanced Alzheimer Disease: Design and Baseline Data from the ALFINE Study.

Filed under: Eating Disorders

J Nutr Health Aging. 2012 May; 16(5): 457-61
Nourhashémi F, Gillette S, Cantet C, Stilmunkes A, Saffon N, Rougé-Bugat ME, Vellas B, Rolland Y

Context: Alzheimer disease (AD) is the most common cause of dementia. Most affected individuals survive to an advanced stage of dementia, which is under-recognized as a terminal illness. Objectives: Our objectives were to better understand the clinical trajectory of advanced AD and to identify the palliative care needs of these patients. Methods: This was an observational prospective study of AD patients in severe stage of disease included after a hospitalization in geriatric wards. They were followed up every three months during 2 years. At each visit, interviews provided data regarding: pain (Elderly Pain Caring Assessment scale), pressure ulcers, eating patterns, daily medications and use of health services. This paper describes the design of the ALFINE study and the characteristics of the recruited cohort. Results: 112 patients were recruited (mean age: 84.03 + 6.96) years; 76.79% were women. Mean time since diagnosis of AD was 5.28 years. Pressure ulcers were observed in 42 patients. Pain assessment with the EPCA showed a mean score of 8.58. One third of patients with an EPCA score of more than 7 (median) had no analgesics. More than half of patients had been treated with antibiotics during the three months before inclusion in the study and 33 patients were still receiving antibiotics at inclusion. Two third of patients had been hospitalized in the month before inclusion. Conclusion: End-of-life care for individuals with end-stage AD is increasingly important because of the rising number of patients with this disease. Health care systems and clinicians should make efforts to ameliorate the suffering of patients and their caregivers.
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Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program.

Filed under: Eating Disorders

Arch Phys Med Rehabil. 2012 Apr 30;
Dombrowski WC, Yoos JL, Neufeld R, Tarshish C

Many elderly patients are hospitalized and discharged to skilled nursing facilities (SNF) for rehabilitation. OBJECTIVES: To examine potential risk factors for rehospitalization of SNF rehabilitation patients. DESIGN: Retrospective review of rehabilitation charts. SETTING: 114 SNF rehabilitation beds at a 514 bed urban, academic nursing home that receives patients from tertiary care hospitals. PARTICIPANTS: 50 consecutive rehabilitation patients who were rehospitalized during days 4-30 of rehabilitation, compared to a matched group of 50 rehabilitation patients that were discharged without rehospitalization. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Data on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation exam and laboratory values. The clinical conditions precipitating rehospitalizations were noted. RESULTS: 62% of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia ( P = 0.001) and malignant solid tumors ( P < 0.001), index hospitalizations involving a gastrointestinal condition ( P = 0.001), needed more assistance with eating ( P = 0.001) and walking ( P = 0.03), and had lower hemoglobin ( P = 0.002) and albumin levels ( P < 0.001). A logistic regression model found the strongest predictors for rehospitalization are history of malignant solid tumor (odds ratio (OR) = 10.10), recent hospitalization involving gastrointestinal conditions (OR = 4.62), and low albumin levels (with each unit decrease in albumin, the odds of rehospitalization is 4 times greater (OR = 0.24, P = 0.005)). CONCLUSIONS: Comorbid conditions, reasons for index hospitalization, and laboratory values are associated with increased risk for rehospitalization. Further studies are needed to identify high risk elderly patients and target interventions to minimize rehospitalizations. HubMed – eating

Planning and coordination of a reach-grasp-eat task in children with hemiplegia.

Filed under: Eating Disorders

Res Dev Disabil. 2012 May 1; 33(5): 1649-1657
Hung YC, Henderson ER, Akbasheva F, Valte L, Ke WS, Gordon AM

Children with hemiplegia have deficits in motor planning in addition to their impairments in movement of their more-affected upper extremity (UE). However, little is known about the relationship between motor planning and multi-segment coordination during functional activities in this population. In the present study, motor planning strategies and multi-segment coordination of the head, trunk, and UE were examined during a functional reach-grasp-eat task in children with hemiplegia. Ten children with hemiplegia (age 4-10 years; MACS levels I-II) and ten age-matched, typically developing children participated in the study. Children were asked to reach, grasp and transport a cookie to the mouth with one hand while 3-D kinematic analyses were performed. A more extended wrist (p=0.001) and higher end-point position of grasping (p=0.001) were found for both UEs of children with hemiplegia. The less-affected UE had greater trunk contribution (p=0.018) and greater shoulder flexion (p=0.002) and elbow extension (p=0.005) during reaching compared to the TDC. The more-affected UE had impaired movement control with greater head rotation (p=0.011), higher variability of end-point location in space (p=0.001), greater trunk contribution (p=0.018), and reduced wrist rotation (p=0.007) compared with the less-affected UE and TDC. Additionally, delayed timing of maximum shoulder (p=0.03) and elbow flexion (p=0.008) during reaching, and maximum wrist pronation (p=0.004) during eating were found for the more-affected UE. The results showed different multi-segment control for both UEs in children with hemiplegia compared to TDC. They also reflect impaired motor planning since the same movement strategies were used for both UEs. Furthermore, we suggest that inefficient multi-segment coordination of the more-affected UE is used to compensate for impaired motor planning and control.
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