ZDRAVJE STAROSTNIKOV HEALTH OF THE ELDERLY Proceedings Edited by Ana Petelin and Nejc Šarabon Uredniški odbor Založbe Univerze na Primorskem Gregor Pobežin, UP Fakulteta za humanistične študije Maja Meško, UP Fakulteta za management Vito Vitrih, UP FAMNIT in UP IAM Silva Bratož, UP Pedagoška fakulteta Aleksandra Brezovec, UP FTŠ – Turistica Ana Petelin, UP Fakulteta za vede o zdravstvu Janko Gravner, University of California, Davis Krstivoje Špijunović, Učiteljski fakultet Užice Miloš Zelenka, Jihočeská univerzita v Českých Budějovicích in Univerzita Konštantína Filozofa v Nitre Jonatan Vinkler, Založba Univerze na Primorskem Alen Ježovnik, Založba Univerze na Primorskem zdravje starostnikov health of the elderly Univerza na Primorskem ■ Fakulteta za vede o zdravju Università del Litorale ■ Facoltà di scienze del a salute University of Primorska ■ Faculty of Health Sciences v sodelovanju z / in col aboration with Splošna bolnišnica Izola Ospedale generale Isola Zdravje starostnikov Health of the Elderly Edited by Ana Petelin and Nejc Šarabon 2018 Contents Monika Brglez, Tamara Poklar Vatovec, Nadja Plazar 9 Nutrition disorders in the elderly living period Kristina Drole, Petra Zaletel 21 Dance and Exercise as Therapy in Patients with Parkinson’s Disease – Case Study Branko Gabrovec 31 Role of physical activity and nutrition in prevention of frailty Andreja Gerl, Tjaša Tkalec, Anita Dolšak Kos, Andrej Starc 43 Positive ageing: the problem of young generation or challenge for modern society Jasna Hrovatin, David Ravnik 51 Adaptability in living space for elderly people Samo Kotnik, Alja Mikec, Andrej Starc 59 Effects of enough omega-3 fatty acids on cardiovascular system in the elderly Urša Mršnik, Eva Žaberl, Miha Kranjc 67 Nutritional Treatment of the Elderly in Nursing Homes Tatjana Novak, Zdenka Katkič 75 Effects of regular exercise on elderly people Helena Olenik, Milica Puklavec, Armina Šahman, Andrej Starc 85 Physical activity of the elderly with a diabetic foot Marjeta Oplot, Gregor Štiglic, Mateja Lorber 93 Physical activity and its importance for the elderly’s health Vida Oražem, Danica Rotar Pavlič, Melita Peršolja 101 Factors influencing hospital length of stay in non-acute care setting Špela Selak, Branko Gabrovec 109 Tackling frailty with the help of information-communication technology Mitja Slapar, Anton Zupan 117 Strategies for successful life in the home environment for elderly disabled people with neuromuscular disorders Nika Slokar, Nina Mohorko 125 Nutritional status of older adults admitted to the Surgical Ward Anja Zagoričnik, Argresa Bylykbashi, Andrej Starc 8 133 Intergenerational programs as a solution to the social isolation of the elderly lderly e f the 144 Conference Sponsors o alth ikov | he stn taroe s zdravj Nutrition disorders in the elderly living period Monika Brglez1, Tamara Poklar Vatovec2, Nadja Plazar3 1 The Secondary School of Nursing Celje, Ipavčeva 10, 3000 Celje, Slovenia 2 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia 3 Alma Mater Europaea - ECM, Slovenska ulica 17, 2000 Maribor, Slovenia Abstract Introduction: A healthy and balanced diet is an important factor in healthy lifestyle in all age groups. It is important to be aware that dietary needs change with age and adjust the daily diet regime accordingly. The purpose of this paper is to review existing research in the field of malnutrition of the elderly, present the most common nutritional disorders and the causes for them in order to prevent malnutrition and to reduce the morbidity among the elderly and thus maintain or improve nutritional status. Methods: A descriptive method of working with a review of domestic and foreign professional literature in the database EBSCOhost, PubMed, Web of Science, Wiley and the shared bibliographic-catalogue database (COBIB.SI) was used. Results and discussion: In the literature review, it was found that in older age frequently occur dietary and metabolic disorders, which are the cause of a poor quality of life in later life. Conclusions: There are many reasons for insufficient food intake for older people, but appropriate education and awareness programs and timely, appropriate identification of malnourished individuals and those with risk of malnutrition, can help reduce the frequency of nutrition disorders. Keywords: healthy nutrition of the elderly, malnutrition of the elderly, prevention of malnutrition, nutrition disorders A healthy and balanced diet helps older people to maintain a high quali- ty of life (Liang-Kung et al., 2007; WHO, 2015), since they favor the ab- sence or delay of various disorders, such as cardiovascular disease, di- abetes, cancer and cognitive impairment (GBD, 2013). Much attention is paid to over-feeding, although malnutrition, especially in the elderly, is more wide- doi: https://doi.org/10.26493/978-961-7055-18-4.9-20 spread (Margetts, 2003; Cederholm et al., 2017), which was long unknown or „skeleton in the hospital closet“ (Butterworth, 1974). The European Society for Clinical Nutrition and Metabolism - ESPEN (European Association for Clini- cal Nutrition and Metabolism) highlighted the diverse nutritional needs of the elderly and the effect of nutrition on the functionality of the elderly (ESPEN, 2010). In Slovenia there is a problem with overweight on the one side, and fre- quent malnutrition among older persons in institutional care and patients on the other (Fajdiga et al., 2012; Gorjup Poženel and Skela Savič, 2013; Hlastan Ribič and Kranjc, 2014). The purpose of this review is to present existing research in the field of malnutrition in the elderly, to present the most common nutritional disorders and their causes in order to prevent malnutrition and reduce morbidity among elderly. 10 Methods Review methods lderly e A descriptive working method with a review of relevant domestic and foreign professional literature was used. As a measuring instrument, we used the med- f the o ical information system PubMed, search in databases EBSCOhost, Web of Sci- alth ence and Wiley and a mutual bibliographic-catalog database (COBIB.SI). The literature review period lasted from May 2017 to April 2018. The following key- ikov | he words were used: healthy nutrition of the elderly, malnutrition of the elderly, stn prevention of malnutrition, nutrition disorders. taroe s In COBIB.SI, we entered the keywords and the requirement „articles and other components“ and limited the search request to the year of publication zdravj 2010 and less. Upon elimination, we obtained three relevant hits. In EBSCOhost, we entered keywords using the Boolean operator AND, in various combinations: healthy nutrition of the elderly, malnutrition of the el- derly, prevention of malnutrition, nutrition disorders, nutritional assessment, elderly. In determining the search criteria, we selected „Academic Search Elite“, all searched terms. The limitations in the search for results were: the possibility of viewing an abstract, a research published in English, the period of publica- tion from 2010 to 2018. On the basis of the obtained results, we have eliminat- ed inappropriate and repetitive. We also searched for PubMed, Web of Science and Wiley in terms of key- words and exclusion criteria, we did not limit the year of publication. We re- viewed titles and summaries and selected relevant scientific and technical con- tributions. In the literature review we included some basic monographs in the field of nutrition and gerontology and web resources. Results Nutrition in the elderly Dietary recommendations dictate the energy input of nutrients in a balance with energy consumption. Ingestion of nutrients should be in the appropriate ratio and quantity, arranged in several daily meals (NIJZ, 2016). The amount of fat consumed should not exceed 30 % of total energy intake, and unsaturated fatty acids must prevail (Fats and fatty acids in human nutrition, 2010). Trans fatty acids must be avoided, with a maximum of 1 % (Nishida and Uauy, 2009) and cholesterol, the limit value of which is 300 mg / day (NIJZ, 2016). The in- take of simple sugars is limited to less than 10 % of the total energy intake of carbohydrates, which is 50-70 % (WHO, 2015). The recommended daily intake of dietary fiber is at least 30 g (NIJZ, 2016). The need for protein in adults is ap- proximately 0.8 g / kg bodyweight / day, which is 15 to 20 % of the daily ener- gy needs (WHO, 2015). Bauer et al. (2013) found that greater protein intake (1- 11 1,2 g / kg body weight) is needed for older (> 65 years), for maintaining good health, for recovery after illness and maintenance of functionality, while Vol- dio pi et al. (2013) recommend even higher daily protein intake of 1.2 to 2.0 g / kg of er body weight. Baum et al. (2016) note that the ingestion of easily digestible pro- iving p teins with a very high proportion of essential amino acids reduces the need for ly l a diet with very high protein intake. Metabolic age changes affect the needs for der micro-nutrients, therefore it is necessary to provide an adequate amount of vi- he el tamins (D, B , B , E and C) and minerals (Calcium, Iron, Zinc) (NIJZ, 2016). 12 6 s in t Some authors note the importance of sufficient intake of vitamin B12 for the der prevention of cognitive disorders or the slowing down of Alzheimer‘s dementia isor d (Moore et al., 2012; OHTAC, 2013). A distinguished Slovenian food expert dr. Dražigost Pokorn writes that the energy needs of the elderly are lower due to reduced metabolism and lower body activity, after the age of 85, due to oxida- nutrition tive stress, protein synthesis (Pokorn, 2003) is complicated, as is confirmed by recent studies (Cerović et al., 2008; Gabrijelčič Blenkuš et al., 2010; NIJZ, 2016). With age, the hormonal activity of the gastrointestinal system changes, peri- stalsis, nutrient absorption and digestive enzymes are reduced, which affects digestion, nutrient utilization and appetite reduction (Hlastan Ribič, 2008), therefore it is important to take nutrition recommendations into account and raise awareness among the elderly about the proper dietary regime. Nutrition and metabolic disorders Sorensen and others (2012) state that in Denmark malnutrition affects about one-third of patients in the hospital. The Australian study shows that 40 % of elderly people living in community-dwelling homes are malnurished, in hos- pitalized elderly people is a low percentage of malnourished or endangered be- tween 30 and 60 (Demeny et al., 2015), while Heersink and others (2010) indi- cate an even 72 % of undernourished in hospital care (in the UK). The study, which was conducted in 211 Turkish homes for the elderly, found 33.6 % of the malnourished (Tasar, 2015). Donini et al. (2013) confirm a high proportion of malnourished (37.6 %) and nutritionally endangered (75.5 %) also in Italy, with a higher proportion of those living in elderly homes. Gorjup Poženel and Skela Savič (2013) found on sample 117 residents of the social welfare institution that 17.9 % of malnourished people and 32.5 % of the elderly between 75 and 95 years of age were at risk of malnutrition, while Poklar Vatovec (2013) on sample 20 residents of the social welfare institution is finding out five at risk of malnutri- tion and none malnourished. Cerovič et al. (2008) found that among the home living elderly population, there are less undernourished than among the elder- ly in institutional and hospital care. Physiological and metabolic changes lead to an age-related progressive decline in muscle tissue and its function, which is further contributed by un- balanced nutrition and insufficient physical activity (Wang et al., 2012), which in turn increases the risk of fragility (Strojnik et al., 2016; Gabrijelčič Blenkuš 12 and Jakovljević, 2017). Inadequate nutrition refers to deficit, surplus or imbalance in the intake of energy and/or nutrients (WHO, 2017). ESPEN has published a conceptual lderly e tree of prevailing eating disorders and defined nutrition, lack of micronutri- f the ents and malnutrition (loss of weight due to starvation, cachexia - disease-re- o lated malnutrition, sarcopenia and weakness or fragility) as nutrition disorders alth (Cederholm et al., 2015). ikov | he Malnutrition is the result of underutilized food intake and leads to a stn change in body composition (decrease in body weight) and body cell mass, taro leading to reduced physical and mental function and disorders in the clinical e s outcome of the treatment of illness (Sobotka, 2011) and presents a burden on zdravj patients and healthcare institutions (Barker, 2011). The age-related decline in muscle mass and the increase in fat and ab- dominal fat is referred to as sarcopenia (Sumbul, 2013) and affects slightly more than a tenth of older adults after the age of 60 and also to half the elderly after the age of 80 (Wang et al., 2012; Ribeiro and Kehayias, 2014). Kaiser and others (2010) state that vitamin D, proteins and antioxidants, such as carotenoids, se- lenium and vitamins E and C., need to be monitored for the prevention of sar- copenia. The term cachexia defines loss of body weight, reduction of fat and mus- cle mass due to the underlying disease and related metabolic changes (Evans, 2008; Rotovnik Kozjek, 2009; Sumbul, 2013) and as a result of the negative pro- tein and energy balance (Ebner et al., 2013 ). Nutrition and metabolic disorders also include overweight problems, which represent the world‘s leading health problem, as 39 % of people are overweight and 13 % obese (WHO, 2018). So- botka (2011) lists even more than 40 % of older people with overweight and 20 % obese. One of the indicators of obesity is the body mass index (ITM) above 30. Weighted individuals have an ITM of over 25 (Sobotka, 2011; WHO, 2018). Fajdiga and colleagues (2012) note that in Slovenia almost half of the popula- tion is aged 50 or over, over-fed (45.1 %) and almost a quarter of the obese (23.9 %). A survey by Hlastan Ribič and Kranjc (2014) shows the trend of rising fat and very obese people. The smallest share of overextended and obese is one of the oldest adults in the group of 80 years or more (Fajdiga et al., 2012). Development factors of eating disorders The ability to eat in the elderly is affected by various factors, such as physiolog- ical: lower energy needs, reduced physical activity, decreased muscle mass and altered metabolism. The functions of the digestive system are weakened, lead- ing to a reduction in saliva flow, dysphagia (difficulty swallowing), reduced gastric secretion, decreased digestion of digestive juices, and weaker taste and smell of food. Common cause for energy and nutritional malnutrition is ag- gravated chewing (dental pathology and oral cavity with prosthetics). The abil- ity to eat is influenced by disease conditions (diarrhea, celiac disease, demen- tia .. ), side effects of drug use, drug interactions and social and psychological 13 factors (emotional problems, depression, loneliness, anorexia, alcoholism), mo- dio bility problems (inaccessibility of foods or Insufficient self-sufficiency), finan- er cial deficits, social isolation, abuse and sometimes even stubbornness (Pečjak, iving p 2007; Cerovič et al., 2008; Smolin and Grosvenor, 2008; Gabrijelčič Blenkuš et ly l al., 2010; Bernstein, 2016 and Nordqvist, 2016). Malnutrition affects all physical der systems and causes a decrease in the immune system, increased susceptibility he el to disease, more complications in treatment, decreased muscle mass and, con- s in t sequently, increased falls, heart failure, weakened wound healing, social isola- der tion, disturbed thermoregulation, cognitive functions (Smolin, 2008 BAPEN, isor 2016) and lower quality of life and higher mortality in the elderly (Fielding et d al., 2011; Ribeiro and Kehayias, 2014). nutrition Malnutrition prevention guidelines A Special Interest Group (SIG) was established in ESPEN, which underlines the importance of timely detection of malnutrition and proper treatment (Mus- caritoli, 2010). ESPEN recommends the use of the screening tools Nutrition- al Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) for Seniors in Homes and the Malnutrition Universal Screen- ing Tool (MUST) for hospitals (Kondrup et al., 2003; Cederholm et al., 2017). Research in hospitals, homes for the elderly and residential communi- ties shows deficiencies such as lack of time intended for eating for the elderly, not enough varied food and inadequate staff qualifications (Merrell et al., 2012; Agarwal et al., 2016) and many other factors, related to staff, type and food preparation, and the environment (Nieuwenhuizen et al., 2010). Similarly, de- ficiencies have been shown in older people receiving home care, such as limit- ed time, insufficient knowledge and frequent change of staff (UKHCA, 2012), and Watkinson-Powell et al. (2014) recommend the social integration of the el- derly, help with the purchase of foods and the preparation of a meal, and take into account the desire for home-prepared fresh food, because pre-prepared meals are often nutritional unbalanced, with high levels of salt and saturated fats, with too little fruits, vegetables and diets fiber (Celnik et al., 2012; How- ard et al., 2012). Discussion When reviewing literature, it was found that many foreign studies dealt with the malnutrition of elderly people in hospital and home care. Research shows a high proportion of malnourished in hospital care (Heersink et al., 2010; So- rensen et al., 2012) and a longer lagging period of malnourished patients (So- rensen et al., 2008) as well as a high proportion of malnutrition and risk for malnutrition in social care homes (Donini et al., 2013; Nazemi et al., 2014; Tasar, 2015) and residential communities (Demeny et al., 2015; Zainudin et al., 2016). According to Gabrijelčič Blenkuš et al. (2010), there is lack of research 14 in the field of elderly nutrition in Slovenia, with too little systematic measures to improve the condition that would be adapted to the local environment. We have developed recommendations for dietary treatment of patients in hospitals lderly e and elderly in retirement homes (Cerović et al., 2008), which also partly cov- f the er home living elderly who are fed with meals from retirement homes, there is o still a large share of home living people that have inadequate eating habits and alth inadequate nutritional support due to lack of recognition for various reasons. In institutional care there are recommendations for dietary screening (Cerovič ikov | he et al., 2008) and dictate screening once a week using a validated MNA ques- stn tionnaire in home care and the NRS-2002 in assessing the nutritional status of taro hospitalized patients. The National Institute for Health and Care Excellence - e s NICE (British National Institute of Health and Clinical Excellence) provides zdravj guidelines for the elderly‘s dietary support and recommends additional profes- sional training for all employees involved in elderly care (Fletcher, 2011). Conclusions A healthy, balanced and age-adjusted diet has a significant impact on the func- tionality of the elderly person (ESPEN, 2010). The introduction of effective nutrition measures would, among other things, allow for more effective and cheaper treatment of age-related illnesses (Resolution, 2015), alleviate the de- cline in cognitive abilities (Vauzour et al., 2017) and prevent the emergence of non-communicable chronic illnesses associated with inappropriate nutrition, movement and lifestyle. With appropriate programs for educating older peo- ple on healthy eating, we could act preventively and prevent the development of eating disorders, modern-day illnesses, and the advancement of pre-existing conditions of the disease, and finally save financially. In order to understand aging, it is necessary to strengthen the knowledge of geriatrics and gerontolo- gy in all areas of education in health, social care, public administration, edu- cation, etc. In addition to knowledge, a wider awareness of the importance of aging for all generations is needed (Skela Savič et al., 2010), and emphasize the holistic approach to providing a healthy lifestyle and prepare appropriate implementation activities (Koch et al., 2014). References AGARWAL, E., MARSHALL, S., MILLER, M. and ISENRING, E., 2016. Op- timising nutrition in residental aged care: A narrative review. Maturitas, vol. 92, pp. 70-78. BAPEN, 2016. What are the consequences of malnutrition? Available from: http://www.bapen.org.uk/malnutrition-undernutrition/introduc- tion-to-malnutrition?start=2. BAUER, J.M., BIOLO, G., CEDERHOLM, T., CESARI, M., CRUZ-JENTOFT, A.J., MORLEY, J.E., PHILLIPS, S., SIEBER, C., STEHLE, P., TETA, D. et al., 2013. Evidence-based recommendations for Optimal dietary pro- tein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, vol. 14, no. 15 8, pp. 542-59. dio BAUM, J.I., KIM, IL-Y. and WOLFE, R.R., 2016. Protein Consumption and the er Elderly: What Is the Optimal Level of Intake? Nutrients, vol. 8, no. 6, pp. iving p 359. ly l BERNSTEIN, M., 2016. The Physiology of ageing. In BERNSTEIN, N. and der MUNOZ, N., ed. Nutrition for the Older Adult. 2nd ed. Burlington: he el Jones&Bartlett Learning, pp. 23-49. s in t BUTTERWORTH, C.E. Jr., 1974. The skeleton in the hospital closet. Nutrition der Today, vol. 9, no. 2, pp. 4-8. isor d CEDERHOLM, T., BARAZZONI, R., AUSTIN, P., BALLMER, P., BIOLO, G., BISCHOFF, S.C., COMPHER, C., CORREIA, I., HIGASHIGUCHI, T., HOLST, M. et al., 2017. ESPEN guidelines on definitions and terminology nutrition of clinical nutrition. Clinical Nutrition, vol . 36: 49-64. CEDERHOLM, T., BOSAEUS, I., BARAZZONI, R., BAUER, J., VAN GOS- SUM, A., KLEK, S., MUSCARITOLI, M., NYULASI, I., OCKENGA, J., SCHNEIDER, S. et al., 2015. Diagnostic criteria For malnutrition – An ESPEN Consensus Statement. Clinical Nutrition, vol. 34, no. 3, pp. 335-340. CEROVIČ, O., HREN, I., KNAP, B., KOMPAN, L., LAINŠČAK, M., LAVRI- NEC, J., MIČETIČ TURK, D., MILOŠEVIČ, M., MLAKAR-MAST- NAK, D., MREVLJE, Ž. et al., 2008. Priporočila za prehransko obravnavo bolnikov v bolnišnicah in starostnikov v domovih za starejše občane. Lju- bljana: Ministrstvo za zdravje. CHAD, C., 2015. Clinical Nutrition and Aging: Sarcopenia and Muscle Metabo- lism. Oakville: Apple Academic Press Inc. CELNIK, D., GILLESPIE, L. and LEAN, M., 2012. Time-scarcity, ready-meals, ill-health and the obesity epidemic. Trends in Food Science and Technolo- gy, vol. 27, no. 1, pp. 4–11. DEMENY, D., JUKIC, K., DAESON, B. and O‘LEARY, F., 2015. Current prac- tices of dietitians in the assessment and management of malnutrition in elderly patients. Nutrition & Dietetics, vol. 7, pp. 254–260. DONINI, L.M., SCARDELLA, P., PIOMBO, L., NERI, B., ASPIRINO, R., PROIETTI, A.R., CARCATERRA, S., CAVA, E., CATALDI, S., CUCI- NOTTA, D. et al., 2013. Malnutrition in elderly: social and economic de- terminants. The Journal of Nutrition, Health & Ageing, vol. 17, no. 1, pp. 9-15. EBNER, N., SPRINGER, J., KALANTAR-ZADEH, K., LAINSCAK, M., DOEHNER, W., ANKER, S.D. and VON HAEHLING, S., 2013. Mecha- nism and novel therapeutic approaches to wasting in cronic disease. Ma- turitas, vol. 75, pp. 199-206. EVANS, W.J., 2010. Skeletal muscle loss: cachexia, sarcopenia, and inactivity. The American Journal of Clinical Nutrition, vol. 91, no. 4, pp. 1123-1127. 16 EVANS, W.J., MORLEY, J.E., ARGILES, J., BALES, C., BARACOS, V., GUT- TRIDGE, D., JATOI, A., KALNTAR-ZADEH, K., LOCHS, H., MAN- lderly TOVANI, G. et al., 2008. Cachexia: A new definition. Clinical Nurtrition, e vol. 27, no. 6, pp. 793-799. f the o ESPEN, 2010. Nutrient Needs of the Older Adult. Satelite Symposium Pro- alth ceedings 32. ESPEN Congress [online]. [viewed 2. May 2017]. Availa- ble from: https://www.nestlenutrition-institute.org/docs/default-source/ ikov | he global-dcoument-library/publications/secured/311995ce0bbfc3ed10e5d- stn 579f947e592.pdf?sfvrsn=0 taroe s FAJDIGA-TURK, V., GREGORIČ, M. and BLAZNIK, U., 2012. Čezmerna hranjenost in debelost med starejšimi odraslimi [online]. [viewed 8. Feb- zdravj ruary 2017]. Available from: http://www.share- slovenija.si/strani/prvi_ rezultati_slovenija Fats and fatty acids in human nutrition: report of an expert consultation., 2010. FAO Food and Nutrition Paper 91. Rome: Food and Agriculture Organi- zation of the United Nations. FIELDING, R.A., VELLAS, B., EVANS, W.J., BHASIN, S., MORLEY, J.E., NEWMAN, A.B., ABELLAN, VAN KAN, G., ANDRIEU, S., BAUER, J., BREUILLE, D. et al., 2011. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and con- sequences. International working group on sarcopenia. Journal of the American Medical Directors Association, vol. 12, no. 4, pp. 249-56. FLETCHER, A. and CAREY, E., 2011. Knowledge, attitudes and practices in the provision Of nutritional care. British Journal of Nursing, vol. 20, no.10, pp. 615-620. GABRIJELČIČ BLENKUŠ, M. and JAKOVLJEVIĆ, M., 2017. Poskus definiranja krhkosti v okviru projekta AHA.si. In: Gabrijelčič Blenkuš, M., ed. Krhkost [online]. Ljubljana: NIJZ, pp. 98-99, [viewed 30. March 2018]. Available from: http://www.nijz.si/sites/www.nijz.si/files/upload- ed/gabrijelcic_blenkus_et_al._jz_01-11.pdf GABRIJELČIČ BLENKUŠ, M., STANOJEVIČ JERKOVIČ, O., ĐUKIČ, B., PREZELJ, M., JEŠE, M., ŠKORNIK TOVORNIK, T., FAJDIGA TURK, V., DREV, A., JERIČ, I. and TRATNJEK, P., 2010. Prehrana in telesna dejavnost za zdravje pri starejših – pregled stanja. Ljubljana: Inštitut za varovanje zdravja. GBD Risk Factors Collaborators., 2013. Global, re- gional, and national comparative risk assessment of 79 behavioural, en- vironmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013[online]. [viewed 6. May 2017]. Available from: http:// www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00128-2.pdf GORJUP POŽENEL, D. and SKELA SAVIČ, B., 2013. Vloga zdravstvene nege pri prehranski ogroženosti starostnikov. Kakovostna starost, vol. 16, no. 2, pp. 13-21. 17 HEERSINK, J.T., BROWN, C.J., DIMARIA-GHALILI, R.A. and LOCHER, dioer J.L., 2010. Undernutrition in hospitalized older adults: patterns and cor- relates, outcomes, and opportunities for intervention with a focus on iving p processes of care. Journal of Nutrition for the Elderly, vol. 29, no. 1, pp. ly l 4-41. der HLASTAN RIBIČ, C., 2008. Zdrava prehrana za starostnike V Cvahtetovi dne- he el vi javnega zdravja 2008, ur. Marjan Bilban, 113-124. Ljubljana: Medicins- s in t ka fakulteta, Katedra za javno zdravje. der isor HLASTAN RIBIČ, C. in KRANJC, M., 2014. Čezmerna hranjenost in debe- d lost. V Izzivi v izboljševanju vedenjskega sloga in zdravja. Desetletje CIN- DI raziskav v Sloveniji, ur. Sonja Tomšič, Tatjana Kofol Bric, Aleš Ko- nutrition rošec, Jožica Maučec Zakotnik, 49-55. Ljubljana: Nacionalni inštitut za javno zdravje. HOWARD, S., ADAMS, J. and WHITE, M., 2012. Nutritional content of su- permarket ready meals and recipes by television chefs in the United King- dom: cross sectional study. British Medical Journal , vol. 345, no. 7607, pp. 1-10. KAISER, M.J., BANDINELLI, S. and LUNENFELD, B. 2010. Frailty and the role of nutrition in older people. A review of the current literature. Acta Biomedica , vol. 8, no.1, pp. 37-45. KOCH, V., BLENKUŠ GABRIJELČIČ, M., GREGORIČ, M. and KOSTANJE- VEC, S., 2014. Risk factors as a result of unhealthy nutrition in the adult population in Slovenia with regard to sociodemographic variables. Zdra- vstveno varstvo, vol. 53, no. 2, pp. 144-155. KONDRUP, J., ALLISON, S.P., ELIA, M., VELLAS, B. and PLAUTH, M., 2003. ESPEN Guidelines for Nutrition Screening 2002. Clinical Nutrition, vol. 22, no. 4, pp. 415-421. LIANG-KUNG, C., MING-HSIEN, L. and SHINN-JANG, H., 2007. Nutri- tional status and clinical outcomes among institutionalized elderly Chi- nese in Taiwan. Archives of gerontology and geriatrics, vol. 44, no. 3, pp. 315-323. MARGETTS, B., THOMPSON, R., ELIA, M. and JACKSON, A., 2003. Prev- alence of risk of undernutrition is associated with poor health status in older people in the UK. European Journal of Clinical Nutrition, vol. 57, no. 1, pp. 69-74. MERRELL, J., PHILPIN, S., WARRING, J., HOBBY, D. and GREGORY, V. 2012., Addressing the nutritional needs of older people in residential care homes. Health and Social Care in the Community, vol. 20, no. 2, pp. 208– 215. MOORE, E., MANDER, A., AMES, D., CARNE, R., SANDERS, K. and WAT- TERS, D., 2012. Cognitive impairment and vitamin B : a review. Interna- 12 18 tional Psychogeriatrics, vol. 24, no. 4, pp. 541-556. MUSCARITOLI, M., ANKER, S.D., ARGILÉS, J., AVERSA, Z., BAUER, J. M., BIOLO, G., BOIRIE, Y., BOSAEUS, I., CEDERHOLM, T., COSTELLI, P. lderly e et al., 2010. Consensus definition of sarcopenia, cachexia and pre-cachex- f the ia: joint document elaborated by Special Interest Groups (SIG) „cachexia- o anorexia in chronic wasting diseases“ and „nutrition in geriatrics“. Clini- alth cal Nutrition, vol . 29, no. 2, pp. 154-9. ikov | he NIJZ - Nacionalni inštitut za javno zdravje, 2016. Referenčne vrednosti za en- stn ergijski vnos hranil: tabelarična priporočila za otroke (od 1. leta staros- taro ti naprej), mladostnike, odrasle, starejše, nosečnice ter doječe matere e s [online]. [viewed 15. March 2017]. Available from: http://www.mz.gov.si/ fileadmin/mz.gov.si/pageuploads/javno_zdravje_2015/foto_DJZ/preh-zdravj rana/2016_referencne_vrednosti_za_energijski_vnos_ter_vnos_hra- nil_17022016.pdf NAZEMI, L., SKOOG, I., KARLSSON, I., HOSSEINI, S., MOHAMMADI, M.R., HOSSEINI, M., HOSSEINZADE, M.J., MESBAH-NAMIN, S.A. and BAIKPOUR, M., 2015. Malnutrition, Prevalence And Relation to Some Risk Factors among Elderly Residents of Nursing Homes in Teh- ran, Iran. Iran Journal of Public Health, vol. 44, no. 2, pp. 218-227. NIEUWENHUIZEN, W.F., WEENEN, H., RIGBY, P. and HETHERING- TON, M.M., 2010. Older adults and patients in need of nutritional sup- port: Review of current treatment options and factors influencing nutri- tional intake. Clinical Nutrition, vol. 29, no. 2, pp. 160-169. NISHIDA, C. and UAUY, R., 2009. WHO Scientific Update on health conse- quences of trans fatty acids: introduction. European Journal of Clinical Nutrition, vol. 63, no. 2, pp. 1-4. NORDQVIST, C., Malnutrition: Causes, Symptoms and Treatments. Medical News Today [online]. [viewed 26. May 2017] . Available from: http://www. medicalnewstoday.com/articles/179316.php OHTAC - Ontario Health Technology Advisory Committee, 2013. Vitamin B and cognitive function: OHTAC recommendation [online]. [viewed 7. 12 April 2018]. Available from: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ontario-health-technology-assess- mentseries/B12- cognitive-function PEČJAK, V., 2007. Psihologija staranja. Bled: samozaložba. POKLAR VATOVEC, T., 2013. Prehransko presejanje v domu za starejše občane. In: Valenčič, G., ed. Prehrana starostnika: zbornik predavanj. Lju- bljana: Strokovna sekcija medicinskih sester in zdravstvenih tehnikov v socialnih zavodih, pp. 47-57. POKORN, D., 2003. Prehrana v različnih življenjskih obdobjih. Ljubljana: Mar- bona. Resolucija o Nacionalnem programu o prehrani in telesni dejavnosti za zdravje 2015 – 2025 [online]. Ur. l. RS 58/2015. [viewed 2. May 2017] Available from: http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/javno_zdrav-19 je_2015/resolucija_preh_gib/ReNPPTDZ_resolucija_o_prehrani_in_ dio gibanju_150715.pdf er RIBEIRO, S.M.L. and KEHAYIAS, J. 2014. Sarcopenia and the Analysis of iving p Body Composition. Advances Nutrition, vol. 5, no. 3, pp. 260-267. ly l ROTOVNIK KOZJEK, N., 2009. Klinična prehrana rakavih bolnikov. Far- der macevtski vestnik, vol. 60, no. 2, pp. 80-84. he el SKELA SAVIČ, B., HVALIČ TOUZERY, S. and ZURC, J., 2010. Staranje pop- s in t ulacije, potrebe starostnikov in nekateri izzivi za zdravstveno nego. Ob- der zornik zdravstvene nege, vol. 44, no. 2, pp. 89-100. isor d SKINNER, K., HANNING, R., SUTHERLAND, C., EDWARDS-WHEESK, R. and TSUJI, L.J.S. 2012., Using a SWOT Analysis to Inform Healthy Eating and Physical Activity Strategies for a Remote First Nations Com- nutrition munity in Canada. American Journal of Health Promotion, vol. 26, no. 6, pp. 159-170. SMOLIN, L.A. and GROSVENOR, M.B., 2008. Nutrition science and applica- tion. Hoboken: John Wiley & Sons. SOBOTKA, L., 2011. Basic in clinical nutrition. Galén, ESPEN. SORENSEN, J., KONDRUP, J., PROKOPOWICZ, J., SCHIESSER, M., KRA- HENBUHL, L., MEIER, R., LIBERDA, M. and EuroOOPS study group., 2008. EuroOOPS: An international, multicentre study to implement nu- tritional risk screening and evaluate clinical outcome. Clinical nutrition, vol . 27, no. 3, pp. 340-349. SORENSEN, J., HOLM, L., FRØST, M.B. and KONDRUP, J., 2012. Food for patients at nutritional risk: A model of food sensory quality to promote intake. Clinical nutrition, vol. 31, no. 5, pp. 637-646. STROJNIK, V., JAKOVLJEVIČ, M., ROTOVNIK KOZJEK, N., GABRI- JELČIČ BLENKUŠ, M., VENINŠEK, G., ŽERJAL, I., STREL, J., VOL- JČ, B., ZERBO ŠPORIN, D. and HADŽIĆ, V., 2016. Preprečevanje in ob- vladovanje krhkosti. In: GABRIJELČIČ BLENKUŠ, M., ed. Aktivno in zdravo staranje v Sloveniji [online]. Ljubljana, pp. 3-11, [viewed 30. March 2018]. Available from http://www.staranje.si/sites/www.staranje.si/files/ upload/images/obvladovanje_krhkosti.pdf SUMBUL, A. and GARCIA, J.M., 2014. Sarcopenia, Cachexia and Aging: Di- agnosis, Mechanisms and Therapeutic Options – A Mini-Review. Geron- tology, vol. 60, no. 4, pp. 294–305. TASAR TOSUN, P., SAHIN, S., KARAMAN, E., ULUSOY, M.G., DUMAN, S., BERDELI, A. and AKCICEK, F. 2015. Prevalence and risk factors of sarcopenia in elderly nursing home. European Geriatric Medicine, vol. 6, pp. 214-219. UKHCA. Commissioning Survey 2012. Care is not a commodity [online]. [viewed 26. May 2017] Available from: https://www.ukhca.co.uk/pdfs/ UKHCACommissioningSurvey2012.pdf 20 VAUZOUR, D., CAMPRUBI-ROBLES, M., MIQUEL-KERGOAT, S., AN- DRES-LACUEVA, C., BÁNÁTI, D., BARBERGER-GATEAUF, P., BOW- MANG, G.L., CABERLOTTO, L., CLARKEI, R., HOGERVORSTJ, E et lderly al., 2017. Nutrition for the ageing brain: Towards evidence for an optimal e diet. Ageing Research Reviews, vol. 35, pp. 222–240. f the o VOLKERT, D., 2010. Nutrient Needs of the Older Adult. Satellite Symposium alth Proceedings 32nd ESPEN Congress. Nice, France. VOLPI, E., CAMPBEL, W.W., DWYER, J.T., JOHNSON, MA, JENSEN, G.L., ikov | he MORLEY, J.E. and WOLFE, R.R., 2013. Is the optimal level of protein in- stn take for older adults greater than the recommended dietary allowance? taro The Journals of Gerontology: Series A, vol. 68, no. 6, pp. 677-681. e s VRDOLJAK, D., BERGMAN-MARKOVIĆ, B., KRANJČEVIĆ, K., VUČAK, zdravj J. and IVEZIĆ-LALIĆ, D., 2014. Short form of the mini nutritional as- sessment is a better proxy for nutritional status in elderly than the body mass index: cross-sectional study. Healthy Aging Research, vol. 3, pp. 9. WANG, C. and BAI, L., 2012. Sarcopenia in the elderly: Basic and clinical issues. Journal of Clinical Gerontology and Geriatrics, vol. 12, no.3, pp. 388−396. WATKINSON-POWELL, A., BARNES, S., LOVATT, M., WASIELEWSKA, A. and DRUMMOND, B., 2014. Food provision for older people receiv- ing home care from the perspectives of home-care workers. Health and Social Care in the Community, vol. 22, no. 5, pp. 553–560. WORLD HEALTH ORGANIZATION, 2015. Guideline: Sugars intake for adults and children[online]. [viewed 3. June 2017]. Available from: http:// apps.who.int/iris/ bitstream/10665/149782/1/9789241549028_eng.pdf WORLD HEALTH ORGANIZATION, 2016. Malnutrition [online]. [viewed 25. June 2017] Available from: http://www.who.int/features/qa/malnutri- tion/en/ WORLD HEALTH ORGANIZATION, 2018. Obesity and overweight. Fact- sheets [online]. [viewed 26. February 2017]. Available from: http://www. who.int/mediacentre/factsheets/fs311/en/ Dance and Exercise as Therapy in Patients with Parkinson’s Disease – Case Study Kristina Drole, Petra Zaletel University of Ljubljana Faculty of Sport, Gortanova ulica 22, Ljubljana, Slovenia Abstract Introduction: Dance has been used as therapy for different medical conditions – physical and mental – for a number of years. The purpose of this study was to find out how dance and exercise influence body posture and certain motor and cognitive functions in a patient with Parkinson’s disease (PD). Methods: The subject was a 74-year-old man with PD. The data was collected with PDQ-39 and a questionnaire about health, which was composed on the basis of literature on PD. We used standard balance tests, attention, memory and functional tests and postural assessment. The workouts were scheduled two times per week for 8 weeks. The length of a single session was 1.5 hours. Each session consisted of a seated warmup with elements of contemporary dance and ballet, stretching exercises for shortened and overworked muscle groups and strength exercises for weak muscles. The dance part included dance moves that were systematically upgraded to the point where the subject was able to perform three Standard dances at the end of the program. Results: We noticed improvements in all tests. The biggest improvement was made in body posture, attention span and memory. The subject also pointed out better overall feeling and less tiredness. Discussion: Dance and exercise therapy turned out to be an efficient asset to improve motor and cognitive functions. Stretching and strength exercises that improve body posture and decrease muscle rigidity also seem to be very effective in patients with PD. Keywords: Parkinson’s disease, dance therapy, health, physical activity, exercise doi: https://doi.org/10.26493/978-961-7055-18-4.21-30 Parkinson’s disease (PD) is a slow-advancing neurodegenerative disease that starts because of unknown factors, although it is believed to involve both genetic and environmental factors. It is the second most common disease behind Alzheimer’s, and there are more than 7000 patients with PD and other parkinsonisms in Slovenia (Trepetlika, 2018). The most afflicted are people over 60 years old, recent studies also confirm that men are under great- er risk (Elbaza et al., 2016). Clinical picture includes tremors, rigidity, bradyki- nesia and loss of balance (Mesec, 1995). There are more than 40 symptoms of the disease, including non-motor symptoms such as depression, apathy, tired- ness and dementia. (Trepetlika, 2018). All of these influence the patient’s qual- ity of life. There are more and more confirmed cases that physical exercise slows down or decreases motoric complications. Animal tests have shown that ex- ercises encourage the synthesis of dopamine in other dopaminergic neurons, 22 which in turn decreases the symptoms of the disease (Sutoo, Akiyama, 2003). Research also shows that physical exercise slows down the symptoms of PD and if it is introduced in early phase of the disease, it can slow down its prog- lderly e ress (Fox et al., 2006). f the National Parkinson Foundation (2016) recommends that PD patients o perform stretching exercises, aerobic activities and strength training. Dance, alth as one of the recommended exercises, has appeared as a therapy in 1950 and is now used to improve cognitive, emotional and motor functions and for so- ikov | he stn cial networking (Premelč, 2016). Dance can be effective in balance and walk- ing problems as well as decreasing psychological problems, improving cogni- taroe s tive functions, motor functions and quality of life in patients with PD (Lewis et al., 2014; Hashimoto et al., 2015). The popular opinion is that dance can have zdravj a great psychological impact because of the challenges that are presented with dance steps and timing. Some of the challenges are memory, learning and spa- tial awareness (Lewis et al., 2014). Westheimer et al. (2015) found that a sound signal with a uniform rhythm (from music or metronome) helps people with PD walk synchronously with rhythm, and lines drawn on the floor help to improve the length of the steps and reduce the sliding steps. Dhami et al. (2015) believe that rhythmic music in dance could contribute to activation of neurons for motor control and increase in blood flow to the regions of hippocampus and frontal, temporal and parietal lobe regions. This could consequently facilitate neuroplasticity and improve movement, balance, and cognitive abilities. Research has shown greater progress and longer lasting effects in the group where dance therapy was performed than in the group that carried out only physiotherapy exercises. (Hashimoto et al., 2015; De Natale et al., 2017). Some studies of patients with PD report cognitive impairment in as much as 30-70 % of patients. The most impaired abilities are: the working memory, response inhibition, planning, organization and control of the goal targeted behavior and the abilities that represent the foundations of voluntary activities and are linked to the areas of the prefrontal cortex (Georgiev, 2018). Due to all the positive effects that dance activity offers, we anticipated that our dance and exercise program will have a beneficial effect on memory, attention, motor skills, and above all the posture of a patient with PD, which is the least studied in the area of PD. Methods The subject of the study was a 74-year old patient, diagnosed a year ago with id- iopathic PD. The main symptoms in his case are muscle rigidity, decreased mo- bility, stooped posture and slow voluntary movements. He was measured be- fore the first and after the last training unit. We used the following tests, which are described in the literature: Timed Up and Go (Moharić, 2009), Berg Balb- ance Scale (Moharić, 2009), Tandem stand with closed eyes and Stork balance 23 stand test (Moharić, 2009), Trail Making Test (Schieber, n.d.), Stroop test (De Natale et al., 2017), Memory Assessment Scales (Williams, 1990). tudy We also used Memory test for motor task; number of the trials in which ase s subject learns a certain simple movement pattern. First, the observer dem- onstrates the movement pattern, second he adds the explanation and in the third step, the observer and the subject perform the movement together. In the isease – c fourth step, the subject performs the movement alone, accompanied by the ver- n’s d bal explanation from the observer. All the following attempts include indepen- dent memory learning. We used two basic steps of low impact aerobics, namely arkinso a Grapevine and the big mambo. We evaluated the body posture by observing ith o the person standing up and while moving, from the front and the side view. We compared the angles of the joints with the model of the ideal body posture. atients w During the evaluation, we took photographs in the first, fifth and eighth weeks n p of the study. herapy is t Intervention The workouts were scheduled twice per week for 8 weeks. 