RESUMEN

Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.

Asunto(s)

RESUMEN

Phase angle (PhA) has been evidenced to be a useful survival indicator and predictor of morbi-mortality in different pathologies, but not in psychogeriatric patients. The aim of this study was to evaluate the clinical utility of PhA as a prognostic indicator of survival in a group of institutionalized psychogeriatric patients. A survival study was conducted on 157 patients (46.5% dementia, 43.9% schizophrenia). Functional impairment stage, frailty, dependence, malnutrition (MNA), comorbidity, polypharmacy, BMI, and waist circumference were registered. Body composition was analyzed using a 50-kHz whole-body BIA; PhA was recorded. The association between mortality and standardized-PhA was evaluated through univariate and multivariate Cox regression models and ROC-curve. The risk of death decreased when Z-PhA, BMI, and MNA were higher. Mortality increases with age, frailty, and dependence. The risk of death was statistically significantly lower (56.5%) in patients with schizophrenia vs. dementia (89%). The Z-PhA cut-off point was -0.81 (Sensitivity:0.75; Specificity:0.60). Mortality risk was multiplied by 1.09 in subjects with a Z-PhA < -0.81, regardless of age, presence of dementia, and BMI. PhA presented a remarkable clinical utility as an independent indicator of survival in psychogeriatric patients. Moreover, it could be useful to detect disease-related malnutrition and to identify subjects eligible for an early clinical approach.

Asunto(s)

RESUMEN

Within the elderly population, psychogeriatric patients may be particularly susceptible to negative mental health effects of the coronavirus crisis. Detailed information about the psychosocial well-being of psychogeriatric patients during the pandemic is still sparse. Here we examined which aspects of subjective experience of the COVID-19 pandemic especially affect levels of depression, anxiety and quality of life in psychogeriatric patients with and without cognitive impairment. A cross-sectional paper survey was conducted during the first German lockdown among patients with a diagnosed psychiatric disorder (≥ 60 years) or a diagnosed neurodegenerative disease (regardless of their age) from the department for neurodegenerative diseases and geriatric psychiatry at the University of Bonn. The WHO-5-, GAD-7- and WHOQOL-old score were used to determine levels of depression, anxiety and quality of life. The second part obtained information about the subjective experience of the COVID-19 pandemic. Statistical analysis included among others principal component analysis and multiple linear regression analysis. COVID-19-related, immediate distress was a strong predictor of elevated symptoms of depression, anxiety and a reduced quality of life. COVID-19-related concerns regarding health and financial security, however, were not significantly associated with negative mental health outcomes. The overall prevalence of symptoms of depression (50.8% [95% CI 43.8-57.6%]) and anxiety (32.7% [95% CI 26.4-39.2%]) among psychogeriatric patients was high. Our findings indicate that psychogeriatric patients are not significantly affected by COVID-19-related concerns but are primarily suffering from emotional consequences resulting from changed living conditions due to the pandemic.

Asunto(s)

RESUMEN

Background: EMPATHY IN HEALTHCARE is an intensive 20-hour experiential training program based on mediation techniques and specialized healthcare role-play for clinicians and medical students. It is hypothesized that the training will improve empathy via the intensive experiential techniques implemented. Methods: A total of 50 medical students (25 males/25 females) took the course voluntarily. Empathy was measured using the Jefferson Scale of Empathy-Medical Students Version (JSE-S) (Greek version), before and after the 20-hour training, along with a 6-month follow-up. Gender, age, preferred medical specialty and baseline empathy score were explored as possible moderator variables of the training effect. Results: Empathy increased after training, with a mean JSE-S score improvement of 11.25 points (±8.848) (P < .001). After 6 months, the mean JSE-S score maintained a difference of 6.514 points (±12.912) (P < .005). No differences were recorded with regard to gender, age group or medical specialty for the pooled data. Women in the 22-24 year-old age group had a 5-point mean difference (P = .05), and higher post-training scores than men. Lower initial scorers were the ones that mostly improved, with a 3-fold mean score difference from the higher scorers regardless of gender (P < .001), while also showing a smaller drop in empathy levels 6 months after the training compared to the higher scorers. Conclusion: Intensive experiential training can improve empathy in a clinical setting. EMPATHY IN HEALTHCARE is a successful training program in improving empathy in medical students, as measured by the JSE-S. A score of 110 and below could be used for selecting medical student candidates who will benefit most from empathy training.

RESUMEN

BACKGROUND: Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of cardiovascular disease. Vascular disease plays an important role in cognitive impairment. METHOD: In 447 elderly patients with mental illness, serum NT-proBNP level and the presence or absence of vascular disease according to the medical record were used to categorize patients in different subgroups of vascular disease. RESULTS AND CONCLUSION: Patients with vascular disease and elevated serum NT-proBNP level had a lower cognition level, shorter survival time, lower renal function and a higher percentage of pathological brain imaging than patients with vascular disease and normal NT-proBNP level. Thus, elevated serum NT-proBNP level might be helpful to detect patients who have a more severe cardiovascular disease.