Sepsis has lasting impact on elderly

Sepsis is a medical emergency in which an infection overwhelms the body. Unless antibiotics and life support are delivered quickly, the condition can lead to organ failure and death. Most of those who recover do so gratefully and move on with their lives. However, elderly people who survive a bout of sepsis may not be so lucky.

Research published Tuesday suggests, for the first time, that sepsis can leave some elderly individuals with long-term physical or cognitive problems. Researchers analyzed data from 1,194 elderly patients who were hospitalized with severe sepsis and compared them with 4,517 elderly people who experienced a hospitalization but did not have sepsis. Examining data from up to eight years after the hospitalization, the researchers found sepsis patients had a threefold higher risk for developing cognitive problems, such as forgetfulness, compared with the people who were hospitalized for other reasons. Moreover, the sepsis patients were more likely to have at least one new physical limitation, such as walking, dressing or bathing, after the hospitalization.

"[A]n episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and their families, resulting in new and often persistent disability, in some cases even resembling dementia," the authors wrote.

It's not uncommon for elderly people to experience some long-term effects from a hospitalization. But the much higher rate of subsequent functional problems in sepsis patients suggests there is something about the illness that takes a particular toll on an older person. It's likely that the effect of the infection can degrade muscle fibers to the extent that the patient's physical strength declines. How sepsis contributes to dementia is less clear. It could be that the massive inflammation that occurs with sepsis causes some brain damage, the authors wrote. Delirium is common in severe sepsis, and delirium has been linked with an increase in cognitive decline in people with Alzheimer's disease.

If these data are accurate, sepsis in people age 65 and older could cause about 20,000 new cases of dementia each year, the authors wrote. More effort is needed to follow elderly survivors of sepsis that might help them recover more fully and avoid long-term repercussions of the illness, the authors said. The study was published in the Journal of the American Medical Assn.

Nuts and Seeds OK in Diverticulosis in Men

In a study completed through the University of Washington, Strat et al. found that nut, corn, and popcorn consumption was not associated with an increased risk of new diverticulitis or diverticular complications, but instead inverse relationships were observed between nut and popcorn consumption and the risk of diverticulitis. After adjustment for other known and potential risk factors for diverticular complications, men with the highest intake of nuts (at least twice per week) had a 20 percent lower risk of diverticulitis compared with men with the lowest intake (less than once per month); men with the highest intake of popcorn had a 28 percent lower risk of diverticulitis compared with men with the lowest intake. No association was seen between corn consumption and diverticulitis, and for diverticular bleeding, there were no significant associations observed for nut, corn, or popcorn consumption.
Implication for practice: A diet that is restrictive in nuts, seeds, and popcorn appears to be unnecessary in treating diverticulitis or diverticular complications.



Source: Lisa L. Strate; Yan L. Liu; Sapna Syngal; Walid H. Aldoori; Edward L. Giovannucci JAMA. 2008;300(8):907-914.

Body Mass Index and Survival

Good news for the overweight older adult - as long as they continue to be active.

Researchers found that older adults who were classified as overweight ran a lower risk of death from all causes including heart disease, cancer, and respiratory disease , than those classified as normal weight, underweight, and obese. The researchers also found that older adults who were sedentary ran a higher risk of death than those who exercised.

It's not completely clear why overweight older adults appear to run a lower risk of death than others. But it's possible that carrying some extra weight, or having extra "nutritional reserves," may help older adults survive if, for example, they become ill, the researchers write in the Journal of the American Geriatrics Society.






Source: Leon Flicker, PhD, Kieran A. McCaul, PhD, Graeme J Hankey, MD, Konrad Jamrozik, PhD, Wendy J. Brown, PhD, Julie E. Byles, PhD, and Osvaldo P. Almeida, PhD.(2010) "Body Mass Index and Survival in Older Men and Women Aged 70 to 75 Years" ournal of the American Geriatrics Society (Volume 59, Issue 2).

Is There a Nutritional Differance Between Grass and Grain Fed Beef?

According to a recent article published in Nutrition Journal (10 March 2010), there are nutritional advantages to consuming grass-fed beef. Grass-fed or grass finished beef had higher Omega 3 levels, higher beta carotene levels, Higher Vitamin E levels and a better fatty acid profile. The researchers did caution that grass-fed beef did have a different flavor, aroma and may require cooking modifications.


Practice Tip: Grass-fed or grass finished beef has a superior nutritional profile when compared to grain fed beef but may require a palate change.

Delayed Feedings After PEG Placement

In this meta-analysis (6 studies, N=467), early feeding (<4 hrs) after a PEG tube placement appeared to be safe and well-tolerated. Usual protocol delays feedings until the day after PEG placement or a wait of 24 hours before feeding is initiated. This analysis indicates that a higher residual may occur with earlier feeding but no complications were noted because of greater residual volumes.

Implication for Practice: Earlier feedings may decrease hospital stays and reduce health care costs.


Source:Bechtold et al.(2008). Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: A meta-analysis. American Journal of Gastroenterology

The Effects of Weight Changes after Middle Age on the Rate of Disability

This Italian longitudinal study of 2910 participants aged 65 and over found that weight gain of as little as 5% and weight loss of 10% was significantly associated with disability, if the person was at normal weight at age 50.
If the person was obese at age 50, there was no correlation in an increase in disability with more than 10% weight loss. In this study disability was defined as an impairment in the Activities of Daily Living (ADLs).

Practice Tip: Work diligently on maintaining a healthy body weight early. For both men and women, middle age is a time of weight gain. More emphasis should be placed on the importance of a healthy body weight as adults approach age 60.




Source: Journal of American Geriatrics Society, 2009