1.5 hour sessions were xercise a consisted of a seated warmup with elements of contemporary dance and bal- nd e let, stretching exercises for shortened and overworked muscle groups (m. pec- toralis, m. iliopsoas, m. quadriceps) and strength exercises for weak muscles dance a (trunk and back muscles, muscles of the upper arm and shoulder girdle, glu- teus muscles). In the first five weeks, the muscles were stretched with a dy- namic and static method, and later, when the muscular tone slightly deterio- rated, we also performed the PNF (proprioceptive neuromuscular facilitation) method, which according to research is considered to be one of the more effec- tive methods for increasing mobility (Sharman et al., 2006; Hindle et al., 2012). With some exercises we included manual stretching with the help of a partner, since this was the only way we could put the muscle in the optimal position for stretching. Subject started with eight repetitions in one set and gradually in- creased the number of sets and repetitions in order to develop the endurance of the postural muscles that were weak in the patient and reflected poor posture. Third and fourth week there were 2 sets with 8 repetitions, the next two weeks we upgraded to 10 repetitions and in the last two weeks the patient was able to perform 3 sets with 8 repetitions. The dance part included dance moves that were systematically upgraded to the point where the subject was able to perform three Standard dances at the end of the program. We chose three dif- ferent dances, depending on the dynamics and style, namely: tango, slow fox- trot and slow waltz. Results The greatest progress in motor skills was observed in some of the subtests of the BBS. In initial measurements we observed that the subject turned with short steps and whole body (“en bloc”) which is typical for patients with PD. At week 24 8, the patient was turning more rapidly, and had a greater natural hand move- ment while walking. The results are consistent with timed up and go test, as lderly this test was also performed faster. Improvement was also observed in other e tasks of the BBS, and it is necessary to mention the 2 points improvement in f the o the examination of the looking over the shoulder. In initial measurements, the patient did not transfer weight when looking over the shoulder and the move- alth ment was performed only in the neck. In the final measurements at week 8, the ikov | he subject transferred weight to the opposite leg, and the turn began at the pelvic stn girdle. The improvement in the weight transfer from one leg to the other is al- taro so reflected in the improvement in the speed of performing the test of alternat- e s ing touch of the box with the legs. An important improvement was observed in the tandem stand with closed eyes, where the subject improved the time for zdravj as much as 18 seconds, indicating a better ability to maintain a balanced posi- tion despite disturbances. The Stroop test showed a significant improvement in version B, where a conflict situation occurs at the level of automatic processing. Table 1: Differences between inital and final state in motor functions. Variables Initial Final TUG 12.29s 9.27s BBS 49 56 Sitting to standing 4 4 Standing unsupported 4 4 Sitting unsupported 3 4 Standing to sitting 4 4 Transfers 3 4 Standing with eyes closed 4 4 Variables Initial Final Standing with feet together 4 4 Reaching forward with outstretched arm 4 *(29cm) 4 *(34cm) Retrieving object from floor 4 4 Turning to look behind 2 4 Turning 360 degrees 2 *(9.47s) 4 *(2.8s) Placing alternate foot on stool 4 *(14.69s) 4 *(11.59s) Standing with one foot in front 4 4 Standing on one foot 3 4 ST (L) 7.39s 11.12s ST (R) 4.54s 7.44s Tandem stand with closed eyes 3.37s 19.76s 25 TUG, Timed up and go test; BBS, Berg Balance Scale; ST (R), Stork test right foot; tudy * Additional parameters ase s Table 2: Differences between initial and final state in cognitive functions isease – c – memory assessment scales. n’s d Variables Initial Final arkinso List learning 8th trial 4th trial ith o Prose memory 5/9 7/9 List recall 11/12 12/12 atients w List recall - recognition 12 12 n p Verbal span 10/18 10/18 Visual recognition 6/7 7/7 herapy is t Visual reproduction 2/6 5/6 Names-faces 7/10 9/10 xercise a Delayed visual recognition 4/6 6/6 nd e dance a Table 3: Memory and attention span – differences between initial and final state. Variables Initial Final MTMT Grapevine 4th trial 3rd trial MTMT Mambo 8th trial 5th trial Stroop test (A) 25s 22s Stroop test (B) 96s 64.6s Trail making test (A) 84s 79s Trail making test (B) 260s 240s MTMT, Memory test for motor task Posture 26 The photograph shows the poor body posture of the subject, which is shown in the severe forward flexion of thoracolumbar spine, bent knees and increased lderly e muscle tone that hinders movement, which is typical for patients with PD. f the o alth ikov | he stn taroe s zdravj Figure 1: Comparison in posture between week 1, 5 and 8, side and frontal view. Discussion Dance and exercise therapy has proven to be an effective means of improving motor and cognitive abilities. We used dance as a means of improving mobili- ty and cognitive abilities, while the strengthening and stretching exercises were primarily aimed at improving the body posture. Studies using auditory cues provided reliable evidence for improved walk- ing speed, stride length and cadence (Nombela et al., 2013). Extrinsic cues are known to facilitate movement, and may provide the input for sequential move- ments, such as stepping, by reducing the reliance on deficient automatized pro- cesses (Hallett, 2008). In PD, observed improvements in gait are thought to be due to synchronizing movement to the temporal expectation of a regular beat, replacing the impaired internal timing function. Dance also involves ma- ny weight transfers from one leg to the other, and is therefore probably a posi- tive influence on walking and coordination skills. 27 In the memory tests, we saw the greatest improvement in the speed of cognitive processes - learning the list. In the initial measurements, the subject tudy needed 8 attempts to list all 12 words, and after the 8th week he needed only 4 ase s attempts. Significant progress was also observed in visual memory, where the subject had to draw a pattern from memory, after we distracted him. The re- isease – c sults also indicate the improvement of other tests of current and delayed mem- n’s d ory. Patients with PD in other studies also exhibited impairment on tests of explicit memory. Beato et al. (2008) suggest that levodopa therapy presents a arkinso positive effect on spatial working memory but no effect on complexity. ith o The progress was most evident in the body posture, which was the most annoying for the patient before the beginning of therapy. It should be noted atients w that the images were taken just after the end of the 1st, 9th and 16th training n p units and that the posture changes during the day because of the load. There is still a lot of work to do on the endurance of postural muscles that have become herapy is t weak due to improper posture. It is apparent that the main problem arises from the muscles of the shoulder and pelvic girdle and the back. When we stretched the psoas muscle, both the posture and walking were improved. That is because xercise a it plays a role in lifting the leg while walking and maintaining a balanced neu- nd e tral position. By improving thoracic mobility, we achieved greater mobility in dance a the upper part of the body and easier turning and looking over the shoulder. The hunched posture strongly affects back pain, as there is a greater strain on the vertebrae (Bloch et al., 2006; Margraf et al., 2010). Pain also affects the gen- eral mood of the patient and his ability to perform day-to-day tasks. When the patient‘s body posture was improved, the overall functionality of the body im- proved, the patient was able to walk more easily and perform daily tasks with less pain. Conclusions Based on the results of this and previous researches, we could therefore say that dancing and exercise are effective rehabilitation methods for patients with PD. Considering that we have conducted a case study, it would be wise to re- peat the study on a larger sample, where we could also monitor the long-term impact of dance and exercise on the course of the disease. Due to the positive effects of dance and exercise on the motor and cognitive abilities and the gen- eral well-being of the patient with PD, these methods could be carried out by the kinesiologists with appropriate knowledge in the centers and societies for patients with PD (such as Trepetlika). It would also be necessary to investigate the effects of dancing and exercise in other disease conditions (eg Alzheimer’s disease, dementia, .. ). We would recommend stretching exercises for short- ened muscle groups on a daily basis and at least three times per week (prefer- ably every day, as a greater range of exercise provides better effects) for danc- 28 ing or exercise. References lderly e BEATO, R., LEVY, R., PILLONI, B., VIDALI, C., MONTCELIV, T. Z., f the DEWEERI, B., BONNET, A. M., HOUETO, J. L., DUBOIS, B., CARDO- o SO, F. 2008. Working memory in Parkinson‘s disease patients: clinical alth features and response to levodopa. Arq. Neuro-Psiquiatr., vol. 66, no. 2. Available from: http://dx.doi.org/10.1590/S0004-282X2008000200001 ikov | he stn BLOCH, F., HOUETO, J. L., TEZENAS DU MONTCEL, S., BONNEVILLE, taro F., ETCHEPARE, F., WELTER, M. L., RIVAUD‐PECHOUX, S., HAHN‐ e s BARMA, V., MAISONOBE, T., BEHAR, et al. 2006. Parkinson‘s disease with camptocormia. Journal of Neurology, Neurosurgery and Psychiatry, zdravj vol. 77, no. 11, pp. 1223–1228. Available from: http://dx.doi.org/10.1136/jn- np.2006.087908 DE NATALE, E. R., PAULUS, K. S., AIELLO, E., SANNA, B., MANCA, A., SOTGIU, G., LEALI, P. T. and DERIU, F. 2017. Dance therapy improves motor and cognitive functions in patients with Parkinson‘s disease. Neu- roRehabilitation, vol. 40, no. 1, pp. 141-144. Available from: https:/ content. iospress.com/articles/neurorehabilitation/nre1399 DHAMI, P., MORENO, S. and DESOUZA, J. F. X. 2015. New framework for rehabilitation – fusion of cognitive and physical rehabilitation: the hope for dancing. Frontiers in psychology, vol. 5. Available from: https://dx.doi. org/10.3389/fpsyg.2014.01478 ELBAZA, A., CARCAILLON, L., KABAB, S. and MOISANC, F. 2016. Epide- miology of Parkinson‘s disease. Revue Neurologique, vol. 172, no. 1, pp. 14- 26. Available from: http://dx.doi.org/10.1016/j.neurol.2015.09.012 FOX, C. M., RAMIG, L. O., CIUCCI, M. R., SAPIR, S., MCFARLAND, D. H. and FARLEY, B. G. 2006. The science and practice of LSVT/LOUD: neue- ral plasticity-principled approach to treating individuals with Parkinson’s disease and other neurological disorders . Semin Speech Lang, vol. 27, no. 4, pp. 283-299. Available from: http://dx.doi.org/10.1055/s-2006-955118 GEORGIEV, D. n.d. O kognitivnih motnjah pri bolnikih s Parkinsono- vo boleznijo. Available from: https:/ www.sinapsa.org/eSinapsa/ste- vilke/2012-4/42/O-kognitivnih-motnjah-pri-bolnikih-s-Parkinsono- vo-boleznijo HALLETT, M. 2008. The intrinsic and extrinsic aspects of freezing of gait. Move- ment di sorders, vol. 23, no. 11, pp. 439–443. Available from: http://dx.doi. org/ 10.1002/mds.21836 HASHIMOTO, H., TAKABATAKE, S., MIYAGUCHI, H., NAKANISHI, H. and NAITOU, Y. 2015. Effects of dance on motor functions, cognitive functions and mental symptoms of Parkinson‘s disease: a quasi rand- omized pilot trial. Complementary therapies in medicine. Available from: http://dx.doi.org/10.1016/j.ctim.2015.01.010 29 LEWIS, C., ANNET, L. E., DAVENPORT, S., HALL, A. A. and LOVATT, P. 2014. Mood changes following social dance sessions in people with Par- tudy kinson‘s disease. Journal of Health Psychology, vol. 21, no. 4, pp. 483-492. Available from: http://dx.doi.org/10.1177/1359105314529681 ase s MARGRAF, NG., WREDE, A., ROHR, A., SCHULZ-SCHAEFFER, WJ., RA- ETHJEN, J., EYMESS, A., VOLKMANN, J., MEHDORN, MH., JANSEN isease – c and O. DEUSCHL, G. 2010. Camptocormia in idiopathic Parkinson‘s n’s d disease: a focal myopathy of the paravertebral muscles. Movement dis- orders, v ol. 25, no. 5, pp. 542-51. Available from: http://dx.do.org/10.1002/ arkinso mds.22780 ith o MESEC, A. 1995. Parkinsonova bolezen. Ljubljana: Nevrološka klinika. MOHARIĆ, M. 2009. Ocenjevanje ravnotežja: Klinični testi in ocenjevalne atients wn p lestvice. Rehabilitacija, vol. 8, no. 1. NOMBELA, C., HUGHES, L.E., OWEN, A. M. and GRAHN, J. A. 2013. Into herapy i the groove: Can rythm influence Parkinson‘s disease? Neuroscience & Bi- s t obehavioral Reviews, vol.37, no. 10, pp. 2564-70. Available from: http://dx. doi.org/10.1016/j.neubiorev.2013.08.003 xercise a PREMELČ, J. 2016. S plesom do zdravja – plesna terapija za bolnike s Parkin- nd e sonovo boleznijo. Available from: https:/ www.researchgate.net/publica- tion/305316412_Dancing_our_way_to_health_-_dance_therapy_for_Par- dance a kinson %27s_patients SCHIEBER, F., n.d. Trail Making Test (TMT) Parts A & B – USD. Universi- ty of South Dakota. Available from: usd-apps.usd.edu/coglab/schieber/ psyc423/pdf/IowaTrailMaking.pdf SUTOO D. and AKIYAMA, K. 2003. Regulation of brain function by exercise. Neurobiol Dis orders, vol. 13, no. 1, pp. 1-14. Available from: http://www. sciencedirect.com/science/article/pii/S0969996103000305?via %3Dihub TREPETLIKA. 2018. Available from: http:/ www.trepetlika.si/ WESTHEIMER, O., MCRAE, C., HENCHLIFFE, C., FESHARAKI, A., GLAZMAN, S., ENE, H. and BODIS-WOLLNER, I. 2015 . Dance for PD: a preliminary investigation of effects on motor function and quali- ty of life among persons with Parkinson‘s disease (PD). Journal of Neural Transmission, vol. 122, no. 9, pp. 1263-1270. Available from: http://dx.doi. org/10.1007/s00702-015-1380-x 30 lderly e f the o alth ikov | he stn taroe s zdravj Role of physical activity and nutrition in prevention of frailty Branko Gabrovec National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia Abstract Introduction: As the process which leads to frailty and disability can be slowed down or even completely reversed, it can be appropriate for early interventions. Early interventions can be found in multiple fields, specially in physical activity and nutrition. Methods: Systematic literature review and good practices review was conducted to obtain the results on two tasks of the Work package 6 – the Management of Frailty at Individual Level JA ADVANTAGE: Nutrition, Physical activity. Results: Malnutrition or being at risk for malnutrition increases the risk of frailty and its consequences. With regard to the importance to recognize malnutrition and risk of malnutrition, the Mini Nutritional Assessment is a well validated tool to be used for screening and assessment. Physical activity and exercise in frail elderly are effective and relatively safe and may reverse frailty. Both, health nutrition and physical activity give best results when they are combined. Discussion and conclusion: Frail patients who are at elevated risk for falls and fracture need Vitamin D supplementation. The Mediterranean diet is associated with lower risk of frailty. Assuring a protein intake of at least 1-1.2 g per kilogram of body weight per day is beneficial. Exercise interventions in frail elderly persons can increase strength and power, have potential to maintain or even slightly increase fat-free mass, and are effective in improving aerobic capacity and balance. Consequently, fall incidence is reduced and quality of life improved. Key words: frailty, nutrition, physical activity Frailty is a progressive age-related decline in physiological systems that re- sults in decreased reserves of intrinsic capacity, which confers extreme vulnerability to stressors and increases the risk of a range of adverse health doi: https://doi.org/10.26493/978-961-7055-18-4.31-41 outcomes (WHO, 2017). Phenotypic definition of frailty is the most common. Muscle and bone, which gives muscle its support, are in the centre of pheno- typic frailty. One of the key determinants of body mass, muscular mass and body composition is the dietary and metabolic state of an individual. An indi- vidual can be influenced by the quality and quantity of consumed food and rel- ative and absolute energy intake, macro and micro nutrients influence an indi- vidual’s condition. Frailty, in terms of clinical dietary and metabolic status of an individual, includes components that are linked to malnourishment (Lan- di et al., 2015). Even without malnutrition, elderly are prone to lose lean body mass and thus frailty because of decreased physical activity (Elmadfa & Mey- er, 2008) and age associated sarcopenia. Weight loss in elderly is associated with increased risk for hip fracture and weight gain with decreased risk for hip fracture with consistent dose response for weight gain and weight loss and ir- respective of current weight or intention to lose weight (Ensrud et al., 2003; Lv 32 et al., 2015).Based on current evidence, dietary protein caloric intake, protein quality, as well as the vitamin D status of older individuals should be checked by clinicians and/or dieticians and individual prescription of nutritional sup- lderly e plements should be considered (Beaudart et al., 2016). f the Based on current evidence, dietary protein caloric intake, protein quality, o as well as the vitamin D status of older individuals should be checked by clini- alth cians and/or dieticians and individual prescription of nutritional supplements should be considered (Beaudart et al., 2016). ikov | he stn Stable body mass or slight increase of body mass with age is desired. Stud- taro ies confirm that increased body weight contributes to a lower mortality in per- e s sons aged 65 and older (Flegal, Kit, Orpana, & Graubard, 2013). With age we zdravj lose muscle mass and gain fat tissue (Elmadfa & Meyer, 2008). Men with con- stantly normal weight over the life course have a good prognosis in late life. Men who are either constantly overweight or who changed from overweight in midlife to normal weight in late life have a poorer prognosis and more frail- ty and disability in late life. Findings support the view that a healthy lifestyle, including weight control, should be maintained throughout life (Strandberg et al., 2013). Reduced physical functioning is the most dominant sign of frailty (Fried et al., 2001). The ageing associated loss of muscle mass seems to be one of the major causes for reduced physical abilities in older age and consequently dis- ability and frailty (Roubenoff 2000). There is abundant evidence from prospec- tive and clinical studies that physical activity not only delays but also prevents or reverses frailty. For instance, a recent observational study (Rogers et al., 2017) showed that physical activity might attenuate frailty. Mild physical activ- ity was insufficient to significantly slow down the progression of frailty, mod- erate physical activity reduced the progression of frailty in some age groups (particularly ages 65 and above) and vigorous activity significantly reduced the trajectory of frailty progression in all older adults. The aim of this study was to examine the role of nutrition and physical activity in perspective of frailty, using a systematic literature review. Methods Descriptive research methodology was used to review peer-reviewed medical literature. A systematic literature review was conducted as it enables the ob- tainment of data from various sources and ensures a holistic understanding of the research subject. The literature search was conducted using the following databases: PubMed, The Cochrane Library, Embase, UpToDate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), by means of several combinations of selected search words in the English language and their syno- nyms were prepared and used with Boolean operators AND or OR, searching in title, key words and in abstract. For nutrition the following key words were selected: Geriatric Nutritional *() OR Elderly Protein deficiency *() OR Frailty Energy intake *() OR Frailty D vitamin *() OR Ostheoporosis Nutrition *() OR 33 Frail Nutrition *() OR Frail Vulnerable Nutrition *() OR Functional decline Protein deficiency *() OR Older person Sarcopenia *() OR Frail D vitamin *() railtyf f OR Aged Dietary supplements *() OR Cognitive decline *() OR Calcium Nu- n o trition *() OR Calcium Older adult *() OR Geriatric Nutrition *() OR Disability Nutrition *(); searching in title, key words and in abstract. For physical activ- reventio ity the following key words were selected: Frail Muscle strength *() OR Frail- n p ty Activity *() OR Elderly Exercise *() OR Older adult Functional ability *() n i OR Aged functional decline *() OR Older person Mobility *() OR Geriatric utritio Disability *() OR Inactivity Vulnerable Elderly *() OR Physical activity Aged Function *() OR Training Aged *() OR Functional outcomes Geriatric *() OR nd n Physical interventions Vulnerable *() OR Sports Older person *() OR Patterns of activity Older adult *() OR Leisure activity Elderly *(); searching in title, key ctivity a words and in abstract. The selection criterion for articles to be included in the review was that hysical af p they were published during the last 15 years, i.e. between 2002 and 2017. Key le o words were selected from a proposal of key words that was prepared by the ro task leader and the working group focusing on Nutrition and Physical activ- ity as part of the European Commission project “Joint Action on Frailty pre- vention – JA ADVANTAGE”, Work Package 6 – Management of Frailty at In- dividual Level. Articles regarding current policies and guidelines on frailty prevention in older people which were published in peer-reviewed scientific journals, as well as international documents, standards, guidelines and research studies per- formed in the EU were reviewed. Information from editorials, letters, inter- views, posters and articles with no access to full text were not included in the study. Grey documents which were identified and proposed by the task leader and the working group were also reviewed and included in the study. Grey doc- uments were identified by means of an opportunistic search, meaning a targeted or focused one, based on the information that each partner in the project Consortium was able to find regarding their own country (Spain, Austria, Bel- gium, Croatia, Cyprus, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Lithuania, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slo- venia and United Kingdom). The term grey literature was used to describe in- formation which is not published commercially or is otherwise hard to find in- cluding government reports, non-governmental organizations (NGO) reports, theses, technical reports, white papers, etc. From initial 39885 search results on Nutrition 28 papers were selected and from 6200043 search results on Physical activity 25 papers were selected for review. Results Nutrition 34 Malnutrition or being at risk for malnutrition increases the risk of frailty and its consequences (Clegg et al., 2013; Ensrud et al., 2003; Goisser et al., 2016; lderly e Strandberg et al., 2013; White et al., 2012). Prevalence of malnutrition depends f the on the setting and criteria used and ranges from 2 % to 60 % (Elmadfa & Meyer, o 2008; Guigoz, 2006; Kaiser et al., 2010; White et al., 2012). In the sample from alth 24 studies from 12 countries, prevalence of malnutrition was 50.5 %, 38.7 %, 13.8 % and 5.8 % in rehabilitation, hospital, nursing home and community, respec- ikov | he tively (Kaiser et al., 2010). The combined prevalence of being at risk for malnu- stn trition was 46.2 % with 41.2 %, 47.3 %, 53.4 % and 31.9 % in rehabilitation, hospi- taroe s tal, nursing home and community, respectively (Kaiser et al., 2010). With regard to the importance to recognize malnutrition and risk of zdravj malnutrition, the Mini nutritional assessment (MNA) is a well validated tool with acceptable sensitivity/specificity to be used for screening and assessment (Guigoz, 2006). Older people with higher protein intake lose lean body mass slower, lose less when losing weight and increase muscle mass more if they increase weight (Houston et al., 2008). When high protein intake (1.3 g/kg) is com- bined with regular exercise, adults and elderly can lose weight and still in- crease their net muscle mass (Verreijen et al., 2017). Although higher protein intake increases total and not femoral neck bone mineral density (Daw- son-Hughes & Harris, 2002) it still significantly decreases risk of hip frac- ture (Wu et al., 2015). Vitamin D insufficiency (<50nmol/l) is significantly associated with frailty in men, but not in women (Shardell et al., 2009). The Mediterranean diet is associated with lower risk of frailty (Goisser et al., 2016). Supplemen- tation of vitamin D improves muscle strength particularly in people aged 65 and older and in those with 25-OH vitamin D level below 30 nmol/l (Beau- dart et al., 2014). Physical activity Muscle mass and strength decrease with ageing. This process is accelerat- ed after the age of 70 (Larsson et al., 1979). Reduced strength may lead to frailty which is characterized by unintentional weight loss, low physical activity lev- els, slow gait speed, exhaustion, and weakness (Fried et al., 2001). The main rea- son behind strength and power decline is sarcopenia, loss of muscle mass with age due to motor neuron death, immunological factors, hormonal change, in- creased sedentary lifestyle and malnutrition (Narici & Maganaris, 2006). On the other hand, strength training has potential to reverse or slow down these processes even at older age (Harridge et al., 1999). Different train- ing interventions have been shown to increase strength in healthy older adults as well as in frail. Supervised center-based interventions seem to be more ef- fective than home interventions at improving strength in frail older persons (Binder et al., 2005; Pahor et al., 2006; King et al., 2002; Fairhall et al., 2014). Researched interventions were of different durations, ranging from 8 weeks 35 up to 2 years. Even the shortest trial duration was enough to increase strength (Serra-Rexach et al., 2011). railtyf f An important parameter of strength training is exercise load, i.e. intensi- n o ty, usually expressed in % of 1RM. Low exercise load studies reported strength gains less frequently. Siegrist et al. (2016) reported no strength gains after 16 reventio week of a supervised exercise training program (1 hour/week) with strength n pn i and power training, challenging balance and gait training with increasing, but in general low, levels of difficulty. With fitness machines and loads of 60 % of utritio 1RM substantial strength improvements were obtained (about 20 % in isomet- nd n ric exercises and about 100 % in lifting weights). Similar effects were seen in a study by Binder et al. (2005), who used exercise loads of 70-80 % of 1RM. In the ctivity a oldest group of old persons, 70 % of 1RM load managed to improve leg press strength by 20% after 8 weeks of hypertrophy type strength training. These re- sults are in agreement with findings that resistance training in healthy older hysical af p persons with greater loads is related to greater increases in strength and power le o parameters (Steib et al., 2010) and support a dose-response relationship. ro Supplementation can enhance the effects of strength training (improved strength and power gains). Amino acid supplementation (AAS) may promote muscle growth but does not necessarily improve strength and power in healthy older adults (Finger et al., 2015). Aerobic capacity may be a limiting factor of mobility and work capaci- ty in frail older persons. Its loss may be due to decreased muscle mass (Fleg & Lakatta, 1988) or lower cardiac output (Ogawa et al., 1992). Ehsani et al. (2003) studied cardiovascular adaptation in older mild-to-moderate frail subjects af- ter endurance exercise at 78 % of peak heart rate. They found 14 % increase in peak VO2 after 9 months of intervention and that the main adaptation was in- crease in heart rate and probably stroke volume. It is not possible to conclude on the optimal regime to improve endurance and VO2max. Falls in adults over 65 years old are frequent (Rubenstein & Josephson, 2002) and are a cause of many injuries (Stevens et al., 2006) leading to impaired mobility and physical fitness. Exercise programs are effective in reducing falls and fall-related injuries in healthy older persons (El-Khoury et al., 2013; Gilles- pie et al., 2012). There is abundant evidence that exercise intervention improves balance in frail elderly persons (Freiberger et al., 2012; Giné-Garriga et al., 2010; King et al., 2002; Binder et al., 2003; Clemson et al., 2012; El-Khoury et al., 2015; Faber et al., 2006; Giné-Garriga et al., 2013; King et al., 2006; Siegrist et al., 2016; Tay-lor et al., 2012), even in very old persons (Cadore et al., 2014). A combination of strength and balance training improves balance outcomes (Binder et al., 2002; Fairhall et al., 2014; Freiberger et al., 2012; Giné-Garriga et al., 2010). When strength and balance were complemented with gait and functional exercises (El-Khoury et al., 2015; Freiberger et al., 2012; Siegriest et al., 2016) no addition- 36 al effect on balance outcomes was observed. Discussion and conclusions lderly e There is sufficient evidence that nutrition and frailty status are related. The f the Mini Nutritional Assessment is a screening and assessment tool developed to o identify patients who are malnourished or at risk of malnutrition. alth Vitamin D supplementation is important in people with 25-OH vitamin D level < 30 nmol/l. Healthy older people should consume in average 1.0 to 1.2 ikov | he stn g/kg of body weight of protein per day. In acute or chronic disease, protein in- taro take should be 1.2 to 1.5 g/kg/day or 2.0 g/kg/day in severe illness, injury or e s marked malnutrition. zdravj Physical activity and exercise in frail elderly are effective and relative- ly safe and may reverse frailty. Most studies researched effects of interventions on fall prevention and functional outcomes. The review showed that different exercise interventions in frail elderly persons can increase strength and power, have potential to maintain or even slightly increase fat-free mass, and are effec- tive in improving aerobic capacity and balance. Consequently, fall incidence is reduced and quality of life improved. The aim of this research was present the results of a systematic litera- ture review and data analysis focusing on nutrition in the context of managing frailty at individual level. For the purposes of this research, a systematic liter- ature review method was used. The method proved to be appropriate and the aim was achieved. Literature BEAUDART, C., BUCKINX, F., RABENDA, V., GILLAIN, S., CAVALIER, E., SLOMIAN, J., PETERMANS, J., REGINSTER, J.Y. in BRUYÈRE, O., 2014. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. The Journal of Clinical Endocrinology and Metabolism, vol. 99, no. 11, pp. 4336-4345. BEAUDART, C., MCCLOSKEY, E., BRUYÈRE, O., CESARI, M., ROLLAND, Y., RIZZOLI, R., ARAUJO DE CARVALHO, I., AMUTHAVALLI THI- YAGARAJAN, J., BAUTMANS, I., BERTIÈRE, M.C. et al., 2016. Sarcope- nia in daily practice: assessment and management. BMC Geriatrics, vol. 16, no. 1, pp. 170. BINDER, E.F., SCHECHTMAN, K.B., EHSANI, A.A., STEGER-MAY, K., BROWN, M., SINACORE, D.R., YARASHESKI, K.E. in HOLLOSZY, J.O., 2002. Effects of exercise training on frailty in community-dwell- ing older adults: results of a randomized, controlled trial. Journal of the American Geriatrics Society, vol. 50, no. 12, pp. 1921–1928. BINDER, E.F., YARASHESKI, K.E., STEGER-MAY, K., SINACORE, D.R., BROWN, M., SCHECHTMAN, K.B. in HOLLOSZY, J.O., 2005. Effects of progressive resistance training on body composition in frail older adults: 37 results of a randomized, controlled trial. The Journals of Gerontology. Se- ries A, Biological Sciences and Medical Sciences, vol. 60, no. 11, pp. 1425– railty 1431. f f n o CADORE, E.L., CASAS-HERRERO, A., ZAMBOM-FERRARESI, F., IDO- ATE, F., MILLOR, N., GÓMEZ, M., RODRIGUEZ-MAÑAS, L. in IZZ- reventio QUIERDO, M., 2014. Multicomponent exercises including muscle power n p training enhance muscle mass, power output, and functional outcomes n i in institutionalized frail nonagenarians. Age (Dordrecht, Netherlands), utritio vol. 36, no. 2, pp. 773–785. nd n CLEGG, A., YOUNG, J., ILIFFE, S., RIKKERT, M.O. in ROCKWOOD, K., 2013. Frailty in elderly people. Lancet (London, England), vol. 381, no. ctivity a 9868, pp. 752–762. CLEMSON, L., FIATARONE SINGH, M.A., BUNDY, A., CUMMING, R.G., hysical a MANOLLARAS, K., O’LOUGHLIN, P. in BLACK, D., 2012. Integra- f p tion of balance and strength training into daily life activity to reduce rate le o of falls in older people (the LiFE study): randomised parallel trial. BMJ ro (Clinical Research Ed.), vol. 345, e4547. DAWSON-HUGHES, B. in HARRIS, S.S., 2002. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. The American Journal of Clinical Nutrition, vol. 75, no. 4, pp. 773– 779. EHSANI, A.A., SPINA, R.J., PETERSON, L.R., RINDER, M.R., GLOVER, K.L., VILLAREAL, D.T., BINDER, E.F. in HOLLOSZY, J.O., 2003. Attenuation of cardiovascular adaptations to exercise in frail octogenarians. Journal of Applied Physiology (Bethesda, Md.: 1985), vol. 95, no. 1, pp. 1781–1788. EL-KHOURY, F., CASSOU, B., CHARLES, M.-A. in DARGENT-MOLINA, P., 2013. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and me- ta-analysis of randomised controlled trials. BMJ (Clinical Research Ed.), vol. 347, f6234. EL-KHOURY, F., CASSOU, B., LATOUCHE, A., AEGERTER, P., CHARLES, M.A. in DARGENT-MOLINA, P., 2015. Effectiveness of two year bal- ance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial. BMJ: British Medical Journal, vol. 351, h3830. ELMADFA, I. in MEYER, A.L., 2008. Body composition, changing physiolog- ical functions and nutrient requirements of the elderly. Annals of Nutri- tion & Metabolism, vol. 52, suppl 1, pp. 2–5. ENSRUD, K.E., EWING, S.K., STONE, K.L., CAULEY, J.A., BOWMAN, P.J., CUMMINGS, S.R. IN STUDY OF OSTEOPOROTIC FRACTURES RE- SEARCH GROUP, 2003. Intentional and unintentional weight loss in- crease bone loss and hip fracture risk in older women. Journal of the 38 American Geriatrics Society, vol. 51, no. 12, pp. 1740–1747. FABER, M.J., BOSSCHER, R.J., CHIN A PAW, M.J. in VAN WIERINGEN, P. C., 2006. Effects of exercise programs on falls and mobility in frail and lderly e pre-frail older adults: A multicenter randomized controlled trial. Ar- f the chives of Physical Medicine and Rehabilitation, vol. 87, no. 7, pp. 885–896. o FAIRHALL, N., SHERRINGTON, C., LORD, S.R., KURRLE, S.E., LAN- alth GRON, C., LOCKWOOD, K., MONAGHAN, N., AGGAR, C. in CAM- ERON, I.D., 2014. Effect of a multifactorial, interdisciplinary intervention ikov | he stn on risk factors for falls and fall rate in frail older people: a randomised taro controlled trial. Age and Ageing, vol. 43, no. 5, pp. 616–622. e s FINGER, D., GOLTZ, F.R., UMPIERRE, D., MEYER, E., ROSA, L.H.T. in SCH- zdravj NEIDER, C.D., 2015. Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis. Sports Medicine (Auckland, N.Z.), vol. 45, no. 2, pp. 245–255. FLEG, J.L. in LAKATTA, E.G., 1988. Role of muscle loss in the age-associat- ed reduction in VO2 max. Journal of Applied Physiology (Bethesda, Md.: 1985), vol. 65, no. 3, pp. 1147–1151. FLEGAL, K.M., KIT, B.K., ORPANA, H. in GRAUBARD, B.I., 2013. Associa- tion of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JA- MA, vol. 309, no. 1, pp. 71–82. FREIBERGER, E., HÄBERLE, L., SPIRDUSO, W.W. IN ZIJLSTRA, G.A.R., 2012. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in com- munity-dwelling older adults: a randomized controlled trial. Journal of the American Geriatrics Society, vol. 60, no. 3, pp. 437–446. FRIED, L.P., TANGEN, C.M., WALSTON, J., NEWMAN, A.B., HIRSCH, C., GOTTDIENER, J., SEEMAN, T., TRACY, R., KOP, W.J., BURKE, G. et al., 2001. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 56, no. 3, pp. M146-156. GILLESPIE, L.D., ROBERTSON, M.C., GILLESPIE, W.J., SHERRINGTON, C., GATES, S., CLEMSON, L.M. in LAMB, S.E., 2012. Interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews, issue 9, CD007146. GINÉ-GARRIGA, M., GUERRA, M., PAGÈS, E., MANINI, T.M., JIMÉNEZ, R. in UNNITHAN, V.B., 2010. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. Jour- nal of Aging and Physical Activity, vol. 18, no. 4, pp. 401–424. GINÉ-GARRIGA, M., GUERRA, M. in UNNITHAN, V.B., 2013. The effect of functional circuit training on self-reported fear of falling and health sta- tus in a group of physically frail older individuals: a randomized con- trolled trial. Aging Clinical and Experimental Research, vol. 25, no. 3, pp. 329–336. 39 GOISSER, S., GUYONNET, S. in VOLKERT, D., 2016. The Role of Nutrition in Frailty: An Overview. The Journal of Frailty & Aging, vol. 5, no. 2, pp. 74– railtyf f 77. n o GUIGOZ, Y., 2006. The Mini Nutritional Assessment (MNA) review of the lit- erature-What does it tell us? The Journal of Nutrition, Health & Aging, vol. reventio 10, no. 6, pp. 466-485; discussion 485-487. n pn i HARRIDGE, S.D., KRYGER, A. in STENSGAARD, A., 1999. Knee extensor strength, activation, and size in very elderly people following strength utritio training. Muscle & Nerve, vol. 22, no. 7, pp. 831–839. nd n HOUSTON, D.K., NICKLAS, B.J., DING, J., HARRIS, T.B., TYLAVSKY, F.A., NEWMAN, A.B., LEE, J.S., SAHYOUN, N.R., VISSER, M., ctivity a KRITCHEVSKY, S.B. et al., 2008. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, hysical a Aging, and Body Composition (Health ABC) Study. The American Jour- f p nal of Clinical Nutrition, vol. 87, no. 1, pp. 150–155. le oro KAISER, M.J., BAUER, J.M., RÄMSCH, C., UTER, W., GUIGOZ, Y., CEDER- HOLM, T., THOMAS, D.R, ANTHONY, P.S., CHARLTON, K.E., MAG- GIO, M. et al., 2010. Frequency of malnutrition in older adults: a multi- national perspective using the mini nutritional assessment. Journal of the American Geriatrics Society, vol. 58, no. 9, pp. 1734–1738. KING, M.B., WHIPPLE, R.H., GRUMAN, C.A., JUDGE, J.O., SCHMIDT, J.A. in WOLFSON, L I., 2002. The Performance Enhancement Project: im- proving physical performance in older persons. Archives of Physical Med- icine and Rehabilitation, vol. 83, no. 8, pp. 1060–1069. LANDI, F., CALVANI, R., CESARI, M., TOSATO, M., MARTONE, A.M., BERNABEI, R., ONDER, G. in MARZETTI, E., 2015. Sarcopenia as the Biological Substrate of Physical Frailty. Clinics in Geriatric Medicine, vol. 31, no. 3, pp. 367–374. LARSSON, L., GRIMBY, G. in KARLSSON, J., 1979. Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology, vol. 46, no. 3, pp. 451–456. LV, Q.-B., FU, X., JIN, H.-M., XU, H.-C., HUANG, Z.-Y., XU, H.-Z., CHI, Y.-L. in WU, A.-M., 2015. The relationship between weight change and risk of hip fracture: meta-analysis of prospective studies. Scientific Reports, 5, ara-ticle number: 16030. NARICI, M.V. in MAGANARIS, C.N., 2006. Adaptability of elderly human muscles and tendons to increased loading. Journal of Anatomy, vol. 208, no. 4, pp. 433–443. OGAWA, T., SPINA, R.J., MARTIN, W.H., KOHRT, W.M., SCHECHTMAN, K.B., HOLLOSZY, J.O. in EHSANI, A.A., 1992. Effects of aging, sex, and physical training on cardiovascular responses to exercise. Circulation, 40 vol. 86, no. 2, pp. 494–503. PAHOR, M., BLAIR, S.N., ESPELAND, M., FIELDING, R., GILL, T.M., GU- lderly RALNIK, J.M., HADLEY, E.C., KING, A.C., KRITCHEVSKY, S.B., e MARALDI, C. et al., 2006. Effects of a physical activity intervention on f the o measures of physical performance: Results of the lifestyle interventions alth and independence for Elders Pilot (LIFE-P) study. The Journals of Ger- ontology. Series A, Biological Sciences and Medical Sciences, vol. 61, no. 11, ikov | he pp. 1157–1165. stn ROGERS, N. T., MARSHALL, A., ROBERTS, C. H., DEMAKAKOS, P., STEP- taroe s TOE, A. in SCHOLES, S., 2017. Physical activity and trajectories of frail- ty among older adults: Evidence from the English Longitudinal Study of zdravj Ageing. PLOS ONE, vol. 12, no. 2, e0170878. ROUBENOFF, R., 2000. Sarcopenia: a major modifiable cause of frailty in the elderly. The Journal of Nutrition, Health & Aging, vol. 4, no. 3, pp. 140–142. RUBENSTEIN, L.Z. in JOSEPHSON, K.R., 2002. The epidemiology of falls and syncope. Clinics in Geriatric Medicine, vol. 18, no. 2, pp. 141–158. SERRA-REXACH, J.A., BUSTAMANTE-ARA, N., HIERRO VILLARÁN, M., GONZÁLEZ GIL, P., SANZ IBÁÑEZ, M. J., BLANCO SANZ, N., OR- TEGA SANTAMARÍA, V., GUTIÉRREZ SANZ, N., MARÍN PRADA, A.B., GALLARDO, C. et al., 2011. Short-term, light- to moderate-intensi- ty exercise training improves leg muscle strength in the oldest old: a ran- domized controlled trial. Journal of the American Geriatrics Society, vol. 59, no. 4, pp. 594–602. SHARDELL, M., HICKS, G.E., MILLER, R.R., KRITCHEVSKY, S., ANDERS- EN, D., BANDINELLI, S., CHERUBINI, A. in FERRUCCI, L., 2009. As- sociation of low vitamin D levels with the frailty syndrome in men and women. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 64, no. 1, pp. 69–75. SIEGRIST, M., FREIBERGER, E., GEILHOF, B., SALB, J., HENTSCHKE, C., LANDENDOERFER, P., LINDE K., HALLE, M. in BLANK, W.A., 2016. Fall Prevention in a Primary Care Setting. Deutsches Ärzteblatt Internas- tional, vol. 113, no. 21, pp. 365–372. STEIB, S., SCHOENE, D. in PFEIFER, K., 2010. Dose-response relationship of resistance training in older adults: a meta-analysis. Medicine and Science in Sports and Exercise, vol. 42, no. 5, pp. 902–914. STEVENS, J.A., CORSO, P.S., FINKELSTEIN, E.A. in MILLER, T.R., 2006. The costs of fatal and non-fatal falls among older adults. Injury Preven- tion: Journal of the International Society for Child and Adolescent Injury Prevention, vol. 12, no. 5, pp. 290–295. STRANDBERG, T.E., STENHOLM, S., STRANDBERG, A.Y., SALOMAA, V.V., PITKÄLÄ, K.H. in TILVIS, R.S., 2013. The ‘Obesity Paradox,’ Frail- ty, Disability, and Mortality in Older Men: A Prospective, Longitudinal Cohort Study. American Journal of Epidemiology, vol. 178, no. 9, pp. 1452– 41 1460. TAYLOR, D., HALE, L., SCHLUTER, P., WATERS, D. L., BINNS, E. E., Mc- railty CRACKEN, H., McPHERSON, K. in WOLF, S. L., 2012. Effectiveness of f f tai chi as a community-based falls prevention intervention: a randomized n o controlled trial. Journal of the American Geriatrics Society, vol. 60, no. 5, pp. 841–848. reventio n p VERREIJEN, A.M., ENGBERINK, M.F., MEMELINK, R.G., VAN DER PLAS, n i S.E., VISSER, M. in WEIJS, P.J.M., 2017. Effect of a high protein diet and/ or resistance exercise on the preservation of fat free mass during weight utritio loss in overweight and obese older adults: a randomized controlled trial. nd n Nutrition Journal, vol. 16, no. 1, pp. 10. WHITE, J.V., GUENTER, P., JENSEN, G., MALONE, A., SCHOFIELD, M., ctivity a ACADEMY MALNUTRITION WORK GROUP, A.S.P.E.N. MALNU- TRITION TASK FORCE in A.S.P.E.N. BOARD OF DIRECTORS., 2012. hysical a Consensus statement: Academy of Nutrition and Dietetics and Ameri- f p can Society for Parenteral and Enteral Nutrition: characteristics recom- le oro mended for the identification and documentation of adult malnutrition (undernutrition). JPEN. Journal of Parenteral and Enteral Nutrition, vol. 36, no. 3, pp. 275–283. WORLD HEALTH ORGANIZATION, 2017. Integrated Care for Older People (ICOPE). Guidelines on community-level interventions to manage de- clines in intrinsic capacity [online]. [viewed 23 January 2018]. Available from: http://apps.who.int/iris/bitstream/10665/258981/1/9789241550109-e ng.pdf?ua=1 WU, A.-M., SUN, X.-L., LV, Q.-B., ZHOU, Y., XIA, D.-D., XU, H.-Z., HUANG, Q.-S. in CHI, Y.-L., 2015. The Relationship between Dietary Protein Con- sumption and Risk of Fracture: a subgroup and dose-response meta-anal- ysis of prospective cohort studies. Scientific Reports, 5, article number: 9151. Positive ageing: the problem of young generation or challenge for modern society Andreja Gerl, Tjaša Tkalec, Anita Dolšak Kos, Andrej Starc University of Ljubljana Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia Abstract Introduction: Retirement is an important life event, which brings new life changes. This reflects on physical, psychological and social levels. The individual is suddenly facing a fear for the future, he is trying to find new roles in society and has a lot of insecurities that ageing can bring. Methods: A systematic literature search of the published literature was conducted at Slovenian libraries with Cobiss. We also used some databases (ScienceDirect, Wiley Online Library, MEDLINE, CINAHL, Cochrane, PubMed), where we were searching within ageing psychology field. We used descriptive method with literature review to make meta- analysis. The review was restricted to studies published since 2007 to 2017. Results: Many studies suggest the process of preparation for ageing is very important for positive ageing. It is important to stay active on all three (physical, psychological and social) levels, because this is the only way to maintain a positive self-image in society. There are equally important factors of positive ageing: the ability of individual’s time perspective and maintaining a sense of cohesion with society. Discussion and conclusions: Positive ageing depends on the environment in which the person lives and works. Different mechanisms, such as the ability of the thought and behavioural adjustment, maintaining a positive sense of self and positive view on ageing are very helpful. Key words: positive ageing, older adults, retirement, views on aging, psychological adjustment Ageing is a process we all share. But not all of us age the same. However, it depends on the opportunities and constraints that are presented to us as we age, and that is greately influenced by the community in which we live (Shenfil, 2009). After retirement, ageing process is felt even more and indi- doi: https://doi.org/10.26493/978-961-7055-18-4.43-49 vidual is suddenly facing a fear for the future, he is trying to find new roles in society and has a lot of insecurities ageing can bring. That is why it is important to find a sense of transcendence, being a part of something beyond the self and trying to find meaning in life (Stevens, 2016). You try to live life to the full- est and age gracefully, which is a good catalyst for positive ageing. A term, used to describe the process of maintaining a positive attitude, feeling good about yourself, keeping fit and healthy, and engaging fully in life as you age (Den- mark and Zarbiv, 2016). Methods We used a descriptive research method with a critical review of Slovenian and English professional and scientific literature. It was carried out using the Slove- nian online library COBISS. We also used some databases such as MEDLINE (Pubmed), CINAHL, Cochrane, ScienceDirect and Wiley Online Library. We 44 were searching within ageing psychology field, coping with retirement and pos- itive ageing. We conducted a meta-synthesis. Literature inclusion criteria were articles published between 2007 and 2017, English language and appropriate lderly e content. The applied keywords in English were: (positive) ageing, older adults, f the elderly, retirement, psychological adjustment, psychology of ageing and posi- o tive view on ageing. The literature search took place from March to April 2018. alth Results ikov | he stn Ten studies were obtained that show tangible evidence on connection between taro preparation for old age, retirement and succesful (positive) ageing. e s Table 1: Overview of studies zdravj Author and year Purpose of research Methodology Results Preparation for old age implies several deci- sions that one needs to take such as making life- Exploring positive aging style changes (e.g., man- Craciun and Flick, 2015 goals in different social Qualitative study – epi- tain physical activity lev- circumstances. sodic interview el, decide where to live in old age and organize care facilities, changing eating or physical activi- ty patterns, etc.). Individuals place em- To provide a better un- phasis on adaptability derstanding of posi- and flexibility more than Craciun et al., 2015 tive views on aging in Qualitative study – epi- on stability and long an emerging precarious sodic interviews term planning, prov- context. ing they have adjusted to their precarious living conditions. Author and year Purpose of research Methodology Results To investigate whether positive views on aging Data reflects the impor- can compensate the det- tance of positive views Craciun et al., 2017 rimental association of Explanatory sequential on aging as a resource a lack of resources with mixed methods for a healthy old age de- health and well-being in spite aging in precarious midlife. circumstances. Variables and factors that are the most con- sistent predictors of To examine the preva- successful aging: men, Fernandez-Ballesteros et. lence of successful aging higher income, better al., 2011 and to identify the pre- Longitudinal study education, physical ac- dictors of aging criteria. tivity, positive emotion- al balance, extraversion, self-efficacy for aging and family network. Retirement led to signif- icant improvements in 45 To analyse if retirement self-reported health in Hessel, 2016 has effects on individu- Longitudinal study men and women as well als‘ health. as lowered risk of report- ciety ing limitations in activ- o ities of daily living for women. dern so Positive views on aging r m are significantly related o To examine potential mediators of the rela- to both subjective health tionship between per- and physical limitations. Hicks and Siedlecki, 2017 ceptions of aging and Longitudinal cohort More positive views on hallenge f health outcomes (i.e. study aging were associat- r c subjective health and ed with better reported n o physical limitations). health, as well as lower degree of self-reported physical limitations. eneratio Passion for work mat- ters in psychological ad- ung go To predict that harmo- justment to retirement f y nious passion will lead – especially harmonious Houlfort et al., 2015 to positive psychologi- Retrospective cross-sec- passion, because with blem o cal adjustment to retire- tional longitudinal study such a passion individu- ro ment. als can invest and engage in activities that satis- he p fy their basic psychologi- cal needs. geing: t Young males, married To obtain evi- individuals and those sitive a Paul et al., 2015 dence-based knowledge Cross-sectional study having higher education- po on how people age. al levels are aging more positively. Older adults are likely To investigate wheth- to experince positive af- fects if they treat them- Phillips and Ferguson, er self-compassion may selves with care and un- 2013 be associated with sub- Quantitative study jective and psychological derstanding to adverse well-being. events and hold painful thoughts and feelings in balanced awareness. Author and year Purpose of research Methodology Results The effect of retirement To find the impact and is impacted by working timing of the transition conditions before retire- Ryser and Wernli, 2017 to retirement on individ- Quantitative study ment, timing of retire- uals‘ emotions – positive ment and social partic- and negative affects. ipation at the time of retirement. Self-compassion has been identified as a strong predictor of psychological health among younger people, and some evidence suggest that it may represent a particularly important psychological resource for older adults as they strive to achieve positive ageing (Phillips and Ferguson, 2013). The most important and common factors for positive ageing are high education, being married, physical activity, positive emotional balance and strong social (or family) net- work. Previous findings show the impact of a positive view of ageing on health 46 by showing that this optimistic view positively affects subjective health and life satisfaction even in the face of a serious health event (Wurm et al., 2008). Be- liefs about ageing as expecting negative life changes like loneliness or disabili- lderly e ty, may be an important influence on older adults‘ motivation to persue new so- f the cial ties (Menkin et al., 2017). o There are also significant improvements in health after retirement, if alth there is proper social participation at the time of retirement and sufficient psy- chological adjustment to it. Retirement improves subjective health status and ikov | he stn mental health, while also reducing outpatient care utilization (Eibich, 2015). But it is not negligibly, retirement can also lead to a break with support net- taroe s works and friends, and may be accompanied by emotional or mental impacts of‚ "loneliness", "obolesce", or‚ "feeling old" (Coe and Zamarro, 2011). zdravj Discussion Positive ageing can be placed in the nomological network of ageing well: op- timal, successful, active, productive, and healthy ageing are relatively new concepts emerging during the last decades of the twentieth century (Fernan- dez-Ballesteros, 2011). Therefore, researchers have turned their attention from younger individuals who hold age stereotypes to those who are targeted by these stereotypes. Stereotype embodiment theory posits that when people in- ternalize prevalent negative age stereotypes, this influences how they actually age (Levy, 2009). So positive self-perception of ageing moderates the effects of stereotype threat, and that positive information promotes better memory per- formance for those older adults with a poorer self-perception of ageing (Fer- nandez-Ballesteros, 2015). Psychological ageing experience includes four dimensions: physical loss, social loss, personal growth, and gaining self-knowledge (Fasbender et al, 2014). Social loss presents loss of social contacts and a feeling of being less needed and less respected, while physical loss describes a decline of physical abilities and the loss of energy. Nevertheless, regular physical activity is a key component of healthy ageing, but few older adults meet physical activity guidelines (Andrews et al., 2017). Physical and social loss are two dimensions that cap- ture negative ageing experience, while on the other side, personal growth and gaining self-knowledge are two dimensions that capture positive ageing expe- rience. Continious personal development, such as learning new skills and im- proving one‘s capabilities are important part of personal growth. The dimen- sion of gaining self-knowledge describes the ageing process as self-acceptance and compensation (i.e. understanding one‘s capabilities and developing meth- ods to work around one‘s limitations) (Fasbender et al., 2014). Life expectancy has increased consistently for more than one century and continues to increase further, so we have to better understand ageing process and post-retirement feelings and emotions. The environment that will receive ageing population needs to be prepared so that there is a huminised caring en- vironment and also this place should have a proposal to offer opportunities to 47 health promotion of the elderly (Pilao et al., 2016). There are also various age- ing theories and its theoretical perspectives that will promote a better under- ciety standing among nurses about the attitudes and behaviors of older adults in dif- o ferent contexts (Lalani, 2017). dern so r mo Conclusions Older adults regard retirement as a positive thing and tend to reduce their so- cial contacts and activities. That is why the importance of physical activity and hallenge f r c social networking cannot be overestimated. There are different pathways to n o reach positive views on ageing. Those who find a sense of meaning in life tend to enjoy better physical health, experience fewer symptoms of depression, are eneratio more happier and age more gracefully. We think nurses need to have an in- depth understanding of the theoretical concepts and its meaning underlying ung go different theories of succesful ageing. This will assist nurses to provide ench- f y anced quality care in their practice settings. blem o Positive ageing nowadays is not that much of a problem of young gener- ro ation, then it is a challenge for modern society. We have to find new ways and he p programmes to encourage individuals to prepare themselvse on new life roles geing: t while leaving midlife period and entering pre-retirement period. It is impor- tant to build a strong psychological support and evolve positive ageing experi- sitive a ence on all four dimensions. po And our young generation? We have to start breaking negative ageing stereotypes and aim to coexistence and open-mind about going in to the same direction. References ANDREWS, R.M., TAN, E.J., VARMA, V.R., REBOK, G.W., ROMANI, W.A., SEEMAN, T.E., GRUENEWALD, T.L., TANNER, E.K. and CARLSON, M.C., 2017. Positive Aging Expectations Are Associated With Physical Activity Among Urban-Dwelling Older Adults. The Gerontologist, vol. 57, no. 2, pp. 178-186. COE, N.B. and ZAMARRO, G., 2011. Retirement effects on health in Europe. Journal of Health Economics, vol. 30, no. 1, pp. 77-86. CRACIUN, C. and FLICK, U., 2015. ‚"I want to be 100 years old, but I smoke too much": Exploring the gap between positive aging goals and reported pre- paratory actions in different social circumstances. Journal of Aging Stud- ies, vol. 35, no. 12, pp. 49-54. CRACIUN, C., GELLERT, P. and FLICK, U., 2015. Is healthy ageing for all? The role of positive views on ageing in preparing for a healthy old age in a pre- carious context. The European Health Psychologist, vol. 17, no. 2, pp. 79- 84. 48 CRACIUN, C., GELLERT, P. and FLICK, U., 2017. Aging in Precarious Cir- cumstances: Do Positive Views on Aging Make a Difference? The Geron- tologist, vol. 57, no. 3, pp. 517-528. lderly e DENMARK, F.L. and ZARBIV, T., 2016. Living Life to the Fullest: A Perspec- f the tive on Positive Aging. Women & Therapy, vol. 39, no. 3-4, pp. 315-321. o EIBICH, P., 2015. Understanding the effect of retirement on health: Mecha- alth nisms and heterogeneity. Journal of Health Economics, vol. 43, no. 0, pp. 1-12. ikov | he stn FASBENDER, U., DELLER, J., WANG, M. and WIERNIK, B.M., 2014. Decid- taro ing whether to work after retirement: The role of the psychological expe- e s rience of aging. Journal of Vocational Behavior, vol. 84, no. 3, pp. 215-224. zdravj FERNANDEZ-BALLESTEROS, R., 2011. Positive ageing: Objective, subjective, and combined outcomes. Electronic Journal of Applied Psychology, vol. 7, no. 1, pp. 22-30. FERNANDEZ-BALLESTEROS, R., 2015. Positive perception of aging and per- formance in memory task: compensating for stereotype threat? Experi- mental Aging Research, vol. 41, no. 4, pp. 410-425. FERNANDEZ-BALLESTEROS, R., ZAMARRON CASSINELLO, D., LOPEZ BRAVO, D., MOLINA MARTINEZ, A., DIEZ NICOLAS, J., MONTE- RO LOPEZ, P. and SCHETTINI DEL MORAL, R., 2011. Successful ag- ing: Criteria and predictors. Psychology in Spain, vol. 15, no. 1, pp. 94-101. HESSEL, P., 2016. Does retirement (really) lead to worse health among Europe- an men and women across all educational levels? Social Science & Medi- cine, vol. 151, no. 2, pp. 19-26. HICKS, S.A. and SIEDLECKI K.L., 2017. Leisure Activity Engagement and Pos- itive Affect Partially Mediate the Relationship Between Positive Views on Aging and Physical Health. Journals of Gerontology: Psychological Scienc- es, vol. 72, no. 2, pp. 259-267. HOULFORT, N., FERNET, C., VALLERAND, R.J., LAFRAMBOISE, A., GUAY, F. and KOESTNER, R., 2015. The role of passion for work and need satisfaction in psychological adjustment to retirement. Journal of Voca- tional Behavior, vol. 88, no. 1, pp. 84-94. LALANI, N., 2017. Positive aging, work retirement, and end of life: role of ger- otranscendence theory and nursing implications. i-manager‘s Journal of Nursing, vol. 7, no. 3, pp. 1-7. LEVY, B., 2009. Stereotype Embodiment: A Psychological Approach to Ag- ing. Current Directions in Psychological Science, vol. 18, no. 6, pp. 332-336. MENKIN, J.A., ROBLES, T.F., GRUENEWALD, T.L., TANNER, E.K. and SEE- MAN T.E., 2017. Positive Expectations Regarding Aging Linked to More New Friends in Later Life. Journals of Gerontology: Psychological Scienc- es, vol. 72, no. 5, pp. 771-781. PAUL, C., TEIXEIRA, L. and RIBEIRO, O., 2015. Positive Aging Beyond ‚"Suc- cess": Towards a More Inclusive Perspective of High Level Functioning in 49 Old Age. Educational Gerontology, vol. 41, no. 12, pp. 930-941. ciety PHILLIPS, W.J. and FERGUSON, S.J., 2013. Self-Compassion: A Resource for o Positive Aging. Journals of Gerontology Series B: Psychological Sciences dern s and Social Sciences, vol. 68, no. 4, pp. 529-539. o r m PILAO, S.J., RELOJO, D., TUBON, G. and SUBIDA, M., 2016. Positive Age- o ing and Perception of Loneliness among Elderly Population. Internation- al Journal of Scientific Research and Innovative Technology, vol. 3, no. 6, hallenge f pp. 105-114. r c RYSER, V.A. and WERNLI, B., 2017. How does transitioning into retirement n o impact the individual emotion system? Evidence from Swiss context. Ad- vances in Life Course Research, vol. 32, no. 12, pp. 42-54. eneratio SHENFIL, S., 2009. Pathways to Positive Aging: A Program to Build an Ag- ung go ing-Friendly Community. Journal of the American Society on Aging, vol. f y 33, no. 2, pp. 82-84. blem o STEVENS, B.A., 2016. Midfulness: A positive spirituality for ageing? Australa- ro sian Journal on Ageing, vol. 35, no. 3, pp. 156-158. he p WURM, S., TOMASIK, M.J. and TESCH-R ÖMER, C., 2008. Serious health geing: t events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view on ageing. European Journal of Ageing, sitive a vol. 5, no. 2, pp. 117-127. po Adaptability in living space for elderly people Jasna Hrovatin1, David Ravnik2 1 Faculty of Design, Associated member of University of Primorska, Prevale 10, 1236 Trzin, Slovenia 2 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia Abstract Introduction: Living environment is one of the factors that can contribute to healthy and safe ageing at home, providing that it is well adapted to the needs of older adults. On the contrary, it can cause stress, discomfort and lead to injuries, resulting in the loss of independence and autonomy. Methods: The aim of research was to determine; whether people are generally content with the functionalities that their homes, and if the degree of negative feedback increases with the ages of the users. We tended to pinpoint any major problems facing elderly people whilst living in their homes, and to establish a criteria for interior design that could be tailored with senior users in mind, particularly within the ambit of safety. A survey questionnaire was used as a research instrument among people older than 55 years. 210 people participated. Results: Common shortcomings include insufficient lighting (32 %), inappropriate sequential composition of work surfaces (56 %), ease of hygiene maintenance (68 %), inappropriately shaped furniture (72 %), and tasks that become troublesome because of declining memory (75 %). Discussion and conclusion: The results show that most users do not realize that they could, with more appropriate interior design, perform daily tasks faster, safer, and with less effort. Keywords: furniture, ergonomics, interior design, elderly, environment Owing to an increasingly higher standard of living as well as improve- ments in health care, the proportion of senior citizens in the general population is rapidly increasing. Statistical prognosis indicates that, by 2030, 36 % of people will be over the age of 60 (Hilderbrand, 2002). Information from the Statistical Office of the Republic of Slovenia states that, in 2018, the percentage of Slovenian citizens aged over 65 years of age was 19,4 % (Statistic doi: https://doi.org/10.26493/978-961-7055-18-4.51-58 Office RS, 2018). With the aging there had also been an increase in the number of people with health problems, mainly with sensory changes, cognitive changes, and weakness (Jaul and Barron, 2017). The quality of life is also dependent on the architecture. Architecture and urban planning affect us and our efforts to achieve a good life and dignified existence (SA, 2009). There are both positive and negative aspects implicit in the design of the buildings, which is important because senior citizens spend a great amount of time indoors. While elderly perform their daily indoor activr- ities, they are subjected to several risks. At the same time hygienic standards are crucial due to the increased susceptibility of the elderly to diseases and in- fections. Consequently, necessary steps need to be taken in the design of spaces where food is prepared and/or consumed (Torrington et al., 2004). In the mat- ter of flats (when elderly live in their own homes) Colombo and his colleagues (1998) identified the most commonly occurring problems facing the elderly, 52 where 1/3 of the flats were identified as having kitchen-security issues, while Boyo (2001) claims that 1/10 of elderly users suffer from difficulties regarding kitchen mobility. A good solution is to design modern residential units with ar- lderly e chitectural and furniture elements that are ergonomically adjusted for end-us- f the ers, from both the standpoint of safety and of functionality (Margolin, 1997). o Most flats are designed with young, fit, and active people in mind. Fur- alth thermore, inappropriately designed housing space can lead to health problems and injuries. Changes of the living space with the needs of the elderly can re- ikov | he stn duce the risk of injury by 30 % - 50 %. The age of the furniture and equipment in taro their homes also plays an important part in determining functionality. Almost e s 2/3 of the senior population who live in their homes have not been renovated or refurnished for over the 20 years, contributing to lower safety and comfort zdravj levels (Anon, 2006). Over 14 % of English elder citizens live in unfit conditions, in homes that are in dire need of renovation and adaptation (Boyo, 2001). On- ly 1/10 of them decide to modify their existing furniture and equipment to re- flect their special needs (Gilderbloom et al., 1996). They often refrain from ren- ovating due to financial concerns, lessening mobility and fear of the upheaval of renovation work. Furthermore, the elderly also suffers from inappropriate room dimensions including rooms which are too big for their (West and Em- mitt, 2004). We have homeless young adults and we have elderly couples living on in large detached houses and unwilling to move because of the exceptional financial disadvantage this would entail (SA, 2009). Methods The main aim of the current research was to discover whether people are sat- isfied with the functionalities of their kitchens and if they feel safe during us- ing them. The research was carried out via individual surveys. The survey on- ly includes people over the age of 55. 210 questionnaires were fulfilled, of which 204 were valid. The respondents were aged between 55 and 91 (Table 1). Most respond- ents, 76 %, were aged between 55 and 74. The survey consists of 75 % women and 25 % men. The questionnaire consists of 54 questions and was divided to 4 parts. Only a few data are present in this article. Full data were published in Drvna Industrija journal (Hrovatin et al., 2012). In the first part questions fo- cus on general data of respondents’ flats and number of people who live there. The second part of questionnaire examines tasks in the kitchen. The third part is collects functionality data concerning the kitchen and the final part exam- ines consumer behavior. In this paper we have been focused on questions con- cerning security and functionality matters. Table 1: Respondent age 55-64 years 65-74 years 75-84 years 85-90+ years Total Women 69 50 27 7 153 Men 21 16 12 2 51 53 Women and Men together 90 66 39 9 204 ple eo The majority (57 %) of respondents live in a single apartment home, whilst the remainder lives in houses with multiple apartments. When com- lderly pr e pared to the overall data for Slovenia, 64 % of households live in a single-apart- o ment house. This represents a satisfactory sample (Statistical Office of the Repub- pace f lic of Slovenia, 2002). iving s The survey was carried out in the respondents’ homes. Most questions n l were closed-ended, using a yes/no dichotomy, but some were multiple choice questions. Very few questions were open-ended. Regarding to information about the proper arrangements of work surfaces, the interviewer carrying out adaptability i the survey answered the questions after receiving detailed instructions on how to assess the arrangement. Results We were interested in the age of the respondents’ kitchen equipment. Table 2 shows that 35 % of respondents have a kitchen older than 20 years, whilst 52 % have a kitchen older than 15 years. Table 2: Ages of respondents’ kitchens KITCHEN AGE Less than 5 years 5-9 years 10-14 years 15-19 years 20-29 years More than 30 years Number of respondents 38 27 33 34 59 13 Percentage (%) 19 13 16 17 29 6 The results about satisfaction with their kitchen is shown in Table 3. It is noteworthy that 72 % of them were satisfied with their kitchen arrangements, despite most of the kitchens were identify as inadequate in their functional or ergonomic way. Table 3: Satisfaction with the degree of kitchen functionality YES NO Number of answers 147 57 Percentage (%) 72 28 Figure 1 includes results about what bothers the respondents the most in their kitchen. Only those who expressed dissatisfaction with their kitch- ens answered this question. Those who were dissatisfied with the functional- ity of their furniture and lighting identified elements as: inadequate lighting over the kitchen work surfaces and inside the cupboards, inappropriate height of shelves, oven, refrigerator, troublesome cleaning set-up (e.g. contact between 54 wall and work surface, contact between work surface and kitchen appliances), inadequate handle design (e.g. too small, slippery, fall off, in the way), hard-to- reach places in the corners or shelves under the cupboards. lderly e f the o alth ikov | he stn taroe s zdravj Figure 1: Graphical representation of respondents’ dissatisfaction with kitchen elements (N=57) Figure 2: Adequate arrangement of three main work areas Figure 2 shows a succession of elements that we deem appropriate. We took into consideration the darkly coloured parts. An appropriate width for a work surface was deemed to be between 60 and 150 cm. Over half (56 %) of the subjects had an inappropriate arrangement of the three main work areas (Ta- ble 4). Table 4: Respondents’ satisfaction with arrangement of the three main work areas and an adequate width of the main work surface YES NO Adequate arrangement of main areas and adequate width of main work surface 89 115 Percentage (%) 44 56 We were interested in the degree to which senior users were prepared to use modern technology and computers. Of the 15 who stated they use a com- puter, 14 were younger than 65. A somewhat higher percentage (21 %) would be 55 comfortable with using kitchen robots (Table 5). ple eo Table 5: Percentage of respondents who use a computer and those who would be willing to use a kitchen robot lderly pr eo YES NO Do you use a computer at home? Number of answers 27 177 pace f Percentage (%) 13 87 iving s Would you be prepared to use kitchen robots? Number of answers 43 161 n l Percentage (%) 21 79 Senior citizens are less agile, having more difficulty moving around a adaptability i room, which means they suffer from a greater risk of injury. We asked the re- spondents whether they bump into open cabinet cupboard or sharp surface and table edges whilst performing kitchen tasks. The results show that 72 % have had problems with bumping into doors or corners. Discussion It had originally been surmised that most senior users would be dissatisfied with the functionality of their kitchens. However, the majority (72 %) of re- spondents were indeed satisfied with their kitchen, even though 56% of them were found to have unsuitably arranged work surfaces, trouble with maintain- ing a hygienic environment, that over a third have unsuitable lighting arrange- ments, and that over half (52 %) of respondents have kitchens older than 15 years. The results show that users are typically unaware that they could per- form their daily tasks faster, with less effort, and more safely (Hrovatin et al., 2012). Those that were not satisfied with their kitchens gave surprising results, since most were uncomfortable with aesthetics rather than functionality. It had been anticipated that senior users would be more dissatisfied by the functionality of their kitchen, as they tend to suffer from restricted agility, sight and/or memory issues. . They become used to their kitchens and have limited desire for change. They typically attribute the problems they face when using their kitchen to their advancing age but are unaware that their problems could be decreased if the space were adapted to their needs. Therefore, household- ers over the age of 55 should already be looking into kitchens that are adapted for use by senior citizens to become accustomed to it whilst they are still active and will get used to new environments with greater ease (Hrovatin et al., 2012). Our research shows that 56 % of respondents have an inappropriate work surface arrangement. A more functional and safer kitchen working environ- ment is gained by appropriately arranging its elements. Particularly important is the arrangement of the kitchen sink, the main work surfaces and stove (Hro- vatin et al., 2015). An appropriate arrangement is one which allows the user to 56 remain in one spot whilst preparing food (slicing, cutting, peeling, washing), whilst and at the same time monitoring the food that is already being cooked (stirring, adding). Additionally, the adjacent position of the sink and stove lderly e would mean that the user needs to travel a shorter distance if he or she needs to f the pour away boiling water. Elderly tend to have sight and agility problems, which o compounds the problem of slippery floors in a kitchen. Every year, 30 % of us- alth ers over the age of 65 experience a fall in their kitchen, a danger that can lead to serious injury or even death (Stevens, 2005). Our research shows that as many ikov | he as 72 % of users bump into open doors and various sharp edges during kitchen stn work. That’s why design and ergonomy of the furniture is important. taroe s It is assumed that in the future, so-called „intelligent“ technology will make an important contribution to kitchen usage and will ease the workloads zdravj of users. Very few of the respondents use a computer and was expected that (79 %) would not want a robot in their kitchen. Many senior users have trou- ble adapting to new technology, and most of them have no wish for it at all. Now younger and middle aged are more familiar with computers so a robot- ically-aided kitchen will be much more attractive to elderly users in the fu- ture. „Smart“ kitchen appliances are step in this direction. Elderly with mem- ory issues tend to leave stoves on, which can easily create a fire hazard. From the point of view of safety, this means intelligent stoves with the option of set- ting cooking times and automatic shut-off systems when operating with an empty container or without one at all. Intelligent refrigerators are also a wel- come addition, for example ones capable of ordering groceries on the internet via a display on the refrigerator door. The refrigerator monitors one’s food in- side via labels and barcodes, whilst also noting the purchase dates of products, and then warning about the expiry date. Use is not complicated, and as senior users tend to have problems with mobility, this addition could be of invaluable help to them. Due to the senior users’ difficulties in keeping up with new tech- nologies it would be necessary to carefully select those appliances that are easy to use and have clear, intuitive interfaces (Hrovatin et al., 2012). It will be nec- essary however, as Casals et al. (2000) determined, to make the commands and controls simple, easy-to-use and user-friendly. Conclusions Most users who renovate their kitchen at an older age count on it being used for the rest of their lives. The results of this research show that most people are un- aware of the importance of ergonomic adaptations to the specific needs that old age brings. Manufacturers should design kitchen furniture systems that would allow for implementation adapted for special needs and should inform buyers more about the significance of an adequately furnished kitchen, heeding the needs of advanced age. Considering that designers during planning space and furniture have in mind the 19 to 65 age-group, the modern kitchen furniture neglects the needs of the elderly. Therefore, our findings corelate to the Dorst and Cross (2001), 57 who recommend for successful design the interaction between goals and ideas. In the future, we would broaden the research to include other parts of residen- ple eo tial unit, thus providing criteria for the design of homes for the elderly. lderly p References r eo ANON, 2006. Home Remodeling - Why Is Home Modification And Repair Important? pace f [online]. [viewed 17 August 2016]. Available from: http://www.aoa.gov/eldfam/ Housing/Home_Remodeling/Home_Remodeling.asp iving sn l BOYO, S., 2001. When a house is not a home. Older People and their housing, London: AGE – Age Concern England: 65 COLOMBO, M., VITALI, S., MOLLA, G., GIOIA, P. and MILANI, M., 1998. The home adaptability i environment modification program in the care of demented elderly. Arch. Ger- ontol.Geriatr.suppl. vol. 6, pp. 83-90. CASALS, A., CUFI, X., FREIXENET, J., MARTI, J. and MUNOZ, X., 2000. Friendly interface for objects selection in a robotized kitchen, ICRA 2000: IEEE Interna- tional Conference on Robotics and Automation, San Francisco, 24-28. 4. 2000, Institute of Electrical and Electronics Engineers Inc. DORST, K. and CROSS, N., 2001. Creativity in the design process: co-evolution of problem-solution. Design Studies, vol. 22, pp. 425–437. GILDERBLOOM, J.I., AFFAIRS, U. and MARKHAM, J.P., 1996. Housing Modification Needs of the Disabled Elderly: What Really Matters? Envi- ronment and Behavior, vol. 28, no. 4, pp. 512-535. HILDERBRAND, H., 2002. Für Ältere und Behinderte. BM, vol. 57, no. 3, pp. 36. HROVATIN, J., ŠIROK, K., JEVŠNIK, S., OBLAK, L. and BERGINC, J., 2012. Adaptability of kitchen furniture for elderly people in terms of safety. Drvna industrija, vol. 63, no. 2, pp. 113-120. HROVATIN, J., PREKRAT, S, OBLAK, L. and RAVNIK, D., 2015. Ergonomic suitability of kitchen furniture regarding height accessibility. Collegium antropologicum, vol. 39, no. 1, pp. 185-191. JAUL, E. and BARRON J., 2017. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Pub- lic Health, vol. 5: 335. MARGOLIN, V., 1997. Getting to know the user. Design Studies, vol. 18, pp. 277-236. SA - SWEDISH ASSOCIATION OF ARCHITECTS, 2009. Architecture and Politics - An architectural policy for Sweden 2010–2015. [online]. [viewed 20 July 2018]. Available from: https:/ www.ace-cae.eu/fileadmin/New_Up- load/6._Architecture_in_Europe/EU_Policy/SE-report.pdf STATISTICAL OFFICE OF THE REPUBLIC OF SLOVENIA, 2002. Population Census results 2002, Households in dwellings by tenure status, type of build- 58 ing, number of rooms, useful floor space, utility spaces, installations and type of settlemen. Slovenia. [online]. [viewed 19 July 2018]. Available from: http:/ www.stat.si/popis2002/si/rezultati/rezultati_red.asp?ter=SLO&st=44 lderly e STATISTICAL OFFICE OF THE REPUBLIC OF SLOVENIA, 2018. Population by age f the o groups and sex, statistical regions, Slovenia. [online]. [viewed 1 July 2018]. Avai - alth lable from: http://www.stat.si/StatWeb/Field/Index/17/104 STEVENS, J.A., 2005. Falls Among Older Adults— Risk Factors and Prevention Strat- ikov | he egies. Journal of Safety Research, vol. 36, no. 4, pp. 409-411. stn TORRINGTON, J.; BARNES, S.; KEVIN, M.; KEVIN, M. and TREGENZA, P., 2004. taro The influence of Building Design on the Quality of Life of Older People. Archi- e s tectural Science Review, vol. 47, no. 2, p. 193-197. zdravj Effects of enough omega-3 fatty acids on cardiovascular system in the elderly Samo Kotnik, Alja Mikec, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia Abstract Introduction: Cardiovascular diseases represent a significant risk factor. In the EU alone, they result in over 1.8 million deaths annually (37%). In 2014, 6.1 million new cases were discovered and their total number rose to almost 50 million. Diet plays an important role, because when it is unhealthy, it can make the disease worse. But when it is healthy, diet can act as a protective factor against cardiovascular diseases. The elderly pose a special challenge, because they represent an increasingly big part of our population. They also have lower caloric intake needs, which puts them at a higher risk of malnutrition. Methods: The descriptive research method with a critical review of Slovene and English professional and scientific literature was used. We conducted a meta-synthesis, using studies published between 2007 and 2017. Results: In the elderly, higher consumption of functional foods, such as omega-3 fatty acids, seems necessary. The amount of omega-3 fatty acids required to lower the risk of cardiovascular complications is expected to be at least 0.5 g higher than the daily recommended amount. Lower food consumption and consequential need to find the right meal composition therefore represent the biggest challenges. Discussion and conclusions: Based on previous research and findings, guidelines for further research and sufficient omega-3 consumption among the elderly will be presented. Key words: health of the elderly, elderly diet, nutraceutics, cardiovascular disease, omega-3. Cardiovascular diseases are illnesses which affect the vessels and are the leading cause of premature death among the adult population in the EU (Fan and Kenny, 2018). In 2014, they resulted in 1.8 million deaths (37.1 doi: https://doi.org/10.26493/978-961-7055-18-4.59-66 %), 6.1 million new cases were discovered and their total number rose to almost 50 million. They do not only represent a vast healthcare challenge but a considerable financial and economic problem as well, since they cost the EU approx- imately 169 billion EUR annually (Eurostat, 2017). Mechanisms which lead to cardiovascular diseases are different, but they are all connected by the fact that in over 90 % of cases they can be prevented. The elderly represent an increas- ingly big part of the population. It is estimated, that by 2050, 35 % of the pop- ulation will be older than 65. Ensuring a healthy and quality ageing therefore presents the greatest challenge (Ubeda et al., 2012). Healthy and balanced diet, adjusted to the needs of an elderly person, plays an important role (IVZ, 2010; Eilat-Adar et al., 2013). Olfactory, gustatory and gastrointestinal changes are typical in elderly and they can result in apetite reduction, thirst and manifest in a slower peri- stalsis, lower amounts of gastric acid secretion together with lower absorption 60 and metabolic ability (IVZ, 2010; Molfino et al., 2014). On the account of re- duced bodily functions, lowered muscular mass and lesser physical activity, en- ergy needs are reduced as well, which can result in malnutrition. Malnutrition lderly e can be prevented by consuming functional foods, such as omega-3 fatty acids, f the that are classified as essential double bond fatty acids, which are indispensa- o ble in a healthy diet, the ageing process and cardiovascular diseases prevention alth (Tur et al., 2012; Ubeda et al., 2012). ikov | he Methods stn taro We used a descriptive research method with a critical review of Slovenian and e s English professional and scientific literature. It was carried out using the Slo- venian bibliographic catalog database COBIB.si, Medline (Pubmed), Cochrane zdravj and Google Scholar. We conducted a meta-synthesis. Literature inclusion crite- ria were articles published between 2007 and 2017, Slovene or English language and appropriate content. The applied keywords in English were: elderly health, elderly diet, omega-3 fatty acids, elderly diet AND omega-3, elderly AND nutri- tional status, nutraceutics, elderly AND cardiovascular disease, omega-3 AND cardiovascular disease, functional food AND cardiovascular disease. Slovene literature search was performed using the following keywords: zdravje starost- nikov, prehrana starostnikov, srčno-žilna obolenja. Statistic data on cardiovas- cular diseases was acquired on website of Eurostat, European Commission. The literature search took place from February to April 2018. Results Sixteen studies were obtained that show tangible evidence on the connection between omega-3 fatty acids and reduced risk of cardiovascular disease, along with the additional amount needed to achieve the cardioprotective effect (Ta- ble 1). Table 1: Overview of studies Author/year Purpose of research Methodology Results The risk of cardiovascu- To compare individu- lar disease is reduced by Alissa and Ferns, 2012 al dietary compounds in a diet rich in function- terms of their cardiovas- Literature review al foods, such as poly- cular protection. unsaturated fats, nuts and fish. Additional 500 mg of To summarize the ef- omega-3 fatty acids per fects of omega-3 fatty ac- day in patients with- out chronic heart dis- Cao et al., 2014 ids in prevention of car- diovascular diseases and A literature review ease and 1 g in patients determine the required with chronic heart dis- amount. ease is recommended to achieve the cardiopro- tective effect. To investigate the pre- Long-term effect of high ventive effect of 1 g/day dose omega-3 fatty acid 61 Casula et al., 2013 of omega-3 fatty acid supplementation can be supplements to patients A meta-analysis. beneficial against the on- with existing cardiovas- set of cardiac death and lderly cular disease. myocardial infarction. he e To determine the effects n t of omega-3 long chain The consumption of Dawczynski et al., 2010 polyunsaturated fatty A cross-sectional study. omega-3 supplemented ystem i acid supplemented prod- products decreases car- ucts on cardiovascular diovascular risk factors. risk factors. To update the current Marine omega-3 fatty ac- evidence on the influ- ids are effective in pre- Delgado-Lista et al., 2012 ence of omega-3 on the A systematic review. venting cardiovascular ardiovascular s rate of cardiovascular events in persons with n c events. high cardiovascular risk To evaluate associations Increased consumption cids o de Oliveira Otto et al., between circulating bio- of omega-3 from sea- marker, dietary omega-3 A prospective cohort food may prevent cardi- atty a 2013 and cardiovascular dis- study. ovascular disease devel- 3 f ease events. opment. ega-m The mediterranean diet To summarize the litera- has been shown to re- ugh o Eilat-Adar et al., 2013 ture on the association of A literature review duce cardiovascular no nutrition and CVD. morbidity in prima- f e ry and secondary pre- vention. The evidence suggests effects o Analysis of cardiovascu- that omega-3 fatty ac- Filion et al., 2010 lar efficacy of omega-3 A meta-analysis. ids may result in a mod- fatty acids. est reduction in mortali- ty and stenosis. To establish a dietary A minimum addition- reference intake of long- al intake of 500 mg Flock et al., 2013 chain omega-3 fatty ac- A literature review omega-3 daily is rec- ids for cardiovascular ommended for adults protection. without chronic heart disease. Author/year Purpose of research Methodology Results The target consumption should be at least 500 To assess the evidence mg/day for individuals without underlying car- Lavie et al., 2009 showing the benefits of omega-3 polyunsaturat- Literature review. diovascular diseases and ed fatty acids. at least 800 to 1,000 mg/ day for those with well known coronary heart disease. To examine the associ- Intake of marine ome- Levitan et al., 2009 ations of fatty fish and A prospective cohort ga-3 fatty acids was asso- omega-3 intake with study. ciated with lower rates of heart failure. heart failure. Moderate consumption To examine the associa- of fatty fish and marine Levitan et al., 2010 tion of marine omega-3 A meta-analysis. omega-3 were associated with heart failure. with a lower rate of first heart failure hospitaliza- 62 tion or death. To investigate the effect Increased dietary con- Merino et al., 2014 of increased omega-3 A prospective cohort sumption of omega-3 consumption on periph- study. improves peripheral vas- lderly e eral artery function. oactivity. To assess if habitual con- Vascular endothelial cell f the o sumption of omega-3 ac- function is improved Mozaffarian et al., 2008 ids is associated with A prospective cohort and arrhytmic risk re- alth more favorable heart rate study. duced by omega-3 fatty variablity. acid intake. ikov | he To study the effects of Dietary fish oil-based stn marine omega-3 fatty acid supplementation in supplementations were taro Shen et al., 2017 older adults with hyper- Experimental study. safe and effective in re- e s tension and/or hyper- ducing blood pressure cholesterolemia. and blood cholesterol. zdravj To assess the effect of Supplementation of Wang et al., 2012 omega-3 fatty acid sup- omega-3 fatty acids sig- plementation on en- A meta-analysis. nificantly improves the dothelial function. endothelial function. Scientific findings show that omega-3 polyunsaturated fatty acids can help reduce the effect of cardiovascular risk factors. These include hyperten- sion, hyperlipidaemia, elevated amounts of low-density lipoprotein (LDL) and elevated inflammatory marker levels (Alissa, Ferns, 2012; Shen et al., 2017). Fur- thermore, increased consumption of omega-3 can help prevent cardiovascular events in those with high cardiovascular risks and reduce cardiovascular mor- bidity in both primary and secondary prevention (de Oliveira Otto et al., 2013; Eilat-Adar et al., 2013). It can also reduce the rate of first heart failure (Levitan et al., 2009; Levitan et al., 2010), improve peripheral vasoactivity (Merino et al., 2014), delay the onset of cardiovascular disease, cardiac death, myocardial in- farction (Casula et al., 2013), reduce stenosis as well as consequential mortali- ty (Filion et al., 2010). With the recommended daily intake of omega-3 fatty acids, the risk of death as a result of cardiovascular causes can be reduced by up to 16 % and my- ocardial infarction by up to 24 % (Tur et al., 2012). However, the exact amount of omega-3 fatty acids needed to achieve better cardioprotective effect is a sub- ject of an ongoing debate among scientists. Studies agree that along with the recommended daily consumption of 1.1 g per day for women and 1.6 g for men, an additional 0.5-0.8 g should be consumed by individuals without chronic heart disease and 1-1.3 g by those with chronic heart disease (Lavie et al., 2009; Flock et al., 2013; Cao et al., 2014). Sufficient amounts can be achieved by means of consuming function- al foods, such as nuts and fish or through supplementation of fish oil or oth- er products (Dawczynski et al., 2010; Delgado-Lista et al., 2012; Wang et al., 2012). Lower food consumption in the elderly, mainly due to lower caloric in- take and the subsequential need to restructure meal composition, presents the main challenge in achieving the sufficient consumption of omega-3 (Mudge et 63 al., 2010). lderly Discussion he e Correct meal planning is essential when it comes to achieving enough omega-3 n t consumption and cardiovascular protection among the elderly. Beside lower ystem i food consumption, they can also lack in knowledge and economic means (Iiza- ka et al., 2008; Vanderwee et al., 2010). Since there is no single correct way to achieve the correct meal compo- sition, modelling based on guidelines and diets seems sensible. One such di- ardiovascular s et is the Mediterranean diet, which is characterized by a high omega-3 fatty n c acid intake, from fish (such as mackerel, sardines or salmon) and plant (such cids o as broccoli or spinach) sources. The diet also includes seasonal vegetables and fruits, whole grains and wholegrain bread, olive oil and nuts. If adequate fish atty a3 f consumption cannot be achieved because of the economic factors, substitution ega- with nuts, such as walnuts, cashews or Brazil nuts is justified (Eilat-Adar et al., m 2013; Estruch et al., 2013). ugh o As an alternative or complementary to Mediterranean diet, DASH (Di- nof e etary Approaches to Stop Hypertension) guidelines could be used. Primary goal of DASH is to lower the hypertension, but since it promotes consumption effects o of similar food types to Mediterranean diet (with emphasis on lower salt and higher low-fat dairy product intake), its use in general cardiovascular disease prevention is possible (Folsom et al., 2007). Conclusion With the available statistical data, it is clear that cardiovascular diseases rep- resent a problem that will become even more important with growing share of the elderly in our population. Recommended daily intake of omega-3 can re- duce the risk of cardiovascular risk factors, but increased consumption can help achieve a better cardioprotective effect. Two diets that recommend high omega-3 consumption are the Mediterranean diet and DASH. This information could be used to raise awareness of cardiovascular diseases on the prima- ry level, to encourage lifestyle changes on secondary level and prevent compli- cations on tertiary level of healthcare. Based on the studies we obtained and their results, further research of this topic is warranted. The additional amount of omega-3 needed to achieve the cardioprotective effect should be worked out more precisely. The second re- search focus could be on how to achieve enough omega-3 consumption among different cultures with different dietary habits. Future research should also fo- cus on how to get the information to the elderly and their health education – to encourage them to follow the proposed dietary patterns. References 64 ALISSA, E.M. and FERNS, G.A., 2012. Functional foods and nutraceuticals in the primary prevention of cardiovascular diseases. Journal of Nutrition lderly e and Metabolism, vol. 3, no. 12, pp. 1–16. f the CAO, Y., LU, L., LIANG, J., LIU, M., LI, X., SUN, R.R., ZHENG, Y. and PEI- o YING, Z., 2014. Omega-3 fatty acids and primary and secondary preven- alth tion. Cell Biochemistry and Biophysics, vol. 72, no. 1, pp. 77–81. ikov | he CASULA, M., SORANNA, D., CATAPANO, A.L. and CORRAO, G., 2013. stn Long-term effect of high dose omega-3 fatty acid supplementation for sec- taro ondary prevention of cardiovascular outcomes: a meta-analysis of ran- e s domized, placebo controlled trials. Atherosclerosis Supplements, vol. 14, zdravj no. 2, pp. 243–51. DAWCZYNSKI, C., MARTIN, L., WAGNER, A. and JAHREIS, G., 2010. Ome- ga-3 LC-PUFA-enriched dairy products are able to reduce cardiovascu- lar risk factors: a double-blind, cross-over study. Clinical nutrition, vol. 29, no. 5, pp. 592–9. DELGADO-LISTA, J., PEREZ-MARTINEZ, P., LOPEZ-MIRANDA, J. and PEREZ-JIMENEZ, F., 2013. Long chain omega-3 fatty acids and cardio- vascular disease: a systematic review. British Journal of Nutrition, vol. 67, no. 6, pp. 201–13. DE OLIVEIRA OTTO, M.C., WU, J.H.Y., BAYLIN, A., VAIDYA, D., RICH S.S., TSAI, M.Y., JACOBS, D.R. and MOZAFFARIAN, D., 2013. Circu- lating and dietary omega-3 and omega-6 polyunsaturated fatty acids and incidence of CVD in the multi-ethnic study of atherosclerosis. Journal of the American Heart Association, vol. 2, no. 6, pp. 1–17. EILAT-ADAR, S., SINAI, T., YOSEFY, C. and HENKIN, Y., 2013. Nutritional recomendations for cardiovascular disease prevention. Nutrients, vol. 5, no. 9, pp. 3646–83. ESTRUCH, R., ROS, E., SALAS-SALVADO, J., COVAS, M.I., CORELLA, D., AROS, F., GOMEZ-GRACIA, E., RUIZ-GUTIERREZ, V., FIOL, M., LA- PETRA, J. et al., 2013. Primary prevention of cardiovascular disease with a mediterranean diet. The New England Journal of Medicine, vol. 368, no. 14, pp. 1279–90. EUROSTAT, 2017. Cardiovascular disease statistics [online]. [viewed 26 March 2018]. Available from: http:/ ec.europa.eu/eurostat/statistics-explained/in- dex.php/Cardiovascular_diseases_statistics FAN, C.W. and KENNY, R.A., 2008. Management of cardiovascular risk in the older person. In: D‘AGOSTINO, R.B., GRAHAM, I.M. eds. Therapeutic strategies in cardiovascular risk. Oxford: Atlas Medical Publishing Ltd, 59–76. FILION, K.B., EL KHOURY, F., BIELINSKI, M., SCHILLER, I., DENDUKU- RI, N. and BROPHY, J. M., 2010. Omega-3 fatty acids in high-risk cardi- 65 ovascular patients: a mety-analysis of randomized controlled trials. BMC Cardiovascular Disorders, vol. 10, no. 24, pp. 1–11. lderly FLOCK, M.R., HARRIS, W.S. and KRIS-ETHERTON, P.M., 2013. Long-chain he e omega-3 fatty acids: time to establish a dietary reference intake. Nutrition n t reviews, vol. 71, no. 10, pp. 692–707. ystem i FOLSOM, A.R., EMILY, D.P. and HARNACK, L.J., 2007. Degree of concord- ance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. American Journal of Hypertension, vol. 20, no. 3, pp. 225–32. ardiovascular s IIZAKA, S., TADAKA, E. and SANADA, H., 2008. Comprehensive assess- n c ment of nutritional status and associated factors in the healthy, commu- cids o nity-dwelling elderly. Geriatrics & Gerontology International, vol. 8, no. atty a 1., pp. 24–31. 3 f INŠTITUT ZA VAROVANJE ZDRAVJA REPUBLIKE SLOVENIJE, 2010. ega-m Prehrana in telesna dejavnost za zdravje pri starejših – pregled stanja [on- line]. [viewed 30 March 2018]. Available from http:/ www.nijz.si/sites/ ugh ono www.nijz.si/files/uploaded/prehranaintelesnadejavnoststarejsih_4940.pdf f e LAVIE, C.J., MILANI, R.V., MEHRA, M.R. and VENTURA, H.O., 2009. Ome- ga-3 polyunsaturated fatty acids and cardiovascular diseases. Journal of effects o the American College of Cardiology, vol. 54, no. 7, pp. 585–94. LEVITAN, E.B., WOLK, A. and MITTLEMAN, M.A., 2009. Fish consump- tion, marine omega-3 fatty acids and incidence of heart failure: a popula- tion-based prospective study of middle-aged and elderly men. European Heart Journal, vol. 30, no. 12, pp. 1495–500. LEVITAN, E.B., WOLK, A. and MITTLEMAN, M.A., 2010. Fatty fish, marine omega-3 fatty acids and incidence of heart failure. European Journal of Clinical Nutrition, vol. 64, no. 6, pp. 587–94. MERINO, J., SALA-VILA, A., KONES, R., FERRE, R., PLANA, N., GIRONA, J., IBARRETXE, D., HERAS, M., ROS, E. and MASANA, L., 2014. In- creasing long-chain n-3PUFA consumption improves small peripher- al artery function in patients at intermediate-high cardiovascular risk. Journal of Nutritional Biochemistry, vol. 48, no. 25, pp. 642–6. MOZAFFARIAN, D., STEIN, P.K., PRINEAS, R.J. and SISCOVICK, D.S., 2008. Dietary fish and omega-3 fatty acid consumption and heart rate variability in US adults. Circulation, vol. 117, no. 9, pp. 1130–7. MUDGE, A.M., ROSS, L.J. YOUNG, A.M., ISENRING, E.A. and BANKS, M.D., 2010. Helping understand nutritional gaps in the elderly (HUN- GER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatiens. Clinical Nutrition, vol. 30, no. 3, pp. 320–5. SHEN, T., XING, G., ZHU, J., ZHANG, S., CAI, Y., LI, D., XU, G., XING, E., 66 RAO, J. and SHI, R., 2017. Effects of 12-week supplementation of marine omega-3 PUFA-based formulation Omega3Q10 in older adults with pre- hypertension and/or elevated blood cholesterol. Lipids in Health and Dis- lderly e eases, vol. 16, no. 1, pp. 1–11. f the TUR, J.A., BIBILONI, M.M., SUREDA, A. and PONS, A., 2012. Dietary sourc- o es of omega 3 fatty acids: public health risks and benefits. British Journal alth of Nutrition, vol. 66, no. 6, pp. 23-52. ikov | he UBEDA, N., ACHON, M. and VARELA-MOREIRAS, G., 2012. Omega 3 fatty stn acids in the elderly. British Journal of Nutrition, vol. 66, no. 6, pp. 137–51. taro VANDERWEE, K., CLAYS, E., BOCQUAERT, I., GOBERT, M., FOLENS, B. e s and DEFLOOR, T., 2010. Malnutrition and associated factors in elderly zdravj hospital patients: a Belgian cross-sectional, multi-centre study. Clinical Nutrition, vol. 29, no. 4, pp. 469–76. WANG, Q., LIANG, X., WANG, L., LU, X., HUANG, J., CAO, J., LI, H. and GU, D., 2012. Effect of omega-3 fatty acids supplementation on endothe- lial function: a meta analysis of randomized controlled trials. Atheroscle- rosis, vol. 43, no. 2, pp. 536–43. Nutritional Treatment of the Elderly in Nursing Homes Urša Mršnik, Eva Žaberl, Miha Kranjc DEOS, celostna oskrba starostnikov, d.d., Gmajna 7, 1357 Notranje Gorice, Slovenia Abstract Introduction: The number of elderly individuals is increasing, due to longer life expectancy. Malnutrition is widespread among the elderly living at home, hospitalized or in nursing homes. Nutritional status affects the quality of life, increases morbidity and mortality. With nutrition treatment, we would like to improve our residents’ quality of life and improve the role of dietitian in nursing homes. Methods: The literature search was carried out in Pubmed, ScienceDirect, Google Scholar and Medline. A filter was applied in order to select papers published in the last 10 years. All types of studies were included. Our research was conducted from April 2017 to March 2018 in seven nursing homes. 1310 residents were included, aged over 65 years. On the basis of MNA-SF® (Mini Nutritional Assessment – Short Form®), we identified undernourished residents. Depending on the degree of malnutrition, we have established appropriate nutritional support. Results: Initial screening showed that in our nursing homes, 50.6 % had good nutritional status, 29.2 % were at risk of malnutrition and 20.2 % malnourished. In March 2018 46.6 % had good nutritional status, 39.9 % were at risk of malnutrition, and 13.5 % malnourished. Discussion: We begin nutritional treatment for every new resident, since early recognition of malnutrition and appropriate measures significantly affect quality of life. We are learning new approaches to nutritional treatment and are expanding the range of measures that will provide healthy life for residents. At the same time, we want to improve the role of dietitian in all nursing homes. Key words: nutrition screening, malnutrition, elderly, nursing home doi: https://doi.org/10.26493/978-961-7055-18-4.67-74 In recent years we have witnessed a dramatic increase in the global elderly population (Boateng and Jeptanui, 2016). In Slovenia, 19.4 % of population is aged 65 or more (Statistical Office of the Republic of Slovenia, 2018). With advances in medicine helping more people to live longer lives, it has been esti- mated that between 2015 and 2050, the number of the elderly will double glob- ally (Boateng and Jeptanui, 2016). Chronic diseases are the main reason for most health problems in old- er age. It is possible to prevent or delay the onset of many of them by engag- ing in healthy behaviors, earlier in life. Many studies suggest that even in very advanced years, physical activity and good nutrition can have powerful bene- fits for health and wellbeing (WHO, 2015). Ageing causes numerous changes in health and the performance of the body. Nutrition plays important role in health maintenance. Changes like decreased salivation, difficulty in swallow- ing, and delay in the emptying of the stomach and esophagus, as well as low- 68 er gastrointestinal movement, affect the ability to maintain good nutritional status. As a result, the elderly are a potentially vulnerable group for the risk lderly of malnutrition (Abolghasem Gorji et al., 2017). One of the changes notable e in the elderly is a decrease in appetite, which can be caused by changes to the f the o physiology, in psychological functioning, in social circumstances, acute illness, alth chronic diseases and the use of medication. Higher rates of appetite decline oc- cur in women, nursing home residents, hospitalized people, and with age (Pil- ikov | he grim et al., 2015). stn Current public health approaches to population ageing have not been ef- taro fective. The health of older people is not keeping up with increasing longev- e s ity (Chatterji et al., 2015). Current health systems are poorly aligned with the zdravj needs of older populations (Smith et al. 2012 and Oliver et al., 2014). Long-term care models are both inadequate and unsustainable (Beard and Petitot, 2011). Malnutrition is a common healthcare problem that predominantly af- fects the elderly population. It has an effect on increasing morbidity and mor- tality, lowers the quality of life, extends hospital stays and raises the costs of care. Malnutrition is common at all levels of healthcare, from primary to spe- cialized and also in nursing homes. Malnutrition is known to be the most fre- quent cause of disability in the elderly that are living at home, hospitalized or in a nursing home (Cuerda et al., 2016). In Slovenia, a dietitian is usually not part of the personnel structure of nursing homes. The employment of dietitians in nursing homes in not yet es- tablished although the importance of good nutritional status in well known. That is why we decided to employ a dietitian and implement a series of actions in order to improve the nutrition status of our residents with the bigger goal of improved quality of life. Hopefully those actions will become widespread on a national level and nutritional treatment will be implemented in all nurs- ing homes. Methods The literature search was carried out in four databases, Pubmed, ScienceDirect, Google Scholar and Medline, and was completed with a manual search on the basis of the references given in the selected papers. Filter was applied in order to select papers published in the last 10 years. In order to be included, papers had to examine nutritional status of elderly, 65 years old or more. All types of studies were included. Research was conducted to determine the prevalence of malnutrition in our nursing homes and compare the prevalence before nutritional treatment with prevalence after establishment of nutritional treatment and to compare our results with the literature. The eligibility criteria were the following: age 65 years and older, residents of DEOS nursing homes and willingness to partici- pate in nutritional treatment. 1310 residents were included. The MNA-SF® (Mini Nutritional Assessment – Short Form®) was used as the nutritional screening instrument in accordance with ESPEN recommendations (Cederholm et al., 69 2017). All the data and measurements were collected by health care profession- esm als in cooperation with a clinical dietitian to assure unified measurements and o evaluation of MNA- SF®. ursing h n n Results Literature review lderly i he e Many studies have been conducted to evaluate the prevalence of malnutri- f t tion across a population that embraces different levels of healthcare. The ent o DREAM+65 Study used MNA screening-assessment instrument and showed the prevalence of malnutrition in hospitals to be 21.7 % and the risk of mal- reatm nutrition 46.6 %. In nursing homes, the prevalence of malnutrition and the nal t risk of malnutrition is slightly lower than in hospitals; 30.9 % of elderly are at risk of malnutrition and 15.6 % are malnourished (Cuerda et al., 2016). Results nutritio of a study carried out in 11 nursing homes in Sweden evaluated 318 subjects. The prevalence, according to MNA assessment of malnutrition was 17.7 % and for the risk of malnutrition, 40.3 %. After 24 months, the nutritional status of 38.7 % subjects worsened (Bolmsjö et al., 2014). A Turkish study was conduct- ed on 402 nursing home residents. The aim of this study was to determine the prevalence of malnutrition risk and sarcopenia in elderly nursing home res- idents. According to MNA, 56.5 % of subjects had normal nutritional status, 24.8 % were at risk of malnutrition and 18.7 % were malnourished (Sakaa et al., 2015). Aukner et al. conducted research across Oslo’s 21 nursing homes. 358 res- idents with dementia or cognitive impairment, of whom 46 % lived in special care units, were included. Nutritional status was assessed using the Malnutri- tion Universal Screening Tool (MUST) and anthropometry. 67 % were classi- fied as being at low risk, 20 % at medium risk, and 13 % at high risk of malnutri- tion. There was no significant difference between residents in open and special care units, assessed by MUST (Aukner et al., 2013). A study conducted in Leb- anese long-term care nursing homes described the differences between elderly men and women on socio-economic, health and nutritional status. Data was obtained from 221 residents; 148 (67 %) women and 73 (33 %) men, living in 36 nursing homes. The prevalence of malnutrition was 3.2 % and of risk of malnu- trition 27.6 %. There was no statistically significant difference between women and men on MNA (Doumit et al., 2014). Guidelines for nutritional treatment vary across countries. Slovenia has some guidelines for nutritional treatment in nursing homes, that are derived from ESPEN guidelines. There are few main points of the guidelines. Nutrition should be part of general care for elderly people in nursing homes (Volkert et al., 2006). Nutrition screenings should be frequent. We must act as soon as we notice a deviation from the normal (Volkert et al., 2006 and Kondrup et al., 2003). Nutritional screening is performed in the elderly once a week. To screen 70 the nutritional status of the elderly, we use the MNA to identify malnutrition and the risk of malnutrition (Kondrup et al., 2003). lderly e f the Implementing nutritional support in nursing homes o alth At the beginning of our research in April 2017, we included 105 residents and one nursing home. Initial screening showed 50.6 % of residents had normal ikov | he nutritional status, 29.2 % were at risk of malnutrition and 20.2 % were malnour- stn ished. With the aim of improving the nutritional status of our residents, we im- taroe s plemented some actions, presented in the second column of Table 1. zdravj Table 1: Measures to improve nutritional status FIELD OF ACTION ACTIONS FUTURE PLAN In 2017, we employed a dietitian. In 2017, we gradually implement- ed nutritional screening. In 2017, we set up an interdisci- In addition to nutritional screen- plinary nutrition support team ing, more attention will be paid to at each nursing home, consisting individual nutritional treatments. ORGANIZATION OF NUTRI- mostly of nursing staff, and work- We will transform the nutrition TIONAL SUPPORT ing closely with a dietitian and a support team, so that it will in- doctor. clude multiple new profiles (more In the last year, we have devot- active involvement of the doctor, ed a lot of attention to interdisci- involvement of physiotherapists, plinary nutritional treatment and occupational therapists etc.). screening for malnutrition across all our residents. Residents with identified malnu- RECOGNITION AND MAN- In April 2017, we implemented trition at admission will receive AGEMENT OF MALNUTRI- routine nutritional screening at individual nutritional treatment. TION admission and periodic screen- We will more often include a clin- ings for all residents. ical dietitian in the departmental expert meetings. FIELD OF ACTION ACTIONS FUTURE PLAN We have created a data report- We will update the computer ing system. nursing program so that it will in- We have created internal forms clude nutritional screening, indi- that make ordering an appropri- vidual nutritional needs, the pre- DOCUMENTATION ate individual diet easier. scribed dietary therapy and other We have created a unified work measures, the diagnosis with the process for the implementation of established degree of malnutrition nutritional screening and deter- and the monitored and valued in- mining appropriate measures. take of food and liquid. Education will include new knowledge about the process of nutritional treatment with the Training of nursing staff for the roles of individual members in it, use of the MNA-SF® question- decision making algorithms about TRAINING / EDUCATION naire was carried out. nutritional measures for individu- Nursing staff was educated for al conditions and diseases. performing nutritional screening. Our work will be presented at sci- entific conferences. Participation in training and 71 workshops in the field of clinical nutrition and food security. es We purchased scales for all nurs- mo PURCHASE OF EQUIPMENT ing homes. We purchased a body composi- tion analyser. ursing h We performed nutrition screen- n n EVALUATION OF NUTRITION ing and reported on the nutrition We will participate in the nutri-SUPPORT PRACTICES treatment to doctors and profes- tionDay worldwide project. lderly i sional director. he e We regularly evaluate the ener- f t gy and nutritional composition of menus. Due to the growing need for indi- ent o In the menus, corrective measures vidualized diets, we will increase were taken to align them with the diversity of dishes offered, to reatm valid recommendations. enrich nutrition and to improve We provided personalized and in- the process and organization of nal t FOOD SUPPLY dividual nutrition, and adapted work in our own kitchens. food consistency for different lev- Critically, we will redefine profes- els of dysphagia. sional requirements for ordering nutritio Residents at risk for malnutri- enteral nutrition and associated tion and malnourished residents feeding systems. are provided with food for special medical purposes. We included one nursing home a month. In 11 months and across 7 nurs- ing homes, 1310 residents were included. The strengths of our research lie in the fact that it was carried out on a broad sample of subjects aged over 65 and living in nursing homes, and that we used MNA as a nutritional screening as- sessment instrument. This makes it easier to perform comparisons with oth- er similar studies, considering the use of MNA in nursing homes is advised by ESPEN. However, we are also aware of some limitations. We started out with a small sample and added more nursing homes with time. Also, many subjects changed during our study due to changes in nursing home, hospitalization, new admissions and high mortality. In March 2018, nutritional screening was performed on 1107 residents. 46.6 % residents had normal nutritional status, 39.9 % were at risk of malnutrition, and 13.5 % were malnourished. Nutritional treatment can help individuals but the overall result is not likely to change by much due to new admissions, hospitalizations, diseases etc. We evaluate that nutritional support has influence on quality of life, muscle mass if com- bined with strength training, better wound healing, but new studies are need- ed to asses these correlations. The multidisciplinary team, consisting of nurs- ing staff, physiotherapists, doctors and clinical dietitians, report the positive influence of nutritional treatment on muscle mass, physical ability and over- all health. In future we expect some changes in prevalence of malnutrition, but due to the high morbidity of this age group, we plan to evaluate individu- al changes more closely than the prevalence. Our future plans are presented in the third column of Table 1. The results of our study are comparable with other studies, especially 72 those using MNA. Most of our residents come from hospitals, are critically ill and are 85 years old or more, and are already malnourished at admission. Residents previously living at home usually have better nutritional status than lderly e those who were hospitalized or lived in other nursing homes. f the o alth Conclusions The use of nutritional screening is rising but predominantly in the hospital ikov | he environment, where malnutrition is most common. Nursing homes also have stn high prevalence of malnutrition, the treatment of which is often neglected due taro to current health policies that do not include dietitians and other nutrition spe- e s cialists in the nursing home employment scheme. More studies on the subject zdravj might provide statistical elements that will help develop new guidelines and protocols on a national level. We implement nutritional treatment for every new resident, as early rec- ognition of malnutrition and appropriate measures significantly affect qual- ity of life. We are learning new approaches to nutritional treatment and are expanding the range of measures that will provide healthy life for residents. Nutritional support seems to have a good influence on quality of life and should be performed in all nursing homes. References ABOLGHASEM GORJI, H., ALIKHANI, M., MOHSENI, M., MORADI – JOO, M., ZIAIIFAR, H. and MOOSAVI, A., 2017. The Prevalence of Mal- nutrition in Iranian Elderly: A Review Article. [online] Iran J Public Health. [viewed 3 June 2018]. Avalible from: http://ijph.tums.ac.ir AUKNER, C., DAHL EIDE, H. and IVERSEN, P.O., 2013. Nutritional status among older residents with dementia in open versus special care units in municipal nursing homes: an observational study. [online] BMC Geri- atrics. [viewed 14 June 2018]. Avalible from: https://doi.org/10.1186/1471-2318-13-26 BEARD, J.R. and PETITOT, C., 2011. Aging and urbanization: can cities be de- signed to foster active aging? [online] Public Health Rev. [viewed 12 May 2018]. Avalible from: https://publichealthreviews.biomedcentral.com/ track/pdf/10.1007/BF03391610 BOATENG, N. and JEPTANUI, N., 2016. Promoting healthy nutrition among the elderly living in a service home. Bachelor’s Thesis [online], Centria Uni- versity of Applied Sciences. [viewed 22 May 2018]. Avalible from: https:// www.theseus.fi/bitstream/handle/10024/117082/NORINDA %20AND %20NANCY_THESIS_1 %205 %20corrected %20AB.pdf?sequence=1 BOLMSJÖ, B.B, JAKOBSSON, U., MÖLSTAD, S., ÖSTGREN, C.J. and MIDLÖV, P., 2014. The nutritional situation in Swedish nursing homes – A longitudinal study. [online] Arch. Gerontol. Geriatr. [viewed 6 July 2018]. Avalible from: http://dx.doi.org/10.1016/j.archger.2014.10.021 73 CEDERHOLM, T., BARAZZONI, R., AUSTIN, P., BALLMER, P., BIOLO, G., esm BISCHOFF, S.C., COMPHER, C., CORREIA, I., HIGASHIGUCHI, T., o HOLST, M., et al. 2017. ESPEN guidelines on definitions and terminolo- gy of clinical nutrition. [online] Clinical Nutrition. [viewed 3 June 2018]. ursing h n n Avalible from: https://doi.org/10.1016/j.clnu.2016.09.004 CHATTERJI, S., BYLES, J., CUTLER, D., SEEMAN, T. and VERDES, E., 2015. lderly i Health, functioning, and disability in older adults–present status and fu- he e ture implications. [online] Lancet. [viewed 7 June 2018]. Avalible from: f t doi:10.1016/S0140-6736(14)61462-8. ent o CUERDA, C., ÁLVAREZ, J., RAMOS, P., ABÁNADES, J.C., GARCÍA-DE- reatm LORENZO, A., GIL, P. and DE-LA-CRUZ, J.J., 2016. Prevalence of mal- nal t nutrition in subjects over 65 years of age in the Community of Madrid. The DREAM + 65 Study. [online] Nutr Hosp. [viewed 3 June 2018]. Avali- nutritio ble from: http://www.redalyc.org/articulo.oa?id=309245773012 DOUMIT, J.H., NASSER, R.N., and HANNA, D.R., 2014. Nutritional and health status among nursing home residents in Lebanon: comparison across gender in a national cross sectional study. [online] BioMed Cend- tral Ltd. [viewed 4 June 2018]. Avalible from: https://doi.org/10.1186/1471- 2458-14-629 KONDRUP, J., ALLISON, S.P., ELLIA, M., VELLAS, B. and PLAUTH, M., 2003. ESPEN Guidelines for nutritional screening 2002. [online] Clin Nutr. [viewed 12 June 2018]. Avalible from: doi:https://doi.org/10.1016/ S0261-5614(03)00098-0 OLIVER, D., FOOT, C. and HUMPHRIES, R., 2014. Making our health and care systems fit for an ageing population. [online] King’s Fund. [viewed 14 May 2018]. Avalible from: https://www.kingsfund.org.uk/sites/default/ files/field/field_publication_file/making-health-care-systems-fit-ageing- population-oliver-foot-humphries-mar14.pdf PILGRIM, A., ROBINSON, S., AIHIE SAYER, A. and ROBERTS, H., 2015. An overview of appetite decline in older people. [online] Nurs Older People. [viewed 7 June 2018]. Avalible from: doi:10.7748/nop.27.5.29.e697. REPUBLIKA SLOVENIJA STATUSTIČNI URAD, 2018. Število in sestava prebivalstva. [online] [viewed 3 June 2018]. Avalible from: http://www. stat.si/StatWeb/Field/Index/17/104 SAKAA, B., OZKAYAB, H., KARISIKB, E., AKINC, S., AKPINARA, T.S., TUFANA, F., BAHATA, G., DOGANB, H., HORASANB, Z., CESURB, K., ERTENA, N. and KARAN, M.A., 2015. Malnutrition and sarcopenia are associated with increased mortality rate in nursing home residents: A prospective study. [online] European Geriatric Medicine. [viewed 10 July 2018]. Avalible from: https://doi.org/10.1016/j.eurger.2015.12.010 SMITH, S.M., SOUBHI, H., FORTIN, M., HUDON, C. and O’DOWD, T., 2012. Managing patients with multimorbidity: systematic review of inter- 74 ventions in primary care and community settings. [online] BMJ. [viewed 3 June 2018]. Avalible from: doi: 10.1136/bmj.e5205 VOLKERT, D., BERNER, Y.N., BERRY, E., CEDERHOLM, T., COTI BER - lderly e TRAND, P., MILNE, A., PALMBLAD, J., SCHNEIDER, S., SOBOTKA, f the L., STANGA, Z., LENZEN-GROSSIMLINGHAUS, R., KRYS, U., PIR- o LICH, M., HERBST, B., SCHÜTZ, T., SCHRÖER, W., WEINREBE, W., alth OCKENGA, J. and LOCHS, H., 2006. ESPEN Guidelines on Enteral Nu- trition: Geriatric. [online] Clin Nutr. [viewed 3 June 2018]. Avalible from: ikov | he doi:10.1016/j.clnu.2006.01.012 stn taro WHO, 2015. World report on Ageing and Health. [online]. [viewed 22 e s May 2018]. Avalible from: http://apps.who.int/iris/bitstream/hanw - dle/10665/186463/9789240694811_eng.pdf;jsessionid=470AF7C04CEBD3 zdravj B91F2268A934282EDE?sequence=1 Effects of regular exercise on elderly people Tatjana Novak, Zdenka Katkič Društvo Šola zdravja, Slamnikarska cesta 18, 1230 Domžale, Slovenia Abstract In 2006/07 exercising for women, aged over 65, started in Kamnik and lasted five years. At the beginning, 32 women of the exercising group were included into active exercising and 32 women of the control group were not included into active exercising. The exercising took place intensively twice a week for 60 minutes from October 2006 to June 2007 and once a week for 60 minutes from October 2007 to June 2011. We performed the measurements of basic physical parameters and the tests of functional physical fitness by checking flexibility, strength and balance. The first measurements for the members of the exercising group were carried out in October 2006, the second after half a year in July 2007 and the third in July 2011, when 20 women of the same exercising group still actively participated after four years. The measurements for the members of the control group were carried out in October 2006 and July 2011, when 17 women of the same control group attended the measurement again. The purpose of the research was to highlight the importance of regular physical activity for the women over 65 years old, to improve their motor skills related to power, flexibility and balance and also endurance, speed and coordination. Statistical analyses were done by using SPSS 16.0 program (SPSS Inc., IBM Corporation, Chicago Illinois, USA, 2008) and were checked at the level of 5-percent risk (p = 0,05). The test results of functional physical fitness of older people showed the considerable improvement in all tests after half a year of adapted exercising; additionally, we noticed progress in most tests, also during the second measurement after the finished exercising in 2007 and 2011. Moreover, the exercising group compared to the control group also achieved substantially better results of motor abilities. Exercising can have a significant impact on the improvement of motor skills of the elderly, which may result in the independent performance of all basic hygiene tasks, dressing, household and domestic work, shopping and doi: https://doi.org/10.26493/978-961-7055-18-4.75-84 other tasks related to freedom of movement, expansion of living space and an independent and autonomous life without the assistance of others. Key words: elderly, women, regular exercise, motor skills, health. In Slovenia, higher number of older people began to emerge when the gen- erations born before and during the World War II started to retire. These generations compared to today’s births are highly numerous and represent a significant group of population due to social, societal, biological and econom- ic factors. It is assumed that in Slovenia in 2020, there would be, according to the data from 2009 around 19 % of people over 65 years old (Sedej, 2009), while by the year 2050 39 % older than 60, among them 13,9 % over 80 (Vertot, 2008). The main challenge of modern times has become the aging of the population. It has become very important how the elderly spend their life after age of 65. 76 Movement and regular exercises are of great importance. It has been proven that the impact of physical activity in old age (Oražem Grm, 2008) is reflected by positive effects in cardio-vascular, muscular-skeletal as well as psycho-so- lderly e cial components of health. Since aging changes physical appearance and phys- f the ical abilities, the appropriate physical activity, such as for example walking, is o important to establish and enhance physical performance in old age. alth Regular exercising (Mišigoj-Duraković et al., 2003) is important for maintaining and improving the level of health, preventing the development ikov | he stn of non-infectious diseases at adults and the elderly, treating and rehabilitating numerous acute and chronic diseases, maintaining the ability for independent taroe s life in old age and increasing the functional abilities or physical fitness. It is an effective method for overcoming stress, since it brings an enjoyable entertain- zdravj ment and relaxation (Tušak, 2002).Daily activities, such as dressing, bathing, walking, eating and maintenance of personal hygiene and instrumental activ- ities such as cooking, shopping, washing, handling money, using the phone, house tasks, cleaning, using means of transport, taking medication and other activities related to independent life at home, are very important for function- al qualifications (Finkel, 2003). Although aging (Berčič, 2002) is an inevitable bio-physiological process, the decline of physiological functions can be slowed down. Each individual should, if it is in his power, take care of as slower aging as possible by daily physical and sports-recreational engagement. Consideration should be given to a type of activity, intensity, frequency, duration as well as gradual approach and regularity of exercise. When choosing exercises, it is important that we find joy, pleasure and stimulus in them, because only then we can persevere. Methods In the research, we were assessing the impact of regular exercising on better and greater physical abilities in old age period; therefore, in 2006/07 we includ- ed 32 women of the exercising group and 32 women of the control group, aged 65 and over, from Kamnik and Domžale and surroundings, into our research. In 2006, the average age of the participants of the exercising group was 69.68 ± 3.83 and of the participants of the control group 70.75 ± 3.67. In 2011, only 20 (62.5 %) participants of the same exercising group were still included in the ex- ercising group, 74.75 ± 4.17 years old on average; and only 17 (53.1 %) women of the control group, on average 75.12 ± 2.97 years old, attended the measurements again. The reasons for lower participation in the measurements were the termi- nation of participation in the research due to poor state of health or even deaths of participants. The information about physical and functional abilities of participants were collected by using the Fullerton test battery (Rikli & Jones, 1999). We were assessing the functional physical condition of the elderly, since the Ful- lerton test battery includes the tests which determine the abilities that are nec- essary for independent life: getting up from the chair for 30 seconds, weight- 77 lifting sitting for 30 seconds, torso bending forward on the bench, touching le hands on the back, stand-up and go, walking for 9 minutes, balance on one eop leg with eyes open and grip strength - power measured by a dynamometer (Ja- ly p der mar Hydraulic Hand Dynamometer - 5030J1, Sammons Preston, Providence, el ZDA). To perform the measurements, we used the devices intended to test pu- pils; the measurement of power was done by a dynamometer lent to us by the cise on xer Department for Physiotherapy from the Health Centre in Kamnik; for weight- lifting sitting we used an appropriate 2, 27 kg heavy handle. The participants ular eeg of the exercising group were tested for the first time in October 2006, for the f r second time after half a year exercising in July 2007 and for the third time in ts o July 2011; the participants of the control group were tested twice, in October fecef 2006 and July 2011. For statistical analysis the SPSS 16.0 program was used (SPSS Inc., IBM Corporation, Chicago Illinois, USA, 2008). The results are presented in the text and in tabular forms. All statistical differences were verified at the level of 5-percent risk (p = 0.05). The results are presented in the text and in tabular forms. All statistical differences were verified at the level of 5-percent risk (p = 0.05). T-test was used to assess the differences between the physical parameters and motor-functional abilities for the members of the exercising group, at the beginning and at the end of exercising in 2006/07 as well as the comparisons for the period from 2006, before and after the exercising, and after five years in 2011, separately for the exercising group and control group; also the analysis of variance (F-test) was used to assess the differences of physical parameters and motor-functional abilities between the members of the exercising group and the control group to compare the periods 2006 and 2011 as well as the analy- sis of covariance to determine the differences in the change between the initial and final state of motor-functional abilities between the members of the exer- cising group and the control group. Results The comparison of members of the exercising group and control group before the start of exercising in 2006/07 showed no statistically significant differenc- es; statistically significant differences between the two groups occurred during the final testing in 2011, in favor of the members of the exercising group (Fig- ure 1, 2, 3, 5 and 8). The comparison of the two groups showed no statistical- ly significant differences before the start of exercising in 2006/07 and after the exercising in 2011 (Figure 4 and 7). At the first measurement, before the start of exercising in 2006/07 the comparison of results of the exercising group and control group showed a statistically significant difference in favor of the exer- cising group; the statistically significant difference was also observed between the two groups at the final testing in 2011 and again in favor of the exercising group members (Figure 6). Statistically significant difference appeared for the members of the control group, between the first and the final measurement, namely the average results of all tests after four years were lower than the re- 78 sults of the initial measurements. lderly e f the o alth ikov | he stn taroe s zdravj Figure 1: Getting up from the chair for 30 seconds (number of repetitions) At the members of the exercising group (Figure 1) before and after the finished exercising in 2006/07 the test results of getting up from the chair for 30 seconds were not statistically significant, but they were statistically signifi- cant when we compared the results of the test before the start of exercising in 2006/07 and after a four-year period in 2011 and after the finished exercising in 2006/07 and after four years. The difference of results (Figure 2) of the members of the exercising group in the test weightlifting sitting for 30 seconds before and after the exercising in 2006 /07 showed a statistically significant difference, in favor of the test after six-month exercising; a statistically significant difference was also observed when we compared the results of the tests before the start of exercising in 2006 /07 and after a four-year period in 2011. 79 le eop ly p Figure 2: Weightlifting sitting for 30 seconds (number of repetitions) der el cise on xer ular eegf r ts o fecef Figure 3: Bending forward on the bench (cm) The test results of bending forward on the bench (Figure 3) were not sta- tistically significant for the members of the exercising group, neither in the pe- riod before and after exercising in 2006 /07 or after four years in 2011. The re- sults of touching hands on the back test (Figure 4) were statistically significant at the members of the exercising group only after six months of exercising in 2006/07. 80 Figure 4: Touching hands on the back (cm) lderly e f the o alth ikov | he stn taroe s zdravj Figure 5: Stand-up and go (in seconds) The test results of stand-up and go test (Figure 5) were not statistically significant at the members of the exercising group before and after exercising in 2006/07, but they were statistically significant when compared to the results be- fore the beginning of exercising in 2006/07 and after a four-year period in 2011 and after the end of exercising in 2006/07 and after four years. The compari- son of results of the exercising group of 9-minute walking test (Figure 6) before and after the exercising in 2006 /07 showed a statistically significant difference in favor of the test after six months of exercising; statistically significant differ- ence was also present when we compared the test results of before the start of exercising in 2006/07 and after a four-year period in 2011. 81 Figure 6: 9-minute walking (number of meters) le eop ly p der el cise on xer ular eegf r ts o fecef Figure 7: Balance on one leg with eyes open (in seconds) The test result of balance on one leg with eyes open test (Figure 7) were for the members of the exercising group statistically significant compared to the beginning of exercising in 2006 /07 and after four years in 2011. The statistical- ly significant difference occurred at the members of the exercising group at grip strength by a dynamometer test (Figure 8) during the measurement before and after the exercising in 2006 /07, as the average power of the grip strength meas- ured by the dynamometer increased. 82 Figure 8: Grip strength by a dynamometer (in kilograms) lderly Discussion e Independent living plays an important role for the elderly, therefore the subjec- f the o tive factors such as age itself, accessibility and proximity of home, physical ex- alth ercising and physical fitness, desire for dealing with certain sport, family sit- uation and financial situation, have greater influence on sports activities than ikov | he objective ones. Fox (1992) states that for people, being active in sport means an stn active spending of free time and socializing, where the criterion is primarily taro the well-being. In California, a research about the effects on strength and flex- e s ibility of 6-week fitness training was made on a small sample of 8 men and 14 zdravj women aged from 60 to 79. For each exercise, the participants performed 12 to 15 repetitions using the fitness equipment, before that they did the 20-minute warm up and the stretching exercises. 15 elderly people of the same age partic- ipated in the control group. Both groups were tested before and after the ex- ercising by using Fullerton test battery for measuring functional physical fit- ness: 6-minute walk, getting up from a chair for 30 seconds, touching of hands on the back, stand-up and go and grip strength. The control group showed a substantially lower physical fitness; the testing group showed better results in grip strength, shoulder flexibility, the number of repetitions of getting up from a chair, walking speed and stand-up and go (Cavani et al., 2002). Very similar results were found when we tested our group, as the members of the exercis- ing group achieved better results in the flexibility of the shoulder girdle, which was shown in touching hands on the back test; in the strength of the upper ex- tremities, which was shown in weightlifting sitting for 30 seconds test and grip strength by the dynamometer test; in the power of the lower extremities, which was shown in the getting up from a chair for 30 seconds test and in general endurance, shown in 9 -minute walking test. We have also noticed that dur- ing the second testing after the end of exercising in 2006/07 and 2011 the mo- tor abilities at the members of the exercising group were still improving which show the tests of getting up from a chair for 30 seconds, weightlifting sitting for 30 seconds, torso bending forward on the bench, stand-up and go and 9-min- ute walking. The decline of motor abilities after four years was observed on- ly in balance on one leg with eyes open test due to the links between the sensory-neuronal system and α -motor neurons, which die with age and weaken the stabilizing of the knee joint (Madhavan et al., 2005 & 2009); it was demonstrat- ed by the comparative research between the young and the elderly over 65. They found out significant differences between the young and the elderly by standing on one leg with squatting exercise, at first with eyes open and then eyes closed. Comparing the sample results of the members of the control group for the peri- od from 2006/07 to 2011, after four years, we noticed the reduction of all motor abilities, because the measured results were lower in all tests, except at touch- ing hands on the back. 83 le Conclusion eop The results of this research are part of recognition that with adapted physical ly p exercising, with an emphasis on strength, flexibility and balance, we can sig- der el nificantly influence the improvement of functioning of the locomotors system, balance and strength at the elderly. Regular exercises improve physical abil- cise on ities and thus the functional competence of the individuals, which is reflect- xer ed in better health and well-being, better independent performance of all basic ular e tasks which in the process enable free physical movement, enlargement of liv- egf r ing space and autonomous living without the help of others. We wish that the ts o results of adapted physical exercising contributed to the decision making of the fecef wider female and male population, aged 65 and over, to make physical activity the way of their life. Since 2009, the exercises are going in the Slovene area by the method of 1000 movements (Grishin, 2012) within the Society of School of health, where elderly have the exercises every day at 7.30 in the morning in na- ture. Further researches of physical activity at the elderly over 65 would be defi- nitely interesting for the follow-up on the national level in order to determine the functional capacity of older people and that would allow us to plan the de- velopment of programs for active spending of life in the third period. References BERČIČ, H., 2002. Redno športno-rekreativno udejstvovanje je eden od temel- jev uspešnega staranja. Ljubljana: Revija Šport, 50 (2), 26-31. CAVANI, V., MIER, C.M., MUSTO, A.A. & TUMMERS, N., 2002. Effects of a 6 – week resistance – training program on functional fitness of older adults. Journal of aging and physical activity, 10, 443-452. FINKEL, T., 2003. A toast to long life. Nature, 425, 132-133 FOX, K., 1992. The complexities of self - esteem promotion in physical education and sport. In: Sports and physical activity –moving towards excel- lence. London: E & FN Spon, 382–389. GRISHIN, N., 2012, 2018. Metoda 1000 gibov. Ljubljana, samozaložba, 64 str. MADHAVAN, S., BURKART, S., CARPENTER, G., READ, K., TECKEN- BURG, T., ZWANZIGER, M. & SHIELDS, R.K., 2005. Influence of age on neuromuscular control of the knee. Journal of Neurological Physical Therapy, 29 (4), str. 190. MADHAVAN, S., BURKART, S., BAGGETT, G., NELSON, K., TECKEN- BURG, T., ZWANZIGER, M. & SHIELDS, R.K., 2009. Influence of age on neuromuscular control during a dynamic weight-bearing task. Jour- nal of aging and physical activity, 17, 329–343. MIŠIGOJ–DURAKOVIĆ, M. et al., 2003. Telesna vadba in zdravje. Ljubljana: Zveza društev športnih pedagogov Slovenije, Fakulteta za šport Univer- 84 ze v Ljubljani, 85–106. ORAŽEM GRM, B., 2008. Telesna aktivnost – inovativno polje za razvijanje lderly medgeneracijskih programov. Ljubljana: Kakovostna starost, 11 (2), str. 41. e RIKLI, R. & JONES, J., 1999. Development and validation of a functional fit- f the o ness test for community-residing older adults. Journal of Aging and Phys- alth ical Activity 7 (2), 129–162. SEDEJ, M., 2009. Izobraževanje starejših v luči trga dela in strategije aktivne- ikov | he ga staranja – utemeljitev strategije aktivnega staranja. V: Zbornik – 13. an-stn dragoški kolokvij Izobraževanje starejših odraslih v letu ustvarjalnosti in taro inovativnosti. Ljubljana: Ministrstvo za delo, družino in socialne zadeve, e s Direktorat za trg dela in zaposlovanje, 1–16. zdravj TUŠAK, M., 2002. Nekateri psihološki problemi ukvarjanja s športno rekreaci- jo. V H. Berčič (ur), Zbornik 3. slovenskega kongresa športne rekreacije: Otočec, 21.-22. november, Ljubljana: Olimpijski komite Slovenije, 64-65. VERTOT, N., 2008. Prebivalstvo Slovenije se stara – potrebno je medgeneraci- jsko sožitje. Ljubljana: Statistični urad RS, 15-30 Physical activity of the elderly with a diabetic foot Helena Olenik, Milica Puklavec, Armina Šahman, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia Abstract Physical activity is an important factor for health itself and for elderly people. Healthy aging means maintaining the health at all levels. Diabetes is a chronic, progressive deterioration of beta cells in the pancreas. Therefore, the adaptation of the treatment is necessary, first with a healthy lifestyle. Chronic elevated blood glucose levels can lead to the failure of organs or organ systems over the years. One of the consequences may be the formation of a diabetic foot. A diabetic foot is the result of chronic complications of diabetes. As the feeling of pain, heat, cold and vibration are reduced or absent, the patient does not pay attention to injuries or does not take appropriate action when injured. The mechanics of walking also change because of the sensitivity impairment. The importance of physical activity is also becoming aware amongst diabetics. Regular diet, regular therapy (antidiabetics, insulin injections, and regular blood sugar monitoring) in addition to regular physical activity can have diabetes well-controlled. Key words: diabetes 2, diabetic foot, physical activity of the elderly Diabetes is one of the most prevalent chronic diseases. Type 2 diabetes is considered a global epidemic and is strongly linked to the style of life and economic change (Anjana and Pradeep, 2017). Treatment is com- plex and includes dieting, exercise, taking tablets or insulin injections. The pa- tient must have a clear idea of his own illness so that he can learn to live with it. The treatment of diabetes in the elderly is a major challenge, involving both healthcare professionals and the patient’s family. (Mlakar, 2014). One of the consequences may be diabetic neuropathy. A diabetic foot is thus a set of dis- ease disorders on the foot that lead to ulcers in the skin. Treatment of foot ulcers requires various measures, including prevention of wounds, conserva- doi: https://doi.org/10.26493/978-961-7055-18-4.85-91 tive and surgical interventions, and rehabilitation after amputation. The goal of treating femoral ulcers is to prevent amputation. Exercise is important when the patient has diabetes, exercise can have effects on the body, reduces blood sugar and maintains the physical activity of the patients. Moreover, improper shooes and absence of later examination of the feet can cause additional prob- lems to the patients with diabetes (Marolt, 2009). Excessive physical activity can lead to undesirable fluctuations in blood sugar. In any case, a consultation with a doctor is necessary, to what extent physical activity is recommended (Ruhland, 1998). Only physical activity does not sufficiently influence the metabolic regulation of diabetes. The basis for treating diabetes is still proper nutrition and insulin doses, while incentives for regular physical activity are a welcome and important addition. Sport therefore influences our attitude towards health, nutrition and lifestyle, and consequent- ly also on the regulation of diabetes (Battelino and Janež, 2007). Patients with 86 a physical activity program improve the quality of life - physically, emotionally and socially. If there is a tendency to hypoglycaemia or even a poor recognition of hypoglycaemia, the patient must take care of his own safety while engaging lderly e in physical activity. Types of exercise where hypoglycaemia may be dangerous f the (swimming, walking along an exposed mountain path, etc.) should be avoided. o It is advisable to consult your doctor, what kind of exercise is appropriate for alth the individual (Lipnik, 2014). In type 2 diabetes, progression of the ability of beta cells to eliminate in- ikov | he stn sulin results in insulin resistance. Most patients may have large abdominal, taro overweight, elevated triglycerides, and high blood pressure. As a rule, there e s are no visible signs of disease for several years. It usually lasts between 5 and 12 years before the disease is detected without the patient having any prob- zdravj lems. Diabetic foot is one of the most common complications of diabetes. The term diabetic foot describes the changes that occur on the legs of patients with diabetes (Hohnjec, 2011). It is a wound that does not start healing without ade- quate professional care. Nerve damage causes a gradual loss of touch, hot and cold, and pain. The foot becomes insensitive primarily on the fingers. Where the pressure on the underlying soft tissue is formed, the cavity is formed. Through cracks, infectious cusps enter the affected tissue and thus form puru- lent infections and inflammation (Medvešček and Pavčič, 2009). In association with the onset of type 2 diabetes, movement is a very impor- tant protective factor. A diabetic patient is recommended at least 150 minutes of aerobic exercise per week. Physical activity must be spread evenly throughout the week. Promoting, gradual escalation of physical activity according to indi- vidual’s wishes and moderation is very important (NIJZ, 2018). Regular phys- ical exercise is one of the important strategies for treating a patient with dia- betes and results in an increased cardiorespiratory function, reduced insulin resistance, and a better blood lipid state (Anjana and Pradeep, 2017). Methods A descriptive method of work was used with a critical review of both scientific and professional literature in the Slovenian and English languages. The litera- ture was searched using the CINAHL, Medline and COBIB.SI databases. The search for literature and resources included literature published between 2007 and 2017. The inclusion criteria for the selection of literature were; free access to full-text articles and articles related to diabetes and diabetes related to physical activity. However, the exclusion criteria concerned mainly older articles that did not fall below a certain limit of literature search. The search was carried out using keywords: Type 2 diabetes, diabetic foot, physical activity of the el- derly. Data collection took place in March until May 2018 (Table 1 and Table 2). Table 1: Keywords Keywords CINAHL Medline COBIB.SI 87 »Type 2 diabetes« 129 144 136 »diabetic foot« 39 52 53 oto »physical activity of the elderly« 28 31 30 Skupaj 196 227 219 iabetic f Table 2: Exclusion criteria ith a d Exclusion criteria Number of units removed lderly w 1) duplication of articles 43 he e 2) focus on other disorders 104 f t 3) focusing only on another population 178 4) older article research 41 5) Focus on diabetes 1 206 ctivity o 6) the contents of the article do not match the author‘s keywords 56 Together 628 physical a Results It has long been known that physical activity affects the reduction of blood sug- ar. With physical work, glucose is consumed. The sensitivity of tissue to insulin is also increased. Physical activity is recommended for every person, including diabetes (after prior consultation with a doctor), because with regular physi- cal activity, the body is kept in good condition, so that it is easier to carry out everyday efforts and daily stress (Battelino and Janež, 2007). A systematic review of literature suggests the importance of physical ac- tivity and exercise as a key intervention in the prevention of diabetic foot, al- though there are several different exercises and methods that have similar ben- efits to the already given goal. The literature review also proves that exercise is a useful non-pharmacological method for the prevention of diabetic periph- eral neuropathy and slows down the appearance of ulceration and skin le- sions in the aforementioned patients. Most specialists recommend aerobic ex- ercise, which causes deep breathing and increases heart rate and stroke volume (Lipnik, 2014). Aerobic exercise has a beneficial effect on metabolism. It us-es fatty acids for energy, and the reduction in the level of free fatty acids in the blood is probably the reason for this. A high level of fatty acids found in obesi- ty, especially in the case of type 2 diabetes, has adverse effects on metabolism. Insulin resistance is increased, insulin secretion from beta cells in the pancre- as is weakened, blood fats are unfavourably altered, the state develops as well as in inflammatory inflammation, and in the long run this leads to cardiovascu- lar disease (Medvešček and Pavčič, 2009). If aerobic activity is carried out reg- ularly, the effects are long lasting. Body weight also decreases, in particular by reducing the amount of fat in the abdomen. The effects are particularly favour- able in the elderly, because the muscle mass decreases with aging, while the fat content of the body increases (Medvešček and Pavčič, 2009). Authors LeMaster et al., (2008) argue that a good program of training for 88 a patient with diabetes, does not necessarily mean the emergence or worsen- ing of diabetic foot. Study by Hung and colleagues. (2009) refers to the theo- lderly ry of tai chi practice where in patients, blood glucose can be improved after 12 e weeks of practice and at the same time reduces the possibility of diabetic foot f the o formation (Table 3). alth Table 3: Overview of studies ikov | he stn Author/year Purpose of research Methodology Results taro The effect of long-term e s Long-term aerobic exercise Balducci et al., 2007 exercise training in pa- Quantitative method tients with type 1 and of work can prevent the onset of dia- betic peripheral neuropathy. zdravj type 2 diabetes. To determine the effect Promoting physical activity LeMaster et al., 2008 of the training program Quantitative method does not mean deterioration in diabetic foot patients of work of the diabetic foot. In patients, blood glu- Study the effect of tai chi cose can be improved for 12 chuan exercise on pe- weeks with tai chi chuan ex- Hung et al., 2009 ripheral nerve modu- Quantitative method ercise. A further larger ran- lation in patients with of work domized controlled clinical type 2 diabetes trial with longer time moni- toring is required. Find out the effects of In patients, blood glu- Tai Chi practice on glu- cose can be improved for 12 cose control, neurop- weeks with tai chi chuan ex- Ahn S, Song R.2012 athy results and quali- Quantitative method ercise. A further larger ran- ty of life in patients with of work domized controlled clinical type 2 diabetes and neu- trial with longer time moni- ropathy. toring is required. Moderate intensities of aero- Assess the effect of mod- bic exercises play an impor- Dixit et al., 2014 erate aerobic exercise on Quantitative method tant role in disorders of the diabetic peripheral neu- of work progression of diabetic pe- ropathy. ripheral neuropathy in type 2 diabetes. The study (Balducci, 2014) mentions for the first time that the long-term prescribed in controlled aerobic exercise, such as fast walking, can alter the natural history of diabetic neuropathy or even delay its onset. The purpose of the study by Dixit and colleagues (2014) is to evaluate the effect of moderate aerobic exercise (40 % - 60 % heart rate) on diabetic periph- eral neuropathy. It has been found that moderate intensity of aerobic exercise can play an important role in diabetes type 2 disorders. LeMaster (2008) points out in his research that the promotion of physical activity does not cause a sig- nificant increase in ulcers on the feet. A single recreational exercise usually involves warm up for 5-10 minutes, followed by 20-30 minutes of main activity and for completion of 5-10 minutes of cooling by low activity exercise, such as walking, ease of movement and re- laxation exercises. The intensity of the exercise can be determined and assessed according to the feeling without any special devices and heart rate measure- ments. The simple criterion for even moderate aerobic exercise is that we can 89 talk normally during exercise (Medvešček and Pavčič, 2009). oto Appropriate forms of physical exercise are a combination of sev- eral activities over a long period of time. Appropriate training is; walk- iabetic f ing or walking uphill, cycling, mountaineering, skiing, rowing, dancing, some fitness activities (bicycle, conveyor belt, repeating various lighter ex- ith a d ercises) and more intensive work in the garden or field (mowing, grabbing). A systematic review of literature suggests the importance of exercise in the lderly w treatment of diabetic feet, as it contributes to a better revitalization of the lower he e limbs. Gymnastics in patients with diabetes have additional benefits, which in f t turn slows down peripheral diabetic neuropathy, skin damage, and ulceration (Matos et al., 2018). ctivity o Discussion and Conclusion physical a Despite the existence of various clinical guidelines and recommendations for the patient’s health and educational work, it is a great challenge for health pro- fessionals to motivate individuals with diabetes to preserve newly acquired habits and lifestyle. Physical exercise is vital here. Before starting physical ac- tivity, diabetes should be discussed with your doctor and diabetologist. A suit- able type of exercise depends to a large extent on other health problems that an individual has. Often, there is fear in elderly patients, whether they should start physical exercises and how intense it should be. It is important to closely mon- itor blood sugar before, during and after exercise. They should also be alert to the condition of their feet, which they regularly inspect. For exercise, choose comfortable sports shoes and suitable socks. A systematic review of literature suggests the importance of physical ac- tivity and exercise as a key intervention in the prevention of diabetic foot, al- though there are several different exercises and methods that have similar ben- efits to the already given goal. The literature review also proves that exercise is a useful non-pharmacological method for the prevention of diabetic peripheral neuropathy and slows down the appearance of ulceration and skin lesions in the aforementioned patients. References AHN, S., SONG, R., 2012. Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. Journal of alternative and complementary medicine, vol, 18, no. 12, 1172–1178. ANJANA, R.M., PRADEEPA, R., 2017. Built environment, physical activity and diabe- tes. Current silence, vol. 113, no.7, pp. 1327–1336. BALDUCCI, S., IACOBELLIS G., PARISI, L., DI BIASE, N., CCALANDRIELLO, E., LEONETTI, F., FALLUCCA, F. , 2007. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications, vol. 20, no. 90 4, pp. 216–223. BATTELINO, T., JANEŽ, A., 2017. Insulinska črpalka. 1. izdaja. Ljubljana: Didakta, pp. 1–25. lderly e DIXIT, S., MAIYA, AG., SHASTRY B.A. , 2014. Effect of aerobic exercise on pe4-f the ripheral nerve functions of population with diabetic peripheral neurop- o athy in type 2 diabetes: a single blind, parallel group randomized con- alth trolled trial. Journal Diabetes Complication, vol.28, no.3, pp. 332–339. ikov | he HUNG, J.W., LIOU, C.W, WANG, P.W. , 2009. Effect of 12-week tai chi chuan stn exercise on peripheral nerve modulation in patients with type 2 diabetes taro mellitus. Journal of Rehabilitation Medicine, vol. 41, no. 11, pp. 924–929. e s LEMASTER, J.W., MUELLER, M.J., REIBER, G.E., MEHR D.R., MADSEN, zdravj R.W., CONN, V.S. , 2008. Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial. Physical Therapy, vol, 88, no. 11, 1385–1398. LIPNIK, B., 2014. Vplivi telesne aktivnosti na bolnico s sladkorno boleznijo ti- pa 1. diploma thesis. Ljubljana. Univerza v Ljubljani, Fakulteta za šport, pp.1–20. MAROLT, I., 2009. Diabetična nevropatija, pozni zaplet sladkorne bolezni in posledice. Sladkorna bolezen, no. 78, pp. 12–13. MATOS, M., MENDES, R., SILVA, A.B., SOUSA, N., 2018. Physical activity and exercise on diabetic foot related outcomes: A systematic review. Dia- betes Research and Clinical Practice, vol. 23, no.1, pp. 81– 90. MEDVEŠČEK, M., PAVČIČ, M., 2009. Sladkorna bolezen tipa 2: kako jo obv- ladati in živeti z njo: sto receptov za zdravo prehrano. 1 izdaja. Ljubljana: Littera picta, pp. 2–36. MLAKAR, P., 2014. Kakovost življenja in sposobnost sprejemanja sladkorne bo- lezni v starosti. diploma thesis. Maribor. Univerza v Mariboru, Fakulteta za zdravstvene vede, pp.1–5. NIJZ, 2018. [online]. [viewed 25. 4. 2018]. Available from: http://www.nijz.si/ sl/sladkorna-bolezen#stevilo- bolnikov-s-sladkorno-boleznijo-v-sloveni- ji-strmo-narasca. ŽERJAV, T. M., 2012. Sladkorčki: vse, kar ste želeli vedeti o sladkorni bolezni. Ljubljana: Društvo za pomoč otrokom s presnovnimi motnjami, 1. izdaja, pp. 256–261. 91 oto iabetic f ith a d lderly w he ef t ctivity o physical a Physical activity and its importance for the elderly’s health Marjeta Oplot1, Gregor Štiglic2, Mateja Lorber2 1 University Medical Centre Maribor, Ljubljanjska 5, 2000 Maribor, Slovenia 2 University of Maribor, Faculty of Health Sciences, Žitna ulica 15, 2000 Maribor, Slovenia Abstract Introduction: Achieving a high age is a reflection of the high quality of life. Regular physical activity is crucial and increases the ability to live independently. The aim of the research was to find out the frequency of physical activity of the elderly in the home environment. Methods: The research sample covered the elderly from Slovenia and 18 other participating countries. More than 86,000 individuals aged over 50 were participated, of whom 2257 were from Slovenia, of whom 1275 were aged 65 and over. The data were analysed with the SPSS Statistics 20 program. Results: 86 % of the elderly people from Slovenia do not have difficulties in performing day-to-day activities. 46 % of Slovenian elderly people do not engage in any sports or intensive activities. As many as 86 % of the elderly from Slovenia do not need help outside the household. The difference in assessment of health according to the elderly (F = 500,50, p <0,001) was found between countries. Slovenia ranked on the 7th place. For those elderly who receive help outside the household, assess their health higher. 70 % of Slovenian elderly people have overweight. Discussion and conclusion: The elderly’s body activity is insufficient, the body weight is too high, which means a higher level of risk for the chronic non-communicable diseases. Only by ensuring adequate healthcare, economic prosperity, social inclusion and health education we can reduce the incidence of chronic non-communicable diseases. Key words: physical activity, elderly people, quality of life, chronic non- communicable diseases With age, there are changes in physical abilities, the flexibility and to- nus of the muscles of the whole body decrease, the bones become fragile, the coordination of movements and cognitive abilities de- doi: https://doi.org/10.26493/978-961-7055-18-4.93-99 creases (Akerman, 2014). Regular physical activity has many positive effects on human health: it strengthens bones and muscles, and develops, increases and maintains psychophysical and functional abilities of the body, which in turn increases the ability to live independently in old age. It also reduces the risk of developing and preventing the progression of various chronic non-communi- cable diseases, helps to reduce stress, anxiety and depression, helps to increase self-esteem and self-confidence, and helps to establish social interaction, so- cial integration, promote the economic and social development of individu- als, community and the whole nation (Zaletel-Kragelj et al., 2011). It has also been shown that physical activity prevents many chronic diseases in the el- derly, like reduce incidence and mortality due to cardiovascular disease, insu- lin-dependent diabetes, colon cancer and osteoporosis (Bilban, 2005). Those who are regularly physically active are forgetting less, fell less anxious, rest- lessness, lonely, and less often feel that everything in their life is meaningless 94 (Ramovš, 2013). Healthy lifestyle reduces the risk factors that are dangerous for our health, and slow down the aging process (Elanie, 2014). With physia- cal activity, we have positive effects on the cardiovascular and musculo-skele- lderly e tal system, and the individual’s congruent performance improves, thereby re- f the ducing the risk of dementia and other neurodegenerative diseases (Emily et o al., 2013). Regular physical activity reduces body fat and the risk of mortali- alth ty due to chronic non-communicable diseases, and also regulates the gener- al body mass index by supplementing the bone density and muscle mass (Kru- ikov | he stn ger et al., 2004). Decreased muscle tonus related with an age, changes the level of activity and can have an effects on the quality of life of elderly (Siparsy et al., taroe s 2014). Thompson et al. (2012) note that older people with functional constraints have lower mental health. Similarly, researchers in the United States (Phillips zdravj et al., 2013), found that regular physical activity is vital to their quality of life. Halvosrud et al. (2010) found that depression has less impact on quality of life than functional constraints. Walking has been identified as an effective measure to promote mobili- ty because it is a simple, inexpensive and very common form of activity. Ac- cording to a study conducted in the United Kingdom (Sugiyama et al., 2009), approximately half of the interviewed elderly reported walking for 2.5 hours or more per week, while in Finland (Tsai et al., 2013) elderly are walking in the average 6.5 km four times a week. Data for Slovenia show that walking is the most popular activity among the elderly. Following the recommendations of the American Heart Association, the following types of physical activity are recommended for the elderly: aerobic exercise, exercises for muscular strength, and balance (Drev, 2010; 2011). In Slovenia, physical activity is also hampered by the stairs, because elderly must walk an average 15 stairs to their apartments (Birsa, 2014). Data from 2012 show that three-quarters of elderly are moderatel- ly active for at least four days a week, and their most popular form of physical activity is walking. The World Health Organization recommends that are the elderly older than 65 years should be active at moderate intensity for at least 150 minutes per week (Health Care Institute, Ljubljana, 2013). To reach the aim of the study the following research questions were set: a.) What is the self-assessment of the health status of the elderly from Slove- nia compared to the elderly in other participating countries and b.) What is the physical activity of the elderly? Methods We used the data obtained with the study Easy SHARE (Survey of Health, Ag- ing and Retirement in Europe). The survey covered older people over 65 in Slo- venia and other participating countries: Austria, Belgium, the Czech Repub- lic, Denmark, Estonia, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, Sweden, Israel and Switzerland. In the research participated 2577 elderly people from Slovenia, of which 1275 were 95 aged 65 and over. All respondents were living in their home environment. ealth Data on the quality of life of the elderly, age, their physical activity and body weight, self-assessment of health status, the number of chronic diseases and self-care capabilities were collected from the first to the fourth wave of the lderly’s h he e Easy SHARE study (Börsch-Supan et al., 2013). The collected data were statisti- r to cally analysed using the Microsoft Excel program and the statistical program IBM SPSS Statistic 20. One-way ANOVA test were used to find statistically sig- rtance f nificant differences. pom ts i nd i Results The daily activity index is the sum of five tasks: dressing, bathing or shower- ctivity a ing, eating and cutting food, walking around the room and getting out of bed. The higher index indicates more problems the older people have with these dai- physical a ly activities. Table 1: Frequency of physical activity in older population Sports and other physical y intensive activities F Percentage ( %) More than once per week 359 28,4 Once per week 176 14,0 Slovenia 1-3 times per week 149 11,8 Less than once per week 579 45,8 Sum 1263 100 More than once per week 13766 24,3 Once per week 6617 11,7 Other 1-3 times per week 4967 8,8 countries Less than once per week 31289 55,2 Sum 56639 100 The ability of self-care was investigated on the basis of the question that asked older people whether they need help from the persons that live outside of their household. The number of participants who claimed they are self-suffi- cient was very high, as 1090 (86 %) of the elderly stated that they do not use help from the outside of the household, while in the remaining countries only 42186 (74 %) of the elderly do not use help from the outside of their household. Addi- tionally, Table 1 shows that almost half of the respondents (46 %) in Slovenia re- ported that they perform sports or high intensity activities less than once per week, while in other countries this rate was as high as 55 %. The lowest estimate of self-assessment of health was reported by the old- er people in Ireland (2.85 ± 1.12) and Switzerland (2.85 ± 0.96). The highest self- assessed health was reported in Poland with an average of 4.13 ± 0.89. We also confirmed the statistically significant difference in self-assessed health among 96 compared countries (F = 500,50, p <0,001). Higher self-assessed health level was observed in older people who receive help from the outside of their house- hold. Most participants in Slovenia rated their health on the scale from 1 to 5 lderly e with 2 (34 %), followed by 3 (33 %). In other countries the most frequent level of f the health was 3 (35 %), followed by 2 (32 %). o alth Table 2: Summary of health self-assesment ikov | he stn Self-assessment of health 95 % confidence taro interval of the mean e s N Mean SD Min Max Low High zdravj Austria 4449 3.18 1.035 3.15 3.21 1 5 Germany 4487 3.48 0.937 3.45 3.51 1 5 Sweden 5113 2.93 1.122 2.89 2.96 1 5 Netherlands 4517 3.12 1.003 3.09 3.15 1 5 Spain 5577 3.70 0.971 3.67 3.72 1 5 Italy 5894 3.55 1.023 3.53 3.58 1 5 France 6539 3.51 0.981 3.48 3.53 1 5 Denmark 3698 2.88 1.153 2.84 2.92 1 5 Greece 3998 3.35 0.962 3.32 3.38 1 5 Switzerland 3440 2.85 0.959 2.82 2.88 1 5 Belgium 6825 3.20 0.980 3.17 3.22 1 5 Israel 2232 3.54 1.182 3.49 3.58 1 5 Czech Republic 4856 3.64 0.915 3.62 3.67 1 5 Poland 2687 4.13 0.891 4.09 4.16 1 5 Ireland 464 2.85 1.117 2.75 2.95 1 5 Hungary 1333 3.93 0.969 3.88 3.98 1 5 Portugal 931 3.89 0.921 3.83 3.95 1 5 Slovenia 1264 3.60 1.040 3.54 3.66 1 5 Estonia 3554 4.06 0.768 4.04 4.09 1 5 Together 71858 3.41 1.055 3.40 3.41 1 5 Discussion The self-assessment of the health status of the older population in Slovenia is among the higher assessed in the survey. In this part of the research, 19 coun- tries were covered, and Slovenia ranked 7th among the countries according to the criterion of the self-assessed health status. The ability of older people in Slo- venia to take care of themselves is very high, as 86 % of them stated that they do not use help from the outside of their household, while the possibility of self-care was lower in the older population from other countries (74 %). The re- search shows that older people from other countries are generally more satis- fied with their lives than older people from Slovenia. At the same time, we com- pared the assessment of health, considering whether the participants are able to care for themselves, and found that self assessed health is higher in Slove- nia and in also in other countries in people who do not need assistance from outside of their household. Mitzer et al., (2013) noted that self-care is associat- ed with positive health behaviour, which leads to improvement of health status, 97 reduces costs of health services, hospital days, number of hospitalizations, vis- its to a doctor; and has positive effects on health. ealth Birsa (2014) notes that in Slovenia, most of the people are largely indepen- dent in carrying out daily tasks, but this independence decreases with age. Dif- lderly’s h ferences between women and men occur mainly in instrumental tasks. Bilban he e (2005) states that, with regular physical activity, we maintain the power, endur- r to ance, flexibility and good balance that is necessary for ensuring mobility and is the basis for independence. Based on the analysed variables, we found that the rtance f physical activity of the elderly is inadequate. pom The results of the study show that the body mass index was not affected ts i by the level of physical activity of an individual. For all participants, both nor- nd i mal and overweight, it is possible to detect the greatest proportion of those who are almost never or never engaged in sports or intense activities. According to a ctivity a study carried out in Rotterdam, the improvement of the nutritional status leads to an improvement in the quality of life (Gariballa, 2011). Additionally, it is im- physical a portant that the older population adapts their activity to their physical abilities and health status (Drev, 2011). Tang & Lee (2011) state that good social inclusion leads to better well-be- ing of older people, including better self-assessed health, lower mortality risk, higher quality of life, and less depression. Wikman et al. (2011) state that poor health does not always mean poor quality of life, as some individuals are able to overcome specific disease limits and adjust their lives to achieve their goals. However, the broader aspects of the quality of life of the elderly, including emo- tional wellbeing, autonomy, self-realization, controlling the important aspects of life with its meaning and fulfilment need more research. Of the 1209 partici- pants in Slovenia, there are as many as 841 (70 %) overweight, while among the 55,000 elderly people in the rest of the world, the total proportion of overweight participants is 34147 (63 %). In both studied groups, both in participants from Slovenia and those from other countries, it can be seen that most of them are overweight, with a slightly worse situation in Slovenia, which also means higher risk of developing heart disease, diabetes, high blood pressure and all the consequences associated with it. It is known that aging reduces muscle mass and increases body fat (Gariballa, 2011). In current generations, older individ- uals have a higher body mass index than the younger ones, which is due to a more sedentary lifestyle (Krueger et al., 2004). Conclusion It is necessary to educate and encourage older people to remain independent for as long as possible, despite their functional limitations as the physical activ- ity of the elderly is insufficient. However, much remains to be done by design- ing state policies and health systems around the world to address this problem. By ensuring appropriate conditions for a high quality of life, adequate health- 98 care, economic well-being, social inclusion and health education in the same way for all people it is possible to reduce chronic non-communicable diseases and related problems. lderly e f the References o alth AKERMAN, B. (2014). Nov program o staranju. Kakovostna starost 17(1), 31-40. BILBAN, M. (2005). Telesna dejavnost za ohranjanje zdravja in preprečevanje ikov | he poškodb. V J. Turk, & E. Bobnar Najžer, Zdrava poznejša leta naj bodo tu- stn di lepa (str. 228-236). Ljubljana: Društvo za zdravje srca in ožilja Sloveni- taroe s je,Inštitut Antona Trstenjaka za gerentologijo in medgeneracijsko. BIRSA, M. (2014). Raziskava o prostovoljstvu in zdravju starejših ljudi na Sev- zdravj ernem Irskem. Kakovostna starost 17(4) , 57-60. BÖRSCH-SUPAN, A., BRANDT, M., HUNKLER, C., KNEIP, T., KORBI- MACHER, J., MALTER, F., in drugi. (29. November 2013). Data Re- sourche Profile: The Survey of Health, Agening and Retirement in Europe (SHARE). Prevzeto 24. Julij 2014 iz International Journal of Epidemiolo- gy: http://www.share-project.org/home0/wave-2.html DREV, A. (2011). Priporočila za telesno/gibalno dejavnost za starejše odrasle. Ljubljana: Inštitut za varovanje Republike Slovenije. DREV, A. (2010). V gibanju tudi v starosti. Ljubljana: Inštitut za varovanje zdravja Republike Slovenije. ELANIE, H. (2014). Vzemite zdravje v svoje roke- Ubežite indrustiji bolezni. Ljubljana: Ara. EMILY, Z., MICHAEL J, T., & VONDA J, W. (27. December 2013). The Role of Mobilityas a Protec- tive Factor of Congonitive Functioning in Aging Adults: A review. Sports Health , 63-69. FRANKLIN, N. C., & TATE, C. A. (2009). Lifestyle and Successful Aging: An Overview. American Journal of Lifestyle Medicine 3(1) , 6-11. GARIBALLA, S. (2011). Nutrition and Quality of Life in Older People. V V. R. Preedy, R. Watson Ross, & C. R. martin, handobbk of Behavior,Food and Nutrition (str. 3099- 3113). London: Springer Science & Business Media. HALVORSRUD, L., KIRKEVOLD, M., DISETH, Å., & KALFOSS, M. (2010). Halvorsrud, Liv; Kirkevold, Marit; Diseth, Åge; Kalfoss, Mary. Research and Theory for Nursing Practice: An International Journal 24(4) , 241-259. KRUGER, P. M., ROGERS, R. G., HUMMER, R. A., & BOARDMAN. (2004). Body Mass, Smoking, and Overall and Cause-Specific Mortality Among OlderU:S: Adukts. Research on Agening 6(1) , 82-107. Ministrstvo za zdravje. (7. Marec 2007). Strategija Vlade Republike Slovenije na podrocju telesne (gibalne) dejavnosti za krepitev zdravja od 2007 do 2012. Prevzeto 24. Julij 2014 iz http://www.mz.gov.si/:http://www.mz.gov. si/fileadmin/mz.gov.si/pageuploads/mz_dokumenti/delovna podrocja/ javno_zdravje/strategija_vlade_RS_podrocje_telesne_dejavnosti.pdf MITZNER, T. L., MCBRIDE, S. E., BARG-WALKOW, L. H., & ROGERS, W. 99 A. (2013). Self-Manegment of Wellness and Illness in an Aging Popula- tion. Reviews of Human Factors and Ergonomics 8(1) , 277-333. PHILLIPS, ealth S. M., WÓJCICKI, T. R., & MCAULEY, E. (2013). Phyisical activity and quality of life in olderadults: an 18-month panel analysis. Qual Life Res 22(7) , 1647-1654. lderly’s h RAMOVŠ, J. (2013). Staranje v Sloveniji. Ljubljana: Inštitut Antona Trstenjaka. he er to SIPARSKY, P. N., KIRKENDALL, D. T., & GARRETT, W. E. (2014). Musde Changes in Aging: Understanding Sarcopenia. Sports Health: A Multidis- ciplinary Approach 6(1), 36-40. rtance fpom SUGIYAMA, T., WARD THOMPSON, C., & ALVES, S. (2009). Associations ts i Between Neighborhood Open Space Attributes and Quality of Life for nd i Older People in Britain. Environment and Behavior 41(1) , 3-31. TANG, F., & LEE, Y. (2011). Social Support Networks and Exspectations for Ag- ctivity a ing in Place and Moving. Research on Agening 33(4) , 344-464. THOMPSON, W. W., ZACK, M. M., KRAHN, G. L., ANDERSEN, E. M., & BARILE, J. P. (2012). Health Related Quality of Life AMong Older Adults physical a With and Without Functional Limitations. American Journal of Public Health 102(3) , 496-502. TSAI, L.-T., RANTAKOKKO, M., PORTEGIJS, E., VILJANEN, A., SAAJAN- AHO, M., ERONEN, J. E., in drugi. (2013). Environmental mobility bar- riers and walking for errands among older people who live alone vs. with others. BMC Public Health , 1-8. WIKMAN, A., WARDLE, J., & STEPTOE, A. (2011). Quality of Life and Affec- tive Well - Being in Middle Aged and Older People with Chronic Medical Illnesses: A Cross -Sectional Population Based Study. PLoS ONE 6(4) , 1-9. ZALETEL - KRAGELJ, L., ERŽEN, I., & PREMIK, M. (2011). Uvod v javno zdravje. Ljubljana: Univerza v Ljubljani. Zavod za zdravstveno varstvo Ljubljana. (9. Maj 2013). Moje zdravje. Svetovni dan gibanja 2013 z redno telesno dejavnostjo v zdrava leta 8(1) , 2-8. Factors influencing hospital length of stay in non-acute care setting Vida Oražem1, Danica Rotar Pavlič2, Melita Peršolja2 1 University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia 2 University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia Abstract Introduction: Aging population results in increased need for non-acute hospital care. Inaccessible treatment is aimed primarily for the elderly, who no longer need diagnostic procedures, but rather the improvement of self-care. Health care is one of the priorities of non-acute treatment. The purpose of the study was to determine factors influencing the length of stay at non-acute care hospital department. Methods: Based on routinely collected data from the Care Department of University Medical Centre Ljubljana in 2016, a retrospective cross- sectional study was carried out. The aims of the study were to detect the relation of hospitalization length of stay with patients’ demographic characteristics, care needs, family participation, and medical diagnosis at discharge. Data on all 431 patients were collected. The average age of the patients was 80 years; most of them were women (70.5 %). Hospitalization for 102 patients (32.6 %) completed after four weeks, and for 115 (26.6 %) after five weeks. Results: Hospitalization was longer in patients below 65 years of age (p = 0.02), in patients with greater number of discharge nursing diagnoses (p = 0.044), in patients with low involvement of relatives (p = 0.024), and in patients after hip fracture or stroke (p < 0.001). Discussion and conclusions: Significant association between the number of discharge nursing diagnoses and the length of hospitalization confirms that nursing care contributes to patients’ progress and quality of life. Key words: hospital length of stay, elderly, non-acute care doi: https://doi.org/10.26493/978-961-7055-18-4.101-108 Non-acute care is aimed primarily for the elderly population, who no longer needs diagnostic procedures, but rather the improvement in self-care. The purpose of the study was to determine what influence the length of hospitalization in non-acute care. The treatment of elderly usually takes longer than the treatment of active population, and with aging the need for hospitalization is increasing due to de- terioration of chronic diseases (Peternelj, 2013). Older people often suffer from a number of diseases, including geriatric syndromes with multiple aetiologies. Signs and symptoms vary according to the individual and are often atypical, so patients visit different hospitals, and at the same time receive numerous screen- ing and recipe tests (Arai et al., 2012). In hospitals, 60 % of adults who are admitted are older than 65 years. Hospitalization due to disease in the age group of 85 years lasts on average 10.84 2 days (National Institute of Public Health [NIJZ], 2014), 8.1 days for men, and 10 for the same age group of women on average 9.7 days (Skela Savič, Zurc and Hvalič Touzery [Skela Savič], 2010). Long hospitalization in high age has an lderly overall impact on the quality of the elderly life and represents an increased risk e of re-hospitalization and accommodation in institutional care (Nazarko, 2012). f the o Treatment of the elderly is prolonged; the complications of the underly- alth ing disease and invasive interventions are more frequent and slow down the re- covery (Poredoš, 2004; Toth, 2009). The hospitalization frequently leads to a ikov | he functional decline or to a partial or complete dependence (Boyd et al., 2008), stn requiering the provision of social assistance (Toth, 2009). In elderly who is not taroe s capable of self-care, several aspects must be considered before discharge from the hospital. The most important are his health status and the need for care zdravj (Lavtižar and Kramar, 2012). An effective non-acute treatment in that age group should be ensured by appropriate programs in which the maintenance and improvement of the quality of life should be emphasized. Early focus on non-acute nursing care and rehabilitation can improve the outcome and positively affect the ability to perform daily life activities (Neyens et al., 2009). Patient classification system identifies the complexity of required health care for each patient. The core con- cepts are: (1) hygiene, (2) mobility, (3) food intake, (4) medicines, (5) supervi- sion. These concepts embrace a 4-tiered scale and assign the patient to one of four categories (Klančnik-Gruden et al., 2013). Nursing diagnoses enable a reli- able assessment of patient care needs (Klančnik et al., 2015) aimed at improving health and restoring autonomy. The goal of planning, in cooperation with the patient and his relatives, is to achieve higher level of life quality. University Medical Centre Ljubljana opened non-acute care department with 33 beds in 2011 and immediately faced referral requests above its limits. This study is an attempt to examine the parameters that influence hospital length of stay at this department. Methods A retrospective cross-sectional study using data from nursing documentation was carried out. The aims of the study were to examine whether the length of hospitalization in non-acute hospital care setting is associated with the patients demographic characteristics, the needs for nursing care, family support, and medical diagnosis at discharge. Population, sample The research sample included data on all (n = 431; 100 %) patients who were hos- pitalized at the Non-acute nursing department of University Medical Center Ljubljana in 2016. The majority (70.7 %, n = 305) were women with an average age of 84.1 years (Standard deviation (Sd) = 10.6). The average age of all patients was 79.5 years (Sd = 10.7). Patients hospital length of stay lasted on average 24.3 3 days (Sd = 10.7). Half of patients (50.35 %) were hospitalized four (n = 102; 23.67 10 %) or five (n = 115; 26.68 %) weeks. In some cases (n = 41; 6.26 %) hospitalization lasted longer than 35 days (Max = 150 days). etting are s Instrument Data were obtained from acute hospital discharge, nursing care documenta- cute c n-a tion, from social workers’ reports and from non-acute nursing discharge doc- o uments. The collected data were: gender, age, the acute hospital referral de- n n partment, the number of hospitalization days, the admission and discharge tay if s medical diagnosis, nursing diagnosis and the category of nursing care. In order to simplify the data analysis, only the first medical diagnosis of the individu- ength o al patient was recorded. Data about visits of patient relatives and their involve- ment in care were summarized from the documentation of the social worker. spital lo Data analysis SPSS version 23.0 was used for data analysis. Variables were described as fre- nfluencing h rs i quencies (n) and proportions (%), the smallest (Min.) and the highest (Max.) value, average (M), median (Me), and the standard deviation (Sd). When facto the numerical variables were not distributed normally, the nonparametric tests were used for analysis. Correlation between the variables was calculat- ed with the Spearman coefficient (r), the difference between two groups with the Mann-Whitney U-test, and the correlations and the difference between the three groups with Kruskal-Wallis test. The confidence level was set at 95 %. Results Patients that were admitted to the non acute care department were transferred mostly from surgical hospital departments, and a fifth of them from the med- ical department (Table 1). Table 1: Admitted patients by referral hospital department Patients Refferal hospital department n % Surgical 269 62.4 Medical 84 19.4 Neurological 35 8.1 Infectious diseases and febrile conditions 22 5.1 Orthopedic 15 3.4 Gynecological 5 1.1 Otorhinolaryngological and maxillofacial surgical 1 0.2 Total 431 100 N, number; %, percent 4 The mean value suggested longer hospitalization for women (M = 10 24.62±12,68 Vs M = 23,68±10,79), but the difference between groups regarding gender was not statistically significant (p = 0.38). lderly Neither the age of patients was significantly correlated (p = 0.91) to the e length of stay at the non-acute care setting. After diviing the sample in two f the o groups considering patients age, the length of hospitalization in patients older alth than 65 years deviated from normal distribution. Therefore, Mann-Whitney U- test was used to check differences between groups. In the group under the age ikov | he of 65, the length of hospitalization was at least 6 and a maximum of 62 days (M stn = 28.2; Me = 29; Sd = 11.9). In the group of patients above 65 years the hospital- taro ization lasted from 0 to 150 days (M = 23.9; Me = 25.5; Sd = 12.1). The difference e s between two groups was statistically significant (p = 0.02). zdravj Needs for nursing care were identified taking into account the categories of nursing care and the quantity of nursing diagnoses per patient. The highest (63.6 %) percentage of patients was classified into category 2, which meant that the patients were assigned by default and received supportive or partial assis- tance from nurses. A fifth (20.96 %) of patients was assigned to the demand- ing category 3. These patients may have required complete assistance with hy- giene care, mobility, elimination, or feeding; the patients received tube care, or their vital signs were monitored more than 6 times every 24 hours. More than a tenth (15.4 %) of the hospitalised patients was assigned to category 1, which meant that they did not receive assistance with hygiene care, mobility, elimi- nation, and feeding; they did not have infusion lines, and their vital signs were monitored less than 6 times every 24 hours (Table 2). The correlation coefficient between nursing care categories and hospital- ization length was not significant (Table 2). Moreover, the correlation coeffi- cient between nursing care categories and the number of discharge nursing di- agnoses was weak (r = 0.104), but statistically significant (p = 0.044). Table 2: Hospitalization length related to the nursing care category Hospitalization length, days Nursing care category n p Min Max M Me Sd I. 64 2 88 24.94 24.5 12.61 II. 264 0 150 24.90 26.0 12.53 0.76 III. 87 0 46 23.38 26.0 10.09 Total 415 0 150 24.59 26.0 12.06 N, number of patients; Min, minimum value; Max, maximum value M, average value; Me, median; Sd, standard deviation P, the result of the Kruskal-Wallis test The number of nursing diagnosis at admission at the non-acute hospital department ranged from two to 25 nursing diagnosis per patient. The variable was not significantly correlated to the length of hospitalization (p = 0.49). Total of discharge nursing diagnosis ranged from 2 to 20, and the variable was signif- 105 icantly correlated to the length of hospitalization (r = 1.04; p = 0.04). The most common discharge medical diagnosis were different fractures etting (35.96 %), internal organ diseases (17.86 %) and cardio-vascular diseases (8.12 %). There was a significant correlation between the hospitalization length and are s the type of discharge medical diagnosis (Table 3). However, the longest hospi- cute c talization of 150 days was observed in patient with hip fracture. n-ao n n Table 3: Hospital length of stay depending on medical diagnosis at tay i discharge f s Length of stay in days Discharge diagnosis n p ength o Min Max M Me Sd Hip fracture 49 0 150 30.49 30.0 19.17 spital lo Stroke 14 3 45 27.64 29.5 11.01 Other neurological diseases 14 10 62 25.93 24.0 12.46 Other fractures 106 4 34 25.84 27.0 8.86 Internal organ diseases 77 1 88 24.57 25.0 11.78 nfluencing h Injury 32 0 45 24.50 28.5 11.36 rs i Cardio-vascular diseases 35 6 36 18.51 17.0 7.99 <0.001 Intracerebral hemorrhage 20 6 47 22.65 22.5 11.69 facto Cancer 24 4 45 22.13 18.0 12.65 Surgical procedures 20 3 37 21.50 24.5 10.07 Other 8 2 36 20.00 20.5 12.28 Infection 32 0 43 18.63 18.0 10.06 Total 431 0 150 23.86 23.75 11.8 N, number of patients; Min, minimum value; Max, maximum value; M, average value; Me, median; Sd, standard deviation; p, statistical significance of the Mann-Whitney U-test The inclusion of family in caring activities was significantly correlated to the length of patients’ hospitalization. Greater quantity of visits by relatives to the patient, reflected in shorter hospitalization period (r = -0.109; p = 0.023). Discussion Non-acute care hospital department is intended for patients that primarily need nursing services. Before admittion, the patient should be physically stable considering that non-acute care programs do not allow diagnostic treatment. This department prioritizes support, care and rehabilitation, adapted for geri- atric patients. In this study significant association has been found between the length of hospitalization at non-acute care hospital department and: a.) total of dis- charge nursing diagnosis; b.) type of medical discharge diagnosis; c.) and in- 6 clusion of family members in care activities. Length of stay was not correlated 10 to the observed demographic characteristics (gender, age), and neither to nurs- ing care needs defined from nursing categories. lderly Findings from this study are supported from authors (Murko, et al., 2016; e Majcen Vivod, Vivod, 2012), as the age and the gender of patients does not af- f the o fect the length of hospitalization. An increase in women’s illness compared to alth men is visible after age of 70, due to the longer life expectancy of women. The correlation between nursing care categories, which describe patient ikov | he needs for care, and nursing diagnoses was significant, meaning that two indi- stn cators are complementary. The sum of nursing diagnoses which were set up up- taro on admission and discharge at the hospital, decreased from an average of 10 to e s eight diagnosis per patient. Significant association between the two variables zdravj suggests that nursing care has an important effect on patient needs, and im- proved health status. Non-acute department activities are tailored to the elder- ly, and based on support, care and rehabilitation. Length of stay at the hospital was correlated to the type of medical dis- charge diagnosis, where the longest time of hospitalization was characteristic for hip fracture. Considering the positive relation of total hospitalization days with typical and most common medical diagnosis of elderly, a special geriatric care would be beneficial. Ellis et al. (2011) researched the effectiveness of treat- ment in elderly who were addmited to the hospital. The study included a to- tal of 10,315 patients from six countries. They examined hospital-rehabilitation programs for patients with heart disease, neurological patients and patients with lung and musculoskeletal disorders. Results show that patients includ- ed in special geriatric treatment had higher probability of survival and inde- pendency compared with the control group receiving standard hospital treat- ment. Patients with geriatric treatment also were at lower risk deterioration of health status and more likely improved cognitive abilities. Similarly Bachman et al. (2010) measured the effects of hospital rehabilitation on patients with ge- riatric treatment and on patients with standard health care. The study includ- ed 17 randomized controlled trials involving 4,780 patients. Again, the results showed a positive effect of special geriatric care on improved functional status, reduced risk of admission to nursing home and lower mortality in elderly. Involvement of relatives in the first two weeks of non-acute hospital care is negatively associated with the length of hospitalization. Thus, many elder- ly people are frail and with serious health problems that require physical help and support from family. Co-operation of relatives is therefore a very impor- tant part of rehabilitation (Skela Savič et al., 2010). Conclusions No significant relations have been found between patient demographic charac- teristics, his nursing care needs and the length of stay at the non-acute hospital department. However, the length of stay is correlated to the sum of nursing di- 7 agnoses, and to the type of medical diagnosis at the discharge time. 10 References etting ARAI, H., OUCHI, Y., YOKODE, M., ITO, H., UEMATSU, H., ETO, F., OSHIMA, S., are s OTA, K., SAITO, Y., SASAKI, H. et al., 2012. Toward the realization of a better aged society: messages from gerontology and geriatrics. Geriatrics & Gerontolo-cute c n-a gy International, vol. 12, no. 3, pp. 16–22. o n n BACHMANN, S., FINGER, C., HUSS, A., EGGER, M., STUCK, A.E. and CLOUGH- tay i GORR, K.M., 2010. Impatient rehabilitation specifically designed for geriatric f s patients. British Medical Journal, no. 340, pp. 1–11. BOYD, C.M., LANDEFELD, C.S., COUNSELL, S.R., PALMER, R.M., FORTINSKY, ength o R.H., KRESEVIC, D., BURANT, C. and COVINSKY, K.E., 2008. Recovery of spital l activities of daily living in older adults after hospitalization for acute medical o illness . Journal of the American Geriatrics Society, vol. 56, no. 12, pp. 2171–2179. ELLIS, G., WHITEHEAD, M.A., ROBINSON, D., O‘NEILL, D. and LANGHORNE, nfluencing h P., 2011. Comprehensive geriatric assessment for older adults admitted to hospi- rs i tal. British medical journal, no. 343, pp. 1–11. facto KLANČNIK GRUDEN, M. et al., 2013. Izidi zdravstvene nege na negovalnem oddelku UKC Ljubljana. In MOREC, D., JOŠAR, D. and LIPIČ BALIGAČ, M., eds. Moč za spremembe: medicinske sestre in babice smo v prvih vrstah zdravstvenega siste- ma, Strokovni seminar, 11. 6. 2013. Murska Sobota: Strokovno društvo medicin- skih sester, babic in zdravstvenih tehnikov Pomurja, pp. 295–301. KLANČNIK GRUDEN, M. et al., 2015. Novosti na področju negovalnih diagnoz. In S. MAJCEN DVORŠAK, S., et al., eds. Z optimalnimi viri do učinkovite zdravst- vene in babiške nege / 10. jubilejni kongres zdravstvene in babiške nege Sloveni- je, Brdo pri Kranju, 11. in 12. maj 2015. Ljubljana: Zbornica – Zveza, Nacionalni center za strokovni, karierni in osebnostni razvoj medicinskih sester in babic, pp. 198–206. LAVTIŽAR, J. and KRAMAR, Z., 2012. Koordinator zdravstvene obravnave pacien-ta. In BAHUN, M., KRAMAR, Z., and SKELA SAVIČ, B., eds. Trajnostni raz- voj na področju kakovosti in varnosti povezava med akreditacijo in varno ter kak- ovostno obravnavo pacientov/ 5. dnevi Angele Boškin, 20. in 21. september 2012, Kranjska Gora. Jesenice: Splošna bolnišnica, Visoka šola za zdravstveno nego, pp. 24–28. MAJCEN VIVOD, B., and VIVOD, M., 2012. Pljučna embolija–pregled bolnikov, spremljanih v ambulanti Centra za transfuzijsko medicino Maribor v letu 2011. Zdravniški vestnik, vol. 81, no. 2, pp. 299–306. MURKO, A., BRILEJ, D., KRUŠIČ, D. and PLASKAN, L., 2016. Dejavniki, povezani z izidom zdravljenja starostnika z nizkoenergetskim zlomom kolka po konča- nem bolnišničnem zdravljenju v Splošni bolnici Celje. Rehabilitacija, vol. 15, no. 3, pp. 4–11. 8 NACIONALNI INŠTITUT ZA JAVNO ZDRAVJE [NIJZ], 2014. Spremljanje bol- 10 nišničnih obravnav (SBO) [online]. [viewed 5 June 2018]. Available from: http:// www.nijz.si/sites/www.nijz.si/files/uploaded/podatki/podatkovne_zbirke_ra- ziskave/sbo/sbo metodoloska-navodila-2016_v1-5.pdf lderly e NAZARKO, L., 2012. Intermediate care: the nursing contribution. Nurse Prescribing, f the vol. 10, no. 10, pp. 508– 512. o alth NEYENS, J.C.L., DIJCKS, B.P.J., TWISK, J., SCHOLS, J.M.G.A., VAN HAASTREGT, J.C.M., VAN DEN HEUVEL, W.J.A. and DE WITTE, L.P., 2009. A multifacto- ikov | he rial intervention for the prevention of falls in psychogeriatric nursing home pa- stn tients, a randomised controlled trial. Age Ageing, vol. 38, no. 2, pp. 194–199. taro PETERNELJ, A. and SIMONIČ, A., 2009. Izkušnje, znanje in predstave zdravstvenih e s delavcev in sodelavcev v paliativni oskrbi. In MAJCEN DVORŠAK, S., KVAS, zdravj A., KAUČIČ, B.M., ŽELEZNIK, D., KLEMENC, D., BUČEK HAJDAREVIĆ, I., ČALIĆ, M., DORNIK, E., FILEJ, B., KAD- IVEC, S., eds. Medicinske sestre in babice – znanje je naša moč / 7. kongres zdra- vstvene in babiške nege Slovenije, Ljubljana, 11.–13. maj 2009. Ljubljana: Zbornica – Zveza, pp. 232. POREDOŠ, P., 2004. Značilnosti zdravstvene obravnave starostnikov. Zdravniški vestnik, vol. 73, no. 6, pp. 536–539. SKELA SAVIČ, B., ZURC, J. and HVALIČ TOUZERY, S., 2010. Staranje populacije, potrebe starostnikov in nekateri izzivi za zdravstveno nego. Obzornik zdravst- vene nege, vol. 44, no. 2, pp. 89–100. TOTH, M., 2009. Dolgotrajna oskrba – nova veja socialne varnosti. Delo in varnost, vol. 54, no. 2, pp. 9–21. Tackling frailty with the help of information- communication technology Špela Selak, Branko Gabrovec National institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia Abstract Introduction: Frailty seems to be highly prevalent among the elderly, while its prevalence is estimated to be between 5 % and more than 45 % depending on definition and age group. Beside impairment, dependence on others, and one or more chronic diseases, it appears to be almost inevitable consequence of demographic changes in the society. Solutions and services adapted to the elderly and supported by the information- communication technology (ICT) seem to significantly contribute to facing population’s demographic ageing. Methods: The literature review, which researches and describes management of frailty with the help of ICT, was carried out (use of PRISMA protocol) between March and June 2017. Results: Number of all research results was 124,634, while 33 articles were included in the analysis. Discussion and conclusions: Application and use of ICT among frail persons is multidimensional and plays an important role within management of frailty. Especially in the sense of physical activity and exercise, and motion detection or falls prevention, as well as nutrition, sleep, overall well-being, cognitive functions, social interaction, communication, psychological state, and support to other daily activities of frail elderly. However, several questions and challenges remain unanswered. Key words: information-communication technology, ICT, ageing, frailty, frailty management We are facing the demographic ageing of the population, whereas by the year 2060 the percentage of EU citizens over 65 is expected to increase 10 % (18-28 %) and the percentage of EU citizens over 80 to more than double (5 – 12 %) (World Health Organization, 2015). Although life doi: https://doi.org/10.26493/978-961-7055-18-4.109-116 expectancy is prolonged, many elderly people are facing dependency on others, frailty impairment and one or more chronic diseases, which seem to be an almost inevitable consequence of these demographic changes. Frailty - »a multidimensional syndrome characterized by decreased reserve and dimin- ished resistance to stressors« (Rodríguez-Mañas et al., 2013) - seems to be high- ly prevalent among elderly persons, while its prevalence is estimated to be be- tween 5 % and more than 45 % depending on the definition and age group (Veninšek and Gabrovec, 2018). Solutions and services, adapted to elderly people and supported by the in- formation-communication technology (hereinafter referred to as ICT), seem to significantly contribute to facing population's demographic ageing (Vollen- broek-Hutten et al., 2017), and also to potentially contribute to health care sys- tems' transformation towards patient-centered and integrated care, which meet the needs of the elderly (World Health Organization, 2015). 110 So far, there have been many ICT solutions that demonstrate benefi- cial outcomes for the elderly. They seem to play an important role in pro- viding more accessible, of better quality and safer health care (Beard and lderly e Bloom, 2015), overall well-being, quality of life and empowerment of the el- f the derly (Keränen et al.,2017), as well as in their improved health and social par- o ticipation (Beard and Bloom, 2015). ICT can also play an important role in alth supporting complex care of frail older people in terms of screening, assess- ment, monitoring and follow-up (Kelaiditi, 2016). ikov | he stn There has been an important step made towards ICT implementation in- taro to several healthcare services, as well in the field of elderly care. However, we e s seem to face some challenges regarding the implementation, namely potential ICT tools without proven clinical effectiveness and service adoption (Jansen zdravj - Kosterink et al., 2016), low system usability and lack of personalization and flexibility (Peruzzini and Germani, 2014), as well as greater, but still limited, technology adoption by the elderly, among which many don't believe ICT can greatly improve the quality of their lives (Heart and Kalderon, 2013). Methods Between March and June 2017, literature review was conducted using PRIS- MA protocol (Moher et al., 2010) and search within PubMed, Cochrane, Em- base, UpToDate and CINAHL databases. We used several combinations of key words in English language, chosen from the list, proposed by the ICT task lead- ers in the frame of Joint Action Advantage, in which National Institute of Pub- lic Health co-leads the work package that deals with managing frailty at an in- dividual level together with Greek University of Patras. Peer-reviewed journal papers, international documents, standards, guidelines, and EU research stud- ies published between 2002 and 2017 were included in the review. Furthermore, grey literature, namely unpublished or hard to find publications, reports, PhD theses etc. were included in the review, whereas the list of these grey documents was also prepared by the ICT task leaders. Editorials, letters, interviews, posters and papers without an access to full text were excluded from the research. Results and discussion We conducted a comprehensive literature review on the management of frail- ty with the help of ICT. Overall number of research results after applying all the combinations of keywords was 124,634. After taking into account the inclu- sion and exclusion criteria and exclusion of the duplicates, 33 papers/sources re- mained for the analysis. One of the main goals of ICT usage in frail elderly is to improve the qual- ity of their lives. ICTs can make life of the elderly and (potentially) frail el- derly easier and improve their productivity. Lifestyle improvement ICTs can play an important role and have a positive impact on the quality of life of the frail elderly by promoting social interaction, communication, physical activi- 111 ty and exercise, nutrition, and support other day-to-day activities. Beside that, ICTs can improve their accessibility to services and consequently improve in- gylo dependence and self-care help, as well as lower frailty rates. o Since frailty often results from reduced physical capacity and decreased chn n te regular physical activity (Rogers et al., 2017), ICTs that promote physical ac- tivity and exercise can also play an important role in its management, which catio can improve body performance and consequently reduce frailty (Binder et al., uni mm 2003; Cadore et al., 2014). ICTs are used both to set up training programs as n-co well as to implement them, and can play an important role with maintaining atio adherence to the program and correct execution of the training. Exercise ad- rmo herence could thus be improved by introducing ICT to promote group exercise, f inf social networking, regular contact with caregivers, involvement of relatives lp o and caregivers, etc. And possibly as well through gaming principles (Barelle he et al.,2014). Although frequency of ICT use seems to be related to clinical out- the comes (Vollenbroek-Hutten et al., 2017), there is no evidence on the ICT based ith exercise programmes for frail elderly in the reviewed literature. Supportive technologies usually include assistive technologies (e.g. for railty w disabilities, home care, etc.) and monitoring of different data and activities (e.g. fall detection, kinematics, position, physiological data, etc.). The latter has tackling f proved to be effective in a positive attitude to health, health literacy, increased confidence in technology (Ogonowski et al., 2016). Supportive ICTs can reduce the burden of formal and informal caregivers taking care of an elderly person's safety living alone and can help to provide home care (Lexis et al., 2013). Com- plex smart home solution that includes monitoring of activities in home en- vironment (e.g. movement detection, usage of devices, etc.) can significantly contribute to the self-management empowerment for independent living of the elderly (Tomita et al., 2010). The smart home solutions can also include ICTs for fall detection and prevention (the latter can also act as a stand-alone appli- cations), which play an important role, especially among the frail elderly (Pie- trzak et al., 2014), to whom falls present one of the greatest risks for independency. ICTs can thus enable home environment and falls’ risk assessment, and most often fall detectors. The latter are based on sensors, usually attached to the body or wrist, which continuously monitor individual's activity to detect a fall and automatically call for help (Pietrzak et al., 2014; Ogonowski et al., 2016). This increases the confidence and sense of security of frail elderly (17). One of the electronic fall detection are smart watches (Gjoreski et al., 2016; Ko- stopoulos et al., 2016). ICTs can also play an important role in the objective identification of prefrail and frail people, whereas gait parameters (stride length, double sup- port, and walking bout duration variability) were shown to be the most sensi- tive to discriminate frailty levels (Ritt et al., 2017; Schwenk et al., 2015). One of the ways this data can be obtained from simple measurements in everyday life is by using a method of gait parameters assessment using two microphones, at- 112 tached to the body and connected to a smartphone (Wang et al.,2016), or by us- ing a single dimensional accelerometer, attached to the top of the foot (personal laboratory experience). For more objective frailty assessment, physical activity lderly e data obtained from the accelerometer can be later combined with clinical indi- f the cators (Fontecha et al., 2013). o alth Social isolation is an important challenge for the elderly (Nicholson, 2012), and is often associated with depression, re-hospitalization, falls, unhealthy be- ikov | he haviours (e.g. excessive, alcohol consumption, and smoking), predominantly stn sedentary lifestyles, lack of adherence in pharmacological treatment, increased taro susceptibility to infectious diseases, etc. ICTs can thus play an important role e s also in tackling social isolation of the elderly, however they are not suitable for zdravj everyone alike (Chen and Schulz, 2016). ICTs can ease the social isolation of the elderly by connecting them with the outside world, gaining social support, engaging in interest activities and boosting self-confidence, whereas the posi- tive effect of ICT use on social connectedness and social support seemed to be of a short-term (did not last for more than six months after the intervention). ICTs can play an important role at the individual level, as well as sup- porting the functions and administration of the health system. Among oth- ers, the support for health systems are also telecare and telehealth. The most effective telecare intervention proved to be the telephone follow-up by nurs- es to improve clinical indicators and to reduce health service use, and in order of the latter also automated vital signs monitoring (Barlow et al., 2007). Phy- sicians can use clinical decision support systems to remotely evaluate patients in adapting therapy, identifying, which patients need more urgent or more de- tailed examination; the number of visits can be significantly reduced (Cabal- lero-Ruiz et al., 2017). ICT-based services for the elderly (telegeriatric services) play an important role in rural and remote communities. They are cost-effec- tive (Versleijen et al., 2015), but their implementation is slow and fragmented (Smith and Gray, 2009). The literature review results suggest that the adoption and the use of new technologies remain problematic, especially for the elderly. The implementation challenge is often present, as the adoption and use of new technologies re- duce with age (this is indicated by the number of the elderly, who start using the Internet) (Niehaves and Plattfaut, 2014), as well as the adoption of health-relat- ed ICTs (Heart and Kalderon, 2013). Resistance to ICT adoption by the elderly is often linked to their abilities, capacity and social impacts, whereas socio-de- mographic factors such as gender, age, education, and income also play an im- portant role. In order to increase the acceptance of health-related ICTs among elderly, ICTs should be simple and useful to users, and special attention should be given to personality traits of the individual as well as learning and support in the use of ICT (Heart and Kalderon, 2013). ICTs should promote successful life- long development in all age groups and should not be focused solely on the state of disability/impairment (Baltes et al., 1999). Therefore, higher rate of ICT us- age among frail elderly could be achieved by introducing ICTs to them well be- 113 fore the onset of the state of disability/impairment (Lindenberger et al., 2008). gyloo Conclusions chn n te Application and use of ICTs among frail persons are multidimensional and seem to play an important role within management of frailty, namely with- catio uni in the support of prevention as well as complex care of frail elderly. Especially mm from the perspective of physical activity and exercise, and motion detection or n-co falls prevention, as well as nutrition, sleep, overall well-being, cognitive func- atio tions, social interaction, communication, psychological state, and support to rmo other daily activities of frail elderly. However, several questions and challeng- f inf es remain unanswered. lp o he the References ith BALTES, P. B., STAUDINGER, U. M. and LINDENBERGER, U., 1999. Lifespan psychology: theory and application to intellectual functioning. Annual railty w Review of Psychology, vol.50, p.471–507. BARELLE, C., TSIRBAS, Ch., IBANEZ, F., VELLIDOU, E., TAGARIS, T., tackling f KOUTSOURI, G. and KOUTSOURIS, D., 2014. KINOPTIM: A Tele-re- habilitation gaming Platform for Fall Prevention in the Elderly Commu- nity. International Journal of Health Research and Innovation, vol.2, no.1, p.37–49. BARLOW, James, SINGH, Debbie, BAYER, Steffen and CURRY, Richard, 2007. A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. Journal of Telemedicine and Telecare, vol.13, no.4, p.172–179. BEARD, John R. and BLOOM, David E., 2015. Towards a comprehensive public health response to population ageing. Lancet, vol.385, no.9968, p.658–661. BINDER, E. F., SCHECHTMAN, K. B., EHSANI, A. A., STEGER-MAY, K., BROWN, M., SINACORE, D. R., YARASHESKI, K. E. and HOLLOSZY, J. O., 2003. Effects of exercise training on frailty in community-dwell- ing older adults: Results of a randomized, controlled trial. Journal of the American Geriatrics Society, vol.50, p.1921–1928. CABALLERO-RUIZ, E., GARCÍA-SÁEZ, G., RIGLA, M., VILLAPLANA, M., PONS, B. and HERNANDO, M.E., 2017. A web-based clinical decision support system for gestational diabetes: Automatic diet prescription and detection of insulin needs. International Journal of Medical Informatics, vol.102, p.35–49. CADORE, E. L., CASAS-HERRERO, A., ZAMBOM-FERRARESI, F., IDOATE, F., MILLOR, N., GÓMEZ, M., RODRIGUEZ-MAÑAS, L. and IZQUIERDO, M., 2014. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional out- comes in institutionalized frail nonagenarians. Age, vol.36, no.2, p.773–85. 114 CHEN, Yi-Ru Regina and SCHULZ, Peter J., 2016. The Effect of Information Communication Technology Interventions on Reducing Social Isolation lderly in the Elderly: A Systematic Review. Journal of Medical Internet Research, e vol.18, no.1, p.e18. f the o FONTECHA, Jesús, NAVARRO, Fco Javier, HERVÁS, Ramón and BRA- VO, José, 2013. Elderly frailty detection by using accelerometer-enabled alth smartphones and clinical information records. Personal and Ubiquitous Computing, vol.17, no.6, p.1073–1083. ikov | he stn GJORESKI, H., BIZJAK, J. and GAMS, M., 2016. Using Smartwatch as Telecare taro and Fall Detection Device. 2016 12th International Conference on Intelli- e s gent Environments (IE), London, 2016, p.242–245. [viewed 15 May 2017]. Available from: https:/ ieeexplore.ieee.org/document/7723508/ zdravj HEART, Tsipi and KALDERON, Efrat, 2013. Older adults: are they ready to adopt health-related ICT? International Journal of Medical Informatics, vol.82, no.11, p.e209-231. JANSEN - KOSTERINK, Stephanie, VOLLENBROEK - HUTTEN, Miriam M. and HERMENS, Hermie J., 2016. A Renewed Framework for the Evalua- tion of Telemedicine. In: Hettinga, M. et al., eds. Proceedings of the Eighth International Conference on eHealth, Telemedicine, and Social Medi- cine (eTELEMED 2016). Venice, Italy: International Academy, Research, and Industry Association ( IARIA ). [viewed 30 April 2017]. Available from: https://www.thinkmind.org/index.php?view=article&articleid=e- telemed_2016_4_30_40183 KELAIDITI, E., 2016. Frailty and Novel Technologies - A Step Ahead. In: B. Vellas, ed. White Book on Frailty. Chengdu, China: Center of Gerontolo- gy and Geriatrics, West China Hospital, Sichuan University. p. 140–142. [viewed 25 April 2017]. Available from: https:/ www.jpn-geriat-soc.or.jp/ga- kujutsu/pdf/whitebook.pdf KERÄNEN, Niina Susanna, KANGAS, Maarit, IMMONEN, Milla, SIMILÄ, Heidi, ENWALD, Heidi, KORPELAINEN, Raija and JÄMSÄ, Timo, 2017. Use of Information and Communication Technologies Among Older People With and Without Frailty: A Population-Based Survey. Journal of Medical Internet Research, vol.19, no.2, p.e29. KOSTOPOULOS, P, KYRITSIS, A .I., DERIAZ, M. and KONSTANTAS, D., 2016. F2D: A location aware fall detection system tested with real data from daily life of elderly people. Procedia Computer Science, vol. 98, p. 212–219 LEXIS, M., EVERINK, I., VAN DER HEIDE, L., SPREEUWENBERG, M., WILLEMS, C. and DE WITTE, L., 2013. Activity monitoring technology to support homecare delivery to frail and psychogeriatric elderly persons living at home alone. Technology and Disability, vol.25, no.3, p.189–197. LINDENBERGER, U., LOVDEN, M., SCHELLENBACH, M., C., Li S. and A., Krüger, 2008. Psychological principles of successful aging technologies: a mini-review. Gerontology. Vol.54, no.1, p.59–68. NICHOLSON, N. R., 2012. A Review of Social Isolation: An Important but Un- 115 derassessed Condition in Older Adults. The Journal of Primary Preven- gy tion, vol.33, no.2–3, p.137–152. loo NIEHAVES, B. and PLATTFAUT, R., 2014. Internet adoption by the elder- chn ly: employing IS technology acceptance theories for understanding the n te age-related digital divide. European Journal of Information Systems, vol.23, no.6, p.708–726. catio uni OGONOWSKI, Corinna, AAL, Konstantin, VAZIRI, Daryoush, REKOWSKI, mm Thomas Von, RANDALL, Dave, SCHREIBER, Dirk, WIECHING, Rain- n-co er and WULF, Volker, 2016. ICT-Based Fall Prevention System for Old- atio er Adults: Qualitative Results from a Long-Term Field Study. ACM Trans. rmo Comput.-Hum. Interact, vol.23, no.5, p.29:1–29:33. f inf PERUZZINI, M. and GERMANI, M., 2014. Designing a user-centred ICT plat- lp o form for active aging. In: Proceedings of 10th International Conference he on Mechatronic and Embedded Systems and Applications (MESA). p.1– the 6. [viewed 2 May 2018]. Available from: https:/ ieeexplore.ieee.org/docu- ith ment/6935624/ railty w PIETRZAK, Eva, COTEA, Cristina and PULLMAN, Stephen, 2014. Does smart home technology prevent falls in community-dwelling older adults: a lit- erature review. Informatics in Primary Care, vol.21, no.3, p.105–112. tackling f RODRÍGUEZ-MAÑAS, Leocadio, FÉART, Catherine, MANN, Giovanni, VIÑA, Jose, CHATTERJI, Somnath, CHODZKO-ZAJKO, Wojtek, GON- ZALEZ-COLAÇO HARMAND, Magali, BERGMAN, Howard, CAR- CAILLON, Laure, NICHOLSON, Caroline et al., 2013. Searching for an Operational Definition of Frailty: A Delphi Method Based Consensus Statement. The Frailty Operative Definition-Consensus Conference Pro- ject. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol.68, no.1, p.62–67. MOHER, David, LIBERATI, Alessandro, TETZLAFF, Jennifer and ALTMAN, Douglas G., 2010. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery, vol.8, no.5, p.336–341. RITT, M., SCHÜLEIN, S., LUBRICH, H., BOLLHEIMER, L. C., SIEBER, C. C. and GASSMAN, K.-G., 2017. High-Technology Based Gait Assessment in Frail People: Associations between Spatio-Temporal and Three-Dimen- sional Gait Characteristics with Frailty Status across Four Different Frail- ty Measures. The Journal of Nutrition, Health & Aging, vol.21, no.3, p.346– 353. ROGERS, N. T., MARSHALL, A., ROBERTS, C. H., DEMAKAKOS, P., STEP- TOE, A. and SCHOLES, S., 2017. Physical activity and trajectories of frail- ty among older adults: Evidence from the English Longitudinal Study of Ageing. PLoS ONE, vol.12, no.2, p.e0170878. SCHWENK, M., MOHLER, J., WENDEL, C., D’HUYVETTER, K., FAIN, M., TAYLOR-PILIAE, R. and NAJAFI, B., 2015. Wearable sensor-based in- home assessment of gait, balance, and physical activity for discrimina- 116 tion of frailty status: baseline results of the Arizona frailty cohort study. Gerontology, vol.61, no.3, p.258–67. lderly SMITH, Anthony C. and GRAY, Leonard C., 2009. Telemedicine across the ag- e es. The Medical Journal of Australia, vol.190, no.1, p.15–19. f the o TOMITA, Machiko R., RUSS, Linda S., SRIDHAR, Ramalingam and alth NAUGHTON M., Bruce J., 2010. Smart Home with Healthcare Tech- nologies for Community-Dwelling Older Adults. In: Mahmoud A., ed. Smart Home Systems. p. 140-158. Rijeka: InTech. [viewed 5 May 2017]. ikov | he stn Available from: https:/ www.intechopen.com/books/smart-home-systems/ smart-home-with-healthcare-technologies-for-community-dwelling-old- taroe s er-adults VENINŠEK, G. and GABROVEC, B., 2018. Management of frailty at individu- zdravj al level - clinical management: systematic literature review. Zdravstveno varstvo, vol.57, no.2, p.110–18. VERSLEIJEN, M., MARTIN-KHAN, M. G., WHITTY, J. A., SMITH, A. C. and GRAY, L. C., 2015. A telegeriatric service in a small rural hospital: A case study and cost analysis. Journal of Telemedicine and Telecare, vol.8, p.459–68. VOLLENBROEK-HUTTEN, Miriam, JANSEN-KOSTERINK, Stephanie, TABAK, Monique, FELETTI, Luca Carlo, ZIA, Gianluca, N’DJA, Aurèle and HERMENS, Hermie, 2017. Possibilities of ICT-supported services in the clinical management of older adults. Aging Clinical and Experimental Research, vol.29, no.1, p.49–57. WANG, C., WANG, X., LONG, Z., YUAN, J., QIAN, Y. and LI, J., 2016. Esti- mation of Temporal Gait Parameters Using a Wearable Microphone-Sen- sor-Based System. Sensors, vol.16, p.2167. WORLD HEALTH ORGANIZATION, 2015. World Report on Ageing and Health. [viewed 1 May 2017]. Available from: http:/ apps.who.int/ iris/bitstream/handle/10665/186463/9789240694811_eng.pdf;jsession- id=98D650DF21964515C2E311E96F906FA1?sequence=1 Strategies for successful life in the home environment for elderly disabled people with neuromuscular disorders Mitja Slapar1, Anton Zupan2 1 Ljudska univerza Tržič, Šolska ulica 2, 4290 Tržič, Slovenia 2 University Rehabilitation Institute, Republic of Slovenia – Soča, Linhartova 51, 1000 Ljubljana, Slovenia Abstract Introduction: The modern world is aware of the trend of an aging population; it is also aware of the needs of elderly people with special needs, in our case elderly disabled people with neuromuscular disorders, to live a quality life in their home environment. The latter is possible, but we need the appropriate support systems and a clearly defined strategy. Methods: The empirical study was carried out according to a qualitative work method, with the help of a semi-structured interviews with seven elderly severely disabled people with neuromuscular disorders. The interviews were carried out in 2017. The collected data were analysed with a qualitative content analysis. Based on these data, a SWOT analysis was made, through which the strategy was elaborated. Results: It was clear from the interviews how elderly disabled people with neuromuscular disorders live, what they need, what they miss, what they are afraid of, what they are looking forward to and other information needed for the SWOT analysis, and for the four components of the strategy derived from the analysis. Discussion and conclusion: The study showed where to direct actions to enable elderly disabled people with neuromuscular disorders living in their home environment. Based on the analysis a Model for the perception of elderly disabled people with neuromuscular disorders in relation to the environment was developed. With wise decisions and good strategies unavoidable changes in the future will be manageable. Key words: elderly people, people with disabilities, neuromuscular diseases, home environment, strategy. Elderly people prefer to live in their own homes rather than moving into assisted living and care institutions (Yusif et al., 2016). Ageing at home is possible with sufficient professional care, which in today’s ageing society doi: https://doi.org/10.26493/978-961-7055-18-4.117-124 provides a strategy for sustaining independence and autonomy (van Hoof at al., 2010). There are many smart technologies available, which the elderly people have already accepted, and which can enable them to live in a home environ- ment (Morris at al., 2013). With ageing deterioration of physical abilities is inev- itable, but the effects of ageing are very individual and sole chronological age is a bad indicator of physical ability of the elderly (Manini, 2011). Disability is one of the main disadvantageous health issues connected with ageing, of which the main causes are bodily impairment caused by a chronic illness, acute events such as hip fracture or brain stroke, as well as progressive illnesses (Fried and Guralnik, 1997). The basic characteristic of neuromuscular disorders is mus- cular weakness. Resulting from this weakness are secondary effects such as scoliosis, contractures, respiratory insufficiency, etc. Rehabilitation of patients with neuromuscular disorders is based on strengthening of the muscles in- cluding strengthening of the respiratory muscles and procedures of cleaning airways, maintenance of the range of motion in joints, stretching of the con- 118 tractures, equipment with orthoses, etc. Psychosocial rehabilitation programs are also very important (Zupan, 2010). The progressive nature of neuromuscu- lderly lar disorders causes a decrease in mobility, and the mobility impaired persons e use wheelchairs as a technological aid for greater independence (Pousada et f the o al., 2017). There are numerous technical aids for mobility, daily activities, con- alth trolling living environment, communication, leisure activities (Zupan, 2015). With modern technical aids, patients with neuromuscular disorders are less ikov | he dependent on foreign aid, more independent and safe in their home environ- stn ment, more involved in the social environment, education and work (Fowler, taro 1998). e s UMAR (2017) in the Strategy of the long living society, explains the con- zdravj ditions for an independent quality life of the elderly. It notes that living condi- tions are not sufficiently adapted to the needs of the elderly, while adjustments are made to a modest extent. It also notes the low mobility of the elderly, which is not typical of older people in other countries, that are developing options to have ownership apartments exchanged for ensuring social security and long- term care. It finds conditions in Slovenia cause overly high costs of apartment upkeep, which further worsen the possibilities of the elderly to meet their oth- er needs. The aim of this study was to identify the strategy for the possibilities of el- derly disabled people with neuromuscular disorders to live independently out- side institutions. We pursued this goal through SWOT analysis and based on it we developed key strategies. Methods We designed an empirical qualitative study, using the case study method. The sample included seven severely disabled persons with neuromuscular disor- ders, who live independently and organise their own lives. Their mobility is dependent on the use of an electrical wheelchair. They were chosen random- ly from the wheelchair bound patients older than 65 years who entered the program of renewal rehabilitation for neuromuscular patients in year 2017 in Rehabilitation centre Dom dva topola Izola. They live in urban and suburban environments all over the country. Four persons were female and three were male. The average age was 70.2 years. All seven persons participated voluntari- ly, anonymity was guaranteed. Original purpose of the interviews was to determine the factors, which influence the possibility of the elderly disabled people with neuromuscular dis- orders to live an independent life outside institution. The open questions of the interview were: How does your typical day look like? In what way do you inte- grate yourself into your social environment, what is your greatest obstacle con- nected with it and what do you miss in that area? How do you evaluate the atti- tude of the community and other public institutions, including religious ones, toward elderly disabled people? What is your greatest obstacle with everyday tasks? What, in your opinion, would improve your independence, quality of 119 life in the home environment and inclusion into the social environment? How . do you see your future? What is your attitude toward the idea of living in an in- ple . stitution (Home for the Elderly)? eo isabled p Results SWOT analysis lderly dr e On the basis of the interviews we have created a SWOT analysis (the Analy- o sis for Strengths, Weaknesses, Opportunities and Threats), through which we ent f have created SO strategy (in which we take advantage of advantages to take ad- nm vantage of opportunities), WO strategy (in which we overcome weaknesses to nviro take advantage of opportunities), ST strategy (in which we identify the benefits e emo that can help us overcome the threats), WT strategy (a plan by which we pre- he h vent the danger from our weaknesses) for living independently in a home envi- n t ronment for the elderly disabled people with neuromuscular disorders. ife i With the SWOT analysis we delineated advantages and disadvantages as well as opportunities and dangers derived from pursuing the goal of living in uccessful l a home environment for the elderly disabled people with neuromuscular dis- r so orders. Disadvantages (D) strategies f D1: Integrating into social networks is limited especially if the elderly people with neuromuscular disorders don’t drive a car (anymore). These people have few contacts with the environment also due to ar- chitectural barriers, and many of them are practically isolated from the outside world in the winter due to cold and snow; D2: Inappropriate attitude of the society toward elderly people with neuromuscular disorders in the environment where they live; D3: Due to the nature of the disorder (progressive disease) elderly people with neuromuscular disorders are often forced to leave their ho- me environment and move into an institution. Advantages (A) A1: Elderly people with neuromuscular disorders remain in a home (closer or wider family circle) environment (family house/flat, home neighbourhood, home village/settlement/city) and don’t move to a removed location, where everything is new; A2: Joy at accomplishing small successes and simple achievements; A3: The activities of Muscular Dystrophy Association, as the national representative organisation of disabled people with neuromuscular 0 disorders. 12 Chal enges (C) lderly e f the C1: To live for as long as possible outside institutions and to inde- o pendently and autonomously organise all they need for their life; alth C2: More understanding, support and cooperation of the wider society; C3: Technical aids could improve quality of life in a home environment. ikov | he stn taro Dangers (D) e s zdravj D1: The greatest fear of elderly disabled people with neuromuscular dis- orders is the need to live in an institution; D2: The society is »afraid« of elderly people with neuromuscular disore- ders, mainly due to stereotypical conceptions; D3: Elderly people with neuromuscular disorders are afraid of the futu- re, when they will be even more dependant. Based on the interviews we have also created the Model for the percep- tion of elderly disabled people with neuromuscular disorders in relation to the environment that is shown in Figure 1. 112 . ple .eo isabled p lderly dr eo ent fnm nviroe emo Figure 1: Model for the perception of elderly disabled people with he h neuromuscular disorders in relation to the environment (Source: own). n t ife i Discussion SWOT analysis is a widely and commonly used tool for performing general uccessful l strategies. Associated advantages and disadvantages are related with internal r so factors, over which we can influence control and act accordingly, while oppor- tunities and dangers are related with external factors, over which we don’t have direct influence and to which we can only adapt. strategies f In this study performed SWOT analysis with four derivative strategies has indicated key guidelines, where action should be directed for enabling life at home for elderly disabled people with neuromuscular disorders. Delineat- ed advantages and disadvantages as well as opportunities and dangers, which originate from the qualitative research, were the basis for the creation of the Model of the perception of elderly disabled people with neuromuscular disor- ders in relation to the environment as shown in figure 1. The model presents el- derly disabled people with neuromuscular disorders (central inner circle), sur- rounded with smaller circles, which represent positive and negative influences, as well as the influences of joy and fear. The results of the qualitative research were the basis for the SWOT analysis that showed different strategies for liv- ing independently in a home environment for the elderly disabled people with neuromuscular disorders: SO strategy (in which we take advantage of advantages to take advantage of opportunities) − Older people with neuromuscular disorders can stay longer in a home environment, closer and wider family environment, with the help of technical aids, which can significantly improve the quality of life in a home environment; − With the help of Muscular Dystrophy Association of Slovenia (dif- ferent ways of assistance) elderly people with neuromuscular disor- 212 ders have some basic corner blocks for a dignified life outside insti- tution and for an independent organisation of all the necessities for their life; lderly e − With the happiness of small accomplishments and simple achieve- f the ments elderly disabled people with neuromuscular disorders can o help us achieve more understanding, support and cooperation of a alth wider society. ikov | he WO strategy (in which we overcome weaknesses to take advantage of op- stn portunities) taroe s − The fact that elderly people with neuromuscular disorders due to the nature of the disease are often forced to leave their home envi- zdravj ronment and move into institutions could be prevented with en- abling a dignified and independent life outside institutions for as long as possible; − Appropriate behaviour of the society toward elderly people with neuromuscular disorders in an environment where they choose to live could be achieved with more understanding, support and coop- eration of the wider society; − Limited integration into social networks and few contacts with the surroundings due to architectural barriers, isolation in winter due to the cold and snow could be overcome with technical aids, which could improve the quality of life in a home environment. ST strategy (in which we identify the benefits that can help us overcome the threats) − With efforts to enable elderly disabled people with neuromuscu- lar disorders to stay in a closer or wider family home environment (family house/apartment, home neighbourhood, home village/ housing estate/settlement/city), we could manage their greatest fear: living in institutions; − Joy at accomplishing small successes and simple achievements could help us deal with the fear of the society, that is afraid of elder- ly disabled people with neuromuscular disorders due to stereotypi- cal conceptions; − The activities of Muscular Dystrophy Association (different ways of assistance), as the national representative organisation of disabled people with neuromuscular disorders could crucially influence the reduction of fear in elderly disabled people with neuromuscular dis- orders of their future, when they will be even more dependent. WT strategy (a plan by which we prevent the danger from our weakness- es) 312 − We need to avoid pressure on elderly disabled people with neuro- . ple . muscular disorders to live in institutions because the life at their eo home environment and their independence are their highest values. − We need to avoid stereotypical conceptions about elderly disabled isabled p people with neuromuscular disorders because that would cause an inappropriate attitude from the society toward elderly disabled peo- lderly dr eo ple with neuromuscular disorders in the environment where they live; ent fnm − We need to avoid an uncertain future for the elderly disabled peo- nviro ple with neuromuscular disorders. We need to prepare for their e em future and ensure it, where key meaning will be their active inte- o gration into social networks, which shrink to a minimum with the he h n t loss of a driver’s licence, architectural barriers, cold and snow in ife i the winter. uccessful l Conclusions r so The study has indicated key elements, which are necessary for understanding the needs of elderly disabled people with neuromuscular disorders to live in a home environment. The strategies derived from the study indicate guidelines, strategies f where we should focus our activity, as well as, which areas need additional strengthening. In the future, strategies derived from this research, should be compared with strategies prepared by the political bodies in the framework for the preparation of the law on long term care and protection for the long-term care. The topic of this study is very current, especially since demographic re- search predicts big changes, for which we should prepare in time, if we want to successfully manage them. References FOWLER, W.M., CARTER, G.T., KRAFT, G.H., 1998. Role of physiatry in the management of neuromuscular disease. Phys Med Rehabil Clin N Am, 9: 1-8. FRIED, L.P., and GURALNIK, J. M., 1997. Disability in older adults: evidence regarding significance, etiology, and risk. Journal of the American Geriat- rics Society, 45(1), 92-100. MANINI, T., 2011. Development of physical disability in older adults. Cur- rent aging science, 4(3), 184-191. MORRIS, M. E., ADAIR, B., MILLER, K., OZANNE, E., HANSEN, R., PEARCE, A. J., and SAID, C. M., 2013. Smart-home technologies to assist older people to live well at home. Jour- nal of aging science, 1(1), 1-9. 412 POUSADA, T., PEREIRA-LOUREIRO, J., DÍEZ, E., GROBA, B., NIETO- RIVEIRO, L., & PAZOS, A., 2017. Needs, demands and reality of people with neuromuscular disorders users of wheelchair. Examines in lderly e Physical Medicine & Rehabilitation, 1(1). f the o YUSIF, S., SOAR, J., & HAFEEZ-BAIG, A., 2016. Older people, assistive tech- alth nologies, and the barriers to adoption: A systematic review. International journal of medical informatics, 94, 112-116. ikov | he stn UMAR, 2017. Strategija dolgožive družbe. Ljubljana: Urad RS za makroekon- taro omske analize in razvoj, 2017. [online], [viewed 2. 4. 2018]. Avilable from: e s http://www.umar.gov.si/fileadmin/user_upload/publikacije/kratke_ana- zdravj lize/Strategija_dolgozive_druzbe/ UMAR_SDD.pdf. van HOOF, J., KORT, H. S., Van WAARDE, H., & BLOM, M.M., 2010. Envi- ronmental interventions and the design of homes for older adults with dementia: an overview. American Journal of Alzheimer’s Disease & Other Dementias, 25(3), 202-232. ZUPAN, A., 2010. Rehabilitacija bolnikov z živčno-mišičnimi boleznimi = Re- habilitation of patients with neuromuscular disorders. V: 21. dnevi re- habilitacijske medicine, Ljubljana, 26.-27. marec 2010. Marinček, Č (ur.), Groleger, K (ur.). Z dokazi podprta rehabilitacija: zbornik predavanj = Ev- idence based rehabilitation: proceedings, (Rehabilitacija, ISSN 1580-9315, letn. 9, supl. 1). Ljubljana: Univerzitetni rehabilitacijski inštitut Republike Slovenije - Soča, letn. 9, supl. 1, str. 128-137. ZUPAN, A., 2015. Assistive technology for a quality life of people with NMD: a lecture given at the 45th Annual general meeting, Belgrade, September 24-27, 2015. Nutritional status of older adults admitted to the Surgical Ward Nika Slokar, Nina Mohorko University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia Abstract Introduction: A substantial number of older adults are malnourished at the time of hospital admission, which negatively influences their recovery time, quality of life, possible complications, length of hospital stay and costs of treatment. Methods: The study was conducted at the Surgical Ward of the Izola General Hospital between January and May 2016. All patients aged 65 years or older were invited to the study within 48 hours after being admitted to the ward. Nutritional examinations were carried out with anthropometric, bioimpedance and functional measures and with NRS- 2002, based on which patients’ nutritional status was defined, patients were nutritionally assessed and classified into two groups; one with increased nutritional risk, the other without it. Results: Out of 67 acute patients (64 % male), 77.0 ± 7.9 years, BMI 28.4 ± 4.4 kg/m2 (BMI ≥ 25 kg/m2: 54 (81 %)) in the study, 39 (58 %) had increased nutritional risk, 11 (28 %) had normal body mass, 16 (41 %) were overweight and 12 (31 %) obese. The group with increased nutritional risk had lower fat free mass index, phase angle and hand grip strength. Discussion and conclusion: Despite the fact that 81 % of patients’ BMI ≥ 25 kg/m2, 58 % of them were grouped as patients with increased nutritional risk. If the nutritional status of patients were determined using only the BMI cut-points for malnutrition (< 20 or ≤ 22 kg/m2) only 8 % of patients would be classified as malnourished. Keywords: older adults, nutritional screening, nutritional assessment, nutritional status, malnutrition Unintentional weight loss and malnutrition are typical for older adults. Aging is often accompanied by physical inactivity, chronic or/and acute disease, reduced dietary intake and hormonal changes which reflects in doi: https://doi.org/10.26493/978-961-7055-18-4.125-132 reduced body mass, change in body composition and sarcopenia (Cruz-Jentoft et al., 2010; Cereda et al., 2017). Despite the fact that the health profession and science are constantly developing, nutrition and nutritional status in older adults often still remain disregarded. Malnutrition is often found associated with an increase in severity and number of complications, longer recovery time, prolonged hospitalization and cost of treatment. A substantial number of older adults are in poor nutrition- al status or malnourished at the time of hospital admission (Kjerstin et al., 2015; Gärtner et al., 2017). With nutritional assessment which consist of nu- tritional screening and assessment of nutritional status it is possible to recog- nize patients with nutritional risk (Kondrup et al., 2003; Van Bokhorst-de van Schueren et al., 2014). Anthropometric measures, hand grip dynamometer and bioelectrical impedance analysis (BIA) enable the determination of body com- position and reliable nutritional status (Scalfi and Troiano, 2013). 612 The purpose of the study was to investigate the nutritional status of older adults at the admission to the surgical ward as well as to determine the associ- ation between age, body mass index (BMI), fat free mass index (FFMI), phase lderly e angle (PA) and hand grip strength (HGS). f the o Methods alth Data collection ikov | he The study was conducted at the Surgical Ward of the Izola General Hospital stn between January and May 2016. All patients aged 65 years or older were invit- taroe s ed to the study within 48 hours after being admitted to the ward (abdominal, urological and vascular surgery) in the preoperative period. Data on demo- zdravj graphic characteristics, clinical history, medical diagnoses and associated dis- eases were obtained from patients’ medical records. Body weight and standing height were measured with calibrated portable scale and stadiometer (KERN MPS 220K100PM). BMI was calculated as [(kg)/ height2 (m)]. The patients’ nu- tritional status was determined based on BMI cut-off points for malnutrition (< 20 kg/m2 (65 y ≤ and < 70 y) or < 22 kg/m2 (≥ 70 y) (Cederholm et al., 2015). Information about the participants’ nutrition risk was collected using the NRS-2002 in accordance with the recommendations Kondrup et al. (2013). Pa- tients who had a total final score ≥ 3 were classified nutritionally-at-risk. With multi-frequency BIA (Bodystat 6000, Bodystat) FFM and PA were measured. FFMI was calculated as [FFM (kg)/ height2 (m)]. For the interpretation of the FFMI and PA the cut-off points were used. Patients were grouped as malnour- ished if FFMI < 15 and 17 kg/m2 for women and men, respectively (Cederholm et al., 2015) and if PA < 4,6° and < 5° for women and men, respectively (Guer- ra et al., 2015). HGS measurement was carried out by hand held dynamome- ter (Jamar Hydraulic hand dynamometer). For the interpretation of HGS cut- off points for sarcopenia were used. Patients were grouped as malnourished if HGS < 20 and < 30 kg for women and men, respectively (Cruz-Jentoft et al., 2010). The nutritional screening and measurements were conducted in the same day. The research was approved by the Commission for Medical Ethics and the Quality and Education Service of the Izola General Hospital. Statistical analyses Statistical analyses were conducted using Microsoft Excel and IBM SPSS Statis- tics 22. The characteristics of the total study sample were presented as frequen- cies (%) and mean ± standard deviation (SD). Student t-test was used to anaa- lyze the differences between the means of the variables of the two independent groups within the sample. In order to analyze the relationship between two variables, we used the Pearson correlation coefficient. Linear regression analy- sis was used to analyze the influence of age on the measured parameters. Results 712 A total of 67 patients were assessed at the admission at the surgical ward with mean age 770 ± 7.9, range 65 and 96 years. Mean BMI was 28.4 ± 4.4 kg/m2, ard range 18.8 and 41.8 kg/m2. Regarding the classification of BMI by the World health organization (WHO), 12 patients (18 %) had normal body mass (18.5–24.9 kg/m2), 26 (39 %) were overweight (25.0-29.9 kg/m2) and 29 (43 %) were obese (≥ urgical w 30 kg/m2). The results of measurements were FFMI 18.4 ± 3.1 kg/m2, HGS 26.0 he s o t ± 10.7 kg and PA 4.4 ± 1.1. There was a negative correlation between age and FFF- MI, HGS and PA of whole sample (Table 1). itted tdm According to the NRS-2002, patients were categorized in groups with in- creased nutritional risk (INR) and low nutritional risk (LNR). 39 (58 %) patients dults a were in INR and the majority of patients (52 %) achieved a total of 3 points (Fig- ure 1). The mean age and BMI of patients with INR was 79.5 ± 7.8 years and 27.4 lder a f o ± 4.7 kg/m2, respectively. Regarding the classification of BMI, 11 patients (28 %) had normal body mass, 16 (41 %) were overweight and 12 (31 %) were obese. tatus o There were significant differences in age, BMI, FFMI, HGS and PA according nal s to the patients’ nutritional status determinated by the NRS-2002 (P < 0.05) (Ta- ble 1). There was no correlation between age and BMI in the group of patients with INR and in the whole sample of patients (P = 0.742) and (P = 0.103), re- nutritio spectively. Table 1: General characteristics and body measures of the study participants. Al participants NRS-2002 increased low nutritional risk nutritional risk P N = 67 N = 39 N = 28 Mean (SD) Mean (SD) Mean (SD) Age (years) 77.4 (7.9) 79.5 (7.8) 74.4 (7.3) 0.009a n (%) n (%) n (%) ≥ 65 and < 70 14 (21) 5 (13) 9 (64) ≥ 70 53 (79) 34 (87) 19 (36) 812 Gender n (%) n (%) n (%) female 24 (36 %) 17 (71) 7 (29) male 43 (64 %) 22 (51) 21 (49) lderly e Mean (SD) Mean (SD) Mean (SD) f the o BMI (kg/m2) 28.4 (4.4) 27.4 (4.7) 29.9 (3.5) .024a .103b .742c alth WHO classification n (%) n (%) n (%) < 18.50 0 / / ikov | he 18.50–24.99 12 (18) 11 (28) 1 (4) stn 25.00–29.99 26 (39) 16 (41) 13 (46) taroe s ≥ 30.00 29 (43) 12 (31) 14 (50) Mean (SD) Mean (SD) Mean (SD) zdravj FFMI (kg/m2) 18.4 (3.1) 17.4 (3) 19.8 (2.8) .001a .004b . 457c Hand-grip (kg) 26.0 (10.7) 22.7 (8.8) 30.7 (11.6) .002a .000b .052c Phase angle (°) 4.4 (1.1) 4.0 (1.0) 4.9 (1.0) .001a .000b .158c SD, standard deviation; BMI, body mass index; FFMI, free fat mass index; HGS, Hand-grip strength; PA, Phase angle. a) T-test; b) Pearson correlation test between age and other parameters (N = 67); c) Pearson correlation test between age and other parameters (N = 39). Patients that screened positive with NRS-2002 (39) were classified as mal- nourished according to cut-off points of measured parameters FFMI, HGS and PA (Table 2). The majority of malnourished patients were determinated by PA (29), little less with HGS (23) and the least with FFMI (13). Only 5 patients were identified within the cut-off points of BMI (≤ 20 kg/m2 or ≤ 22 kg/m2). Figure 1: Results of nutritional screening with NRS-2002. Table 2: Number of patients within BMI, FFMI, HGS and PA cut-off points for malnutrition. 912 Inside cut-off points increased nutritional risk (N = 39) low nutritional risk (N= 28) P ard malnourished n (%) Mean (SD) n (%) Mean (SD) urgical w BMI (kg/m2) 5 (100) 20.1 (1.2) / he s FFMI (kg/m2) 13 (81) 14.4 (1.6) 3 (19) 14.9 (0.2) 0.667 o t HGS (kg) 23 (70) 17.4 (5.2) 10 (30) 21.4 (6.7) 0.075 itted t PA (°) 29 (67) 3.7 (0.8) 14 (33) 4.2 (0.7) 0.040 dm SD, standard deviation; BMI, body mass index; FFMI, free fat mass index; HGS, hand-grip dults a strength; PA, phase angle. lder a f o Discussion In our sample, 39 (58 %) patients were screened positive by NRS-2002 of which tatus o 34 (87 %) patients with the age ≥ 70 years. The majority of patients achieved a nal s total of 3 points (Figure 1) of which 30 (86 %) with the age ≥ 70 years. There were significant differences in age according to the patients’ nutritional status deter- nutritio mined by the NRS-2002 (P = 0.009) (Table 1). Because NRS-2002 contains an additional point for the adults with the age ≥ 70 years this directly impacts on the final sum of points and on the determination of patients’ nutritional status (≤ 2 or ≥ 3 points). The mean BMI in the group with INR was 27.4 ± 4.7 kg/m2 with signifi- cant statistical difference with BMI in LNR (P = 0,024). 34 (87 %) patients with INR had BMI > 22 kg/m2 of which 28 had BMI ≥ 25 kg/m2 at their admission to the hospital, which causes concerns. If we had used only the cut-off points of BMI (≤ 20 kg/m2 or ≤ 22 kg/m2) for screening of malnutrition at the admission, only 5 (8 %) patients would be classified as malnourished, which is less than one quarter comparing to the results of NRS-2002. This indicates the need for screening patients at the hospital admission with screening tools, since the dis- tinction based on BMI, although adapted to the elderly, shows poor sensitivity. Therefore, the use of BMI would be more appropriate for monitoring the changes of nutritional status during the hospitalization. Although WHO clas- sifies the risk of malnutrition based on low BMI for all age groups in the same way, Beck and Ovesen (1998) argued in the previous researches that the cut- off point for determination of malnourished older adults should be 24 kg/m2 and healthy BMI should be raised on 24–29 kg/m2. Similarly, Rojer et al., 2016 in study came to the conclusion, that overweight patients with unintentional weight loss had still high BMI which is typical also for geriatric patients. In our sample, as well as in the group with INR, there was no statistical correlation be- tween age and BMI (Table 1) which means that in our sample age did not im- pact on lower BMI. BIA and dynamometer were used for the measurements of body compo- sition while cut-off points for a clinical diagnosis of malnutrition and sarcope- 013 nia (Cruz-Jentoft et al., 2010; Cederholm et al., 2015; Guerra et al., 2015) were used for determining nutritional status. Patients that screened positive with NRS-2002 (39) were classified as malnourished according to cut-off points of lderly e measured parameters FFMI, HGS and PA (Table 2). The majority of malnour- f the ished patients were determined by PA (29). In the recent study, Ringaitiene et o al., 2016 showed that a preoperative PA value derived from BIA distinguish- alth es malnourished from well-nourished patients. It is possible to conclude that the use of PA is a good indicator of malnutrition. However, further research is ikov | he needed to evaluate the clinical application of PA. stn taro The measured parameters FFMI, HGS and PA inside the groups with LNR e s and INR showed significant statistical difference (P < 0.05). In the whole sam- ple, age showed statistical correlation with FFMI, HGS, PA (P < 0.05), which zdravj means that age impacts nutritional status (Elia in Stratton, 2012). It is interestm - ing that in the group with INR there was no statistically significant correlation between age and FFMI, HGS, PA (P > 0.05) (Table 1). Besides age, the disease, infection, physical inactivity, etc., which affect the change in body composi- tion, reduction of muscle mass and muscle strength (Cruz-Jentoft et al., 2010) may have greater influence on patients’ nutritional status in the group with INR. Limitations The information on unintentional weight loss at the admission in older adults is unreliable and can affect the misinterpretation of the results in determining the nutritional status because most of the patients do not remember or monid- tor their weight. Therefore, we have used the information about unintention- al weight loss only in the NRS-2002. Information on unintentional weight loss is reliable only when the body weight during hospitalization or at the readmis- sion is compared to the body weight from patient’ medical record at the last ad- mission. Conclusions The majority of patients had increased nutritional risk. Age influences poor nu- tritional status, but in patients with INR it is not directly associated with lower levels of FFMI, PA and HGS. It is also not associated with lower BMI. The use of BMI for nutritional screening of older adults at the admission is not sensitive enough. Therefore, the use of BMI resulted to be more appro- priate for monitoring the changes of nutritional status during the hospitaliza- tion. Different parameters determined different numbers of malnourished. We conclude that set cut-off points of measured parameters have a significant in- fluence on the assessment of the nutritional status. For a more precise defini- tion of nutritional status and severity of the disease we suggest laboratory tests. References 1 BECK, A.M., OVESEN, L. 1998. At which body mass index and degree of weight 13 loss should hospitalised elderly patients be considered at nutritional risk? Clinical Nutrition, vol. 17, no. 5, pp. 195198. ard CRUZ-JENTOFT, A.J., BAEYENS, J.P., BAUER, J.M., BOIRIE, Y., CE- DERHOLM, T., LANDI, F., MARTIN, F.C., MICHEL, J.P., ROLLAND, urgical w Y., SCHNEIDER, S.M., TOPINKOVÁ, E., VANDEWOUDE, M., ZAM- he s o t BONI, M.; EUROPEAN WORKING GROUP ON SARCOPENIA IN OLDER PEOPLE, 2010. Sarcopenia: European consensus on definition itted tdm and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and Ageing, vol . 39, no. 4, pp. 412-423. dults a CEDERHOLM, T., BOSAEUS, I., BARAZZONI, R., BAUER, J., VAN GOS- lder a SUM, A., KLEK, S., MUSCARITOLI, M., NYULASI, I., OCKENGA, J., f o SCHNEIDER, S,M., DE VAN DERSCHUEREN, M.A., SINGER, P. 2015 Diagnostic criteria for malnutrition–An ESPEN Consensus Statement. tatus o Clinical nutrition, vol. 34, no. 3, pp. 335-340. nal s CEREDA, E., KLERSY, C., HIESMAYR, M., SCHINDLER, K., SINGER, P., LAVIANO, A., CACCIALANZA, R.; NUTRITIONDAY SURVEY COL- nutritio LABORATORS. 2017. Body mass index, age and in-hospital mortality: The Nutrition Day multinational survey. Clinical nutrition, vol.36, no. 3, pp. 839-847. ELIA, M., STRATTON, R.J., 2012. An analytic appraisal of nutrition screening tools supported by original data with particular reference to age. Nutri- ton, vol. 28, no. 5, pp. 477494. GÄRTNER, S., KRAFT, M., KRÜGER, J., VOGT, L.J, FIENE, M., MAYER- LE, J, AGHDASSI, A., STEVELING, A., VÖLZKE, H., BAUMEISTER, S.E., LERCH, M.M., SIMON, P. 2017.Geriatric nutritional risk index cor- relates with length of hospital stay and inflammatory markers in older in- patients. Clinical Nutrition, vol. 36, no.4, pp. 1048-1053. GUERRA, R.S., FONSECA, I., PICHEL, F., RESTIVO, M.T., AMARAL, T.F., 2015. Usefulness of six diagnostic and screening measures for undernu- trition in predicting length of hospital stay: a comparative analysis. Jour- nal of the Academy of Nutrition and dietetics, vol. 115, no. 6, pp. 927-938. KJERSTIN, T., THRÜMER, H., INDERHAUG HUSBY, M., DE SOYSA, A.K, HELVIK, A.S., 2015. Nutritional risk screening in hospitalized patients with heart failure. Clinical Nutrition, vol. 34, no. 2, pp. 257-264. KONDRUP, J., ALLISON, S.P., ELIA, M., VELLAS, B., PLAUTH, B., 2003. ES- PEN guidelines for nutrition screening 2002. Clinical Nutrition, vol. 22, no. 4, pp. 415-421. RINGAITIENE, D., GINEITYTE, D., VICKA, V., ZVIRBLIS, T., NORKIENE, I., SIPYLAITE, J., IRNIUS, A., IVASKEVICIUS, J. 2016. Malnutrition as- sessed by phase angle determines outcomes in low-risk cardiac surgery 2 patients. Clinical Nutrition, vol. 35, no. 6, pp. 1328-1332. 13 ROJER, A.G., KRUIZENGA, H.M., TRAPPENBURG, M.C., REIJNIERSE, E.M., SIPILÄ, S., NARICI, M.V., HOGREL, J.Y., BUTLER-BROWNE, G., MCPHEE, J.S., PÄÄSUKE, M., MESKERS, C.G., MAIER, A.B., DE VAN lderly e DER SCHUEREN, M.A., 2016. The prevalence of malnutrition according f the to the new ESPEN definition in four diverse populations. Clinical Nutri- o tion, vol. 35, no. 3, pp. 758-762. alth SCALFI, L. in TROIANO, E., 2013. Principi applicativi per la valutazione del- ikov | he lo stato di nutrizione. V: Manuale di nutrizione clinica e scienze dietetiche stn applicate, 8th edition. taro VAN BOKHORST-DE VAN SCHUEREN, M.A.E., REALINO GUAITOLI, P., e s JANSMA, E.P., DE VET, H.C.W., 2014. Nutrition screening tools: Does zdravj one size fit all? A systematic review of screening tools for hospital setting. Clinical Nutrition, vol. 33, no. 1, pp. 39-58. Intergenerational programs as a solution to the social isolation of the elderly Anja Zagoričnik, Argresa Bylykbashi, Andrej Starc University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia Abstract Introduction: Loneliness and social isolation are becoming a serious problem within the institutionalized care of elderly people in nursing homes and they are major obstacle to the mental and physical health of the elderly. On the market we can find robot animals for solving this problem, but we believe that there is a more empathic solution at the level of intergenerational program. This solution is practice in foreign countries. Methods: We will undertake a systematic overview of Slovenian and foreign scientific and professional literature with a descriptive method of work in the field of the distribution of intergenerational programs for children and the elderly, as well as the positive and negative properties of these. We used descriptive method with literature review to make meta- analysis. The review was restricted to studies published since 2007 to 2017 and included 10 articles. Results: As with other people, the need for active life, socialization and social inclusion is also evident in the life of elderly. By reviewing the literature we justified the benefit of intergenerational cooperation, highlighted the problems of the elderly, presented examples of well- organized intergenerational associations around the world and justified the importance of socializing older people. Discussion and conclusions: The solution of mentioned problem within institutionalized care is necessary since the population of the elderly around the world is growing and is facing us with a wide array of challenges. Key words: intergenerational program, active aging, pre-school children, nursing homes, social isolation of older people doi: https://doi.org/10.26493/978-961-7055-18-4.133-143 Aging is a social phenomenon concerning nearly all the high-income countries (Kinsella and He, 2008; Gualano et al., 2017). In particular, the Eurostat estimations suggest that in 2030 over a fourth of the Eu- ropean population will be over 65 years old. All of the developed countries have problems related to a declining birth rate and increasing aging population (Yasunaga et al., 2016). Older adults are at risk of being socially isolated due to poor health, low morale, and communication difficulties (Findlay, 2003; Morita and Kobayas- hi, 2013). This condition affects individual health, and it appears to be associat- ed with a higher risk of hypertension, depression, cognitive decline, and even suicide (Fratiglioni et al., 2000; Findlay, 2003; Iliffe et al., 2007; Gualano et al., 2017). Conversely, social involvement for elders can be extremely advantageous (Fratiglioni et al., 2000; Findlay, 2003; Varma et al., 2015; Gualano et al., 2017). One of the urgent challenges is providing services where older adults can main- 413 tain their health along with their engagement in meaningful activities. Inter- vention programs need to focus on acquiring social capital (SC) and generally target “groups” and not “individuals” (Yasunaga et al., 2016). lderly e Since the beginning of the 1990s, the productive aspects of aging have f the been considered as an essential aspect of the successful aging concept. Volun- o teering is considered as activity that represent productive aging (Fujiwara et alth al., 2006; Yasunaga et al., 2016) and is found to have a high correlation with the physical and psychological health of older participants (Fujiwara, 2005; Yasu- ikov | he naga et al., 2016). Keeping older people healthy and active is an emerging chal- stn lenge as presence of the physical activity in life is associated with decreased risk taroe s for numerous chronic diseases (Schroeder et al., 2017). An intergenerational program (IGP) it is a form of human service that in- zdravj volves on going and organized interaction between members of younger and older age groups for the benefit of all participants (Erikson, 1950; Yasunaga et al., 2016). Intergenerational (IG) learning is actually the oldest method of learn- ing and is the process whereby knowledge, skills, values and norms are trans- mitted between generations (Hoff, 2007; Fitzpatrick, 2013). The aim of IGP is to improve interactions and communication between different ages through- out shared experiences (Epstein and Boisvert, 2006; Gualano et al., 2017) and as a provider of generative roles for older adults, allowing children to grow up and be meaningful for older adults’ functional capacity (Fujiwara et al., 2003; Sakurai et al., 2016). IGP was proposed as a bonds developer, between two generations (New- man, 1989; Morita and Kobayashi, 2013). As defined by the International Con- sortium for IGP, “IGP” are “social vehicles that create purposeful and ongoing exchanges of resources and learning among older and younger generations” (Kaplan, 2002; Morita and Kobayashi, 2013). Methods 513 lderly he ef t n o latioso cial io he s o t n t lutioo s a ss a gramro nal p Figure 1: Results of literature review according to PRISMA methodology (Moher et al., 2009) We used a descriptive method of work with a critical overview of Slo- intergeneratio vene and English professional and scientific literature. The literature review was from March to May 2018. The literature search was carried out using the Slovenian bibliographic-catalog database COBIB.SI, University database Di- Kul and foreign CINAHL and Medline databases (PubMed) and Google Scholar. The search criteria used the basic inclusive factors as required key- word combined with Boolean operator AND and OR, published between 2013 and 2018 and language criterion (Slovenian or English). The applied keywords associated with the Boolean operator AND in English were: »(kindergarten OR preschool) AND (elderly OR aged OR older OR geriatric OR senior) AND intergenerational program AND social isolation AND (retirement home OR nursing home)« in different variants. Slovene literature was searched with the following keyword: »medgeneracij* program*«. Table 1: List of inclusion and exclusion criteria Inclusion criteria Exclusion criteria IG program Dementia IG activity Adults, young people (everyone up to 7 years) Social isolation Book Elderly (everyone up to 65 years) Architecture of IG buildings or places Children (7 years or younger) Thesis Articles with appropriate methodology Kindergarten or preschool 6 Retirement home 13 Results lderly e Table 2: Overview of studies f the o Author(s) and year Aim of research Methodology Results alth Exploring care A lot of participants spoke of im- home residents’ portance of keeping in touch with family for their quality of life. ikov | he views of connec- Cook and Bailey, 2013 tions they have and Qualitative study They also valued contact with stn would like to have with interviews people that are not relatives. The authors represented the challeng- taro with younger gener- e s ations. es of implementing IG initiatives with pros and cons. zdravj Exploring why IGP It was obtained that there is the learning involv- lack of research and evaluation ing young children data on extra-familial IG learning and older people is in the academic literature. How- important in con- ever, a wide range of more infor- temporary Europe; mal documentation and evidence explain key defini- illustrating a limited number of tions, concepts and examples of IGP. terminology; syn- Contribution of young children thesize key Europe- Literature review for to IG learning is an issue that Fitzpatrick, 2013 an research which Europe IG project merits more attention. identifies the goals (TOY) Building critical capacity over and benefits of IG time will require key sectors such learning; exploring as schools, care settings and civ- if regional trends il society groups to recognize the exist in relation to potential of IG learning. At lo- IG learning; identi- cal government level planning for fying emerging is- communities and public spaces sues and concerns, requires awareness of the benefits which will be fur- of all generations meeting and in- ther explored. teracting. Author(s) and year Aim of research Methodology Results For older adults, IGP shows the primary outcome as decreased disability in mobility and Instru- Trial evaluates re- mental Activities of Daily Living sults from IGP Ex- (IADL). Secondary outcomes are perience Corps. decreased frailty, falls, and mem- Whether senior vol- ory loss; slowed loss of strength, unteer roles within balance, walking speed, cortical this program bene- plasticity, and executive function; objective performance of IADLs; Fried et al., 2013 ficially impact chil- dren’s academ- Dual evaluations and increased social and psycho- ic achievement and logical engagement. classroom behavior For children, primary outcomes in public elementa- are improved reading achieve- ry schools and im- ment and classroom behaviour pact on the health in Kindergarten through the 3rd of volunteers. grade; secondary outcomes are improvements in school climate, teacher morale and retention, 7 and teacher perceptions of old- 13 er adults. To summarize the Ten studies evaluated children’s effects of IG activi- outcomes outlining the positive lderly ties on both, elderly impact of IGP upon children’s he e and children. Literature review - perception of elderly. The effects f t Gualano et al., 2017 Identifying the key followed the PRISMA on older participants were varie- n o elements of the IG statements gated. The retrieved studies out- activities and deter- lined the importance of a care- latio mining the success ful organization and of a specific so of these programs. training for all staff members. cial i Slovenia is facing the challenge o of maintaining and improving he s To review and sum- the systems of IG solidarity in the o t marize recent ac- current demographic conditions. n t tivities in the field of IG cooperation Another challenge the country is facing is establishing an appropri- lutio in Slovenia in or- o der to highlight cer- Perspective, opin- ate link between various govern- ment departments, non-govern- s a s Hozjan, 2010 tain difficulties, to ion and commentary s a stimulate new re- article mental organizations and active search and to estab- individuals. This is not a sim- gram lish more system- ple task, since the planning of ro atic connections IGP touches the family, educa- tion, employment, health system, nal p between partici- pants. pension insurance, housing pol- icy, health system, spatial plan- ning, etc. To synthesize cur- rent findings on The findings of this review may intergeneratio the relationship be- inform future directions for addi- tween social en- tional research and for develop- Kang, et al., 2016 gagement and cog- ing and testing the efficacy of po- nition during two Integrative review tential interventions to facilitate particularly critical cognitive development and/or periods of life, early preservation via increased social childhood and older engagement. adulthood. Author(s) and year Aim of research Methodology Results Compartment of the changes in visual at- IGP with preschool children tention, facial ex- brought smiles and conversation pression, engage- to older adults. The social-ori- ment/behaviour, ented IG program allowed old- and IGP conversa- er adults to play more roles than Morita and Kobayas- tion in older par- Time sampling - the performance-based IG pro- hi, 2013 ticipants in perfor- structured observa- gram. The IG programs provide mance-based and tion study opportunities to fulfill basic hu- social-oriented IG man needs and reintegrate older programs to deter- adults into society. Further devel- mine a desirable in- opment of such beneficial pro- teraction style for grams is warranted. older adults. Clarify the effect of IGP could serve as key health an IGP on elderly promoters among elderly peo- persons’ symptoms ple by decreasing the risk of so- of depressive mood cial isolation and loneliness due 813 Murayama et al., 2015 and in improving to the greater sense of meaning- their sense of coher- Evaluating fulness. However, given our lim- ence, which is an el- ited sample size, generalizabili- ement for successful ty was restricted and studies with lderly coping with stress- larger cohorts are required to fur- e ors. ther validate our findings. f the The present study indicates that o This study exam- the REPRINTS IGP has long- alth ined the long-term term, positive effects that help Sakurai et al., 2016 effects of the IGP A follow-up assess- maintain and promote intellectu- picture-book read- ment al activity, physical functioning, ikov | he ing program “RE- and IGP exchange, although the stn PRINTS” effect of the increasing amount of physical activity is unclear. taroe s A targeted review of IGP by focusing on REPRINT as a school volunteer zdravj novel interventional program Research program is a “win–win” project Yasunaga et al., 2016 on Productivity A non-randomized with various reciprocal merits for through IGP Sym- trial design multi-generations based on two pathy (REPRINT) - theories: social capital and gen- picture-book read- erativity. ing program. Positive outcomes of IGP have the great potential to promote health and well being of older adults and children as the literature suggests that IGP bene- fit both (Morita and Kobayashi, 2013). For children there are specified positive aspects in the improvement of children perceptions of elder people (Gualano et al., 2017), improving the academic success of young children from IGP in reading activity (Sakurai et al., 2016) and understanding of the aging process (Jarrott et al., 2006; Newman and Hatton-Yeo, 2008; Morita and Kobayashi, 2013). On the other hand, elderly that were included in IGP maintained great- er functional abilities and intellectual activities (Sakurai et al., 2016), they also increased self-esteem, improved well-being (Hernandez and Gonzalez, 2008; Morita and Kobayashi, 2013), increased social contact (Newman and Riess, 1992; Morita and Kobayashi, 2013), decrease distress (George and Singer, 2011; Morita and Kobayashi, 2013), fight social isolation (Gualano et al., 2017) and gratifica-tion for their contribution to the community (Newman and Hatton-Yeo, 2008; Morita and Kobayashi, 2013). IGP also completes the need of elderly people to be purposeful and meaningful, it gives them the opportunity to share lived ex- periences and to exchange generational differences and skills, sharing news and views on common interests (Cook and Bailey, 2013). Researchers (Fried et al., 2013) defined three reasons for dropping out; medical problems lack of time, loss of interest and mortality. Gualano et al. (2017) mention the importance of the settings where the IGP is implemented. In particular, the careful organiza- tion of evidence-based IG activities appeared to be extremely important (Jar- rott and Smith, 2011; Jarrott et al., 2011; Gualano et al., 2017). It is the role of fa-cilitators to offer a program, which draws out the strengths of both generations, and to promote sustained attention and self-motivated involvement, while en- suring that older adults and children are always the main focus of the IGP (Morita and Kobayashi, 2013). No projects or programs can be easily initiated 913 without support from public policies (Yasunaga et al., 2016). This includes re- alistic recognition of political and community realities (Fried, et al., 2013). As well as the variety of settings, a wide heterogeneity of IG activities emerged, lderly such as reading, mentoring, dancing, or playing. (Gualano et al., 2017). In liter- he ef t ature we found two examples of the evidence-based IG practice; “REPRINTS” n o (Research of Productivity by Intergenerational Sympathy) in Japan (Yasuna- latio ga et al. 2016) and The Experience Corps (EC) in USA (Fried, 2013). In EU are so Kindergarten project (Spain), Generation Gardens (Netherlands) (Fitzpatrick, cial i 2013), Hand in Hand (Slovenia) (Narat et al., 2012; Fitzpatrick, 2013) and many o others (Fitzpatrick, 2013). he s o t We cannot forget that social engagement can take many forms, ranging n t from close friendships to participation in novel activities and all of them result lutioo in acquisition of new behavioural repertoires and ideas (Sakurai, 2016). s a ss a Discussion gram Clearly, fun and enjoyment is a key motivator for young children’s learning ro whether in the company of their peers, or older people. It is important that we nal p pay attention to categorising IG practice according to their forms, functions and learning areas (Fitzpatrick, 2013). The main expressed needs to reach an improvement of IGP are: increase of the number of participants or staff, the intergeneratio necessity of higher resources and the expansion of the projects (Morita and Kobayashi, 2013). The implementation of strictly evidence-based IG activities appears to be remarkably fascinating (Gualano et al., 2017). IGP with preschool children bring smiles and conversation to older adults. Smiles and conversation correspond to interpersonal acceptance, which is a basic human need. When older adults are given meaningful roles as men- tors or role models, they are reminded of their ability to contribute to society. So there is a need for developing new programs which would fulfil the space with natural smiling and laughter. (Morita and Kobayashi, 2013). Having roles attractive to older adults that also bring new social capital to societal needs could provide a positive framing of society’s aging. Finding effective approaches to accomplish these multiple goals as a win–win is of criti- cal importance to our future societal wellbeing (Fried, et al., 2013). Eventually, beyond the individual effects, IGP seemed to increase the sense of communi- ty for all the involved participants (Wilson et al., 1997; Teater, 2016; Gualano et al., 2017). In Slovenia IG cooperation does not yet have wide dimensions as the countries, where the IG cooperation programs have been implemented since the 1970s. Nevertheless, in the recent time, more organizations are working to strengthen the participation of generations. In Slovenia more and more kinder- gartens, homes for the elderly, elementary and secondary schools, and pension- ers’ societies are becoming involved in IG cooperation (Hozjan, 2010). 0 Conclusions 14 IGP need more research and more implementations of evidence-based IGP in local environments (more information on benefits, better promotion and pre- lderly e cise planning). An important consideration in the introduction of IGP into the work environment is the well-defined task and input-output definition of each f the o participating group: children, elderly and operators, where each are very im- alth portant. Let us be examples of good practices in encourage of implying IGP in our ikov | he local environment because we have to start fighting against the social isolation stn of the elderly, to take advantage of the benefits of IGP for the brighter future of taroe s children and to make every effort to change the world for the better. zdravj References COOK, G. and BAILEY, C., 2013. Older care home residents’ views of intergen- erational practice. Journal of Intergenerational Relationships, vol. 11, no. 4, pp: 410–24. EPSTEIN, A. S. and BOISVERT, C., 2006. Let’s do something together: iden- tifying the effective components of intergenerational programs [online]. Journal of Intergenerational Relationships, vol. 4, no. 3, pp. 87–109. [viewed 14 May 2018]. Available from: 10.1300/J194v04n03_07. ERIKSON, E., 1950. Childhood and Society. New York: Norton. FINDLAY, R. A., 2003. Interventions to reduce social isolation amongst old- er people: where is the evidence [online]? Ageing and Society, vol. 23, no. 5, pp. 647–58. [viewed 14 May 2018]. Available from doi:10.1017/ S0144686X03001296. FITZPATRICK, A. and THE TOY PROJECT CONSORTIUM, 2013. Intergen- erational learning involving young children and older people, Leiden: The TOY Project; pp. 1–34. FRATIGLIONI, L., WANG, H. X., ERICSSON, K., MAYTAN, M. and WIN- BLAD, B., 2000. Influence of social network on occurrence of dementia: a community-based longitudinal study [online]. Lancet London England, vol. 355, no. 9212 1315–9. [viewed 14 May 2018]. Available from: doi:10.1016/ S0140-6736(00)02113-9. FRIED, L.P., CARLSON, M.C., MCGILL, S., SEEMAN, T., XUE, Q., FRICK, K., TAN, E., TANNER, E.K., BARRON, J., FRANGAKIS, C., et al., 2013. Experience Corps: A dual trial to promote the health of older adults and children’s academic success [online]. Contemporary Clinical Trials vol. 36, no. 1, pp. 1–13 [viewed 15 May 2018]. Available from: http://dx.doi. org/10.1016/j.cct.2013.05.003 FUJIWARA, Y., NISHI, M., WATANABE, N., LEE, S., INOUE, K., YOSHI- DA, H., and SHINKAI, S., 2006. An intergenerational health promotion program involving older adults in urban areas: Research of productivi- 1 ty by intergenerational sympathy (REPRINTS): first-year experience and 14 short-term effects. Japanese Journal of Public Health, vol. 53, no. 9, pp. 702–14. lderly FUJIWARA, Y., SHINKAI, S., KUMAGAI, S., AMANO, H., YOSHIDA, Y., he e YOSHIDA, H. and SHIBATA, H., 2003. Longitudinal changes in high- f t n o er-level functional capacity of an older population living in a Japanese urban community. Archives of Gerontology and Geriatrics, vol. 36, no. 2, latioso pp. 141–53. cial i FUJIWARA, Y., SUGIHARA, Y and SHINKAI, S., 2005. Effects of volunteer- o ing on the mental and physical health of senior citizens: significance of he s o t senior-volunteering from the view point of com- munity health and wel- n t fare (in Japanese). Japanese Journal of Public Health, vol. 52, no. 4, pp. lutio 293–307. o s a s GEORGE, D. R. and SINGER, M.E., 2011. Intergenerational volunteering and s a quality of life for persons with mild to moderate dementia: results from gram a 5-month intervention study in the United States. The American Journal ro of Geriatric Psychiatry, vol. 19, no. 4, pp. 392–6. nal p GUALANO, M.R, VOGLINO, G., BERT, F., THOMAS, R., CAMUSSI, E. and SILIQUINI, R., 2017. The impact of intergenerational programs on chil- dren and older adults: a review [online]. International Psychogeriatric, vol. 30, no. 4, pp. 451-68. [viewed 14 May 2018]. Available from: https://doi. intergeneratio org/10.1017/S104161021700182X HERNANDEZ, C. R. and GONZALEZ, M.Z., 2008. Effects of intergeneration- al interaction on aging. Educational Gerontology, vol. 34, no. 4, pp. 292– 305. HOFF, A., 2007. Intergenerational learning as an adaptation strategy in ag- ing knowledge societies. In: EUROPEAN COMMISSION, ed. Education, Employment, Europe. Warsaw: National Contact Point for Research Pro- grams of the European Union, pp.126–129. HOZJAN, T., 2010. Aktualne dejavnosti na področju medgeneracijskega sodelovanja v Sloveniji. Andragoška spoznanja vol. 16, no. 4, pp. 45–52. ILIFFE, S., KHARICHA, K., HARARI, D., SWIFT, C., GILLMANN, G. and STUCK, A. E., 2007. Health risk appraisal in older people 2: the impli- cations for clinicians and commissioners of social isolation risk in older people. British Journal of General Practice Journal Royal College of Gener- al Practice, vol. 57, no. 535, 277–82. JARROTT, S. E. and SMITH, C. L., 2011. The complement of research and theo- ry in practice: contact theory at work in nonfamily intergenerational pro- grams [online]. Gerontologist, vol. 51, no. xx, pp. 112–21. [viewed 14 May 2018]. Available from: doi:10.1093/geront/gnq058. JARROTT, S. E., GIGLIOTTI, C. M. and SMOCK, S.A., 2006. Where do we stand? Testing the foundation of a shared site intergenerational program. 214 Journal of Intergenerational Relationships, vol. 4, no. 2, pp. 73–92. JARROTT, S. E., MORRIS, M. M., BURNETT, A. J., STAUFFER, D., STREM- MEL, A. S. and GIGLIOTTI, C. M., 2011. Creating community capaci- lderly e ty at a shared site intergenerational program: “like a barefoot climb up a f the mountain” [online]. Journal of Intergenerational Relationships, vol. 9, no. o xx, pp. 418–34. [viewed 14 May 2018]. Available from: doi:10.1080/1535077 alth 0.2011.619925. KANG, D.H., BOSS, L. and CLOWTIS, L., 2016. Social support and cognition: ikov | he stn Early childhood versus older adulthood. Western Journal of Nursing Re- taro search, vol. 38, no. 12, pp. 1639–59. e s KAPLAN, M., 2002. Intergenerational programs in schools: considerations of zdravj form and function. International Review of Education, vol. 48, no. 5, pp. 305–34. KINSELLA, K. and HE, W., 2009. An Aging World: 2008. US Census Bureau. International Population Reports, PS95/09-1. Washington DC: US Gov- ernment Printing Office. MOHER, D., LIBERATI, A., TETZLAFF, J., ALTMAN, D.G. and THE PRIS- MA GROUP, 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine, vol. 6, no. 7, pp. 1–6. MORITA, K. and KOBAYASHI, M., 2013. Interactive programs with preschool children bring smiles and conversation to older adults: time-sampling study [online]. BMC Geriatrics, vol. 13, no. 111, pp. 1–8. [viewed 14 May 2018]. Available from: https://doi.org/10.1186/1471-2318-13-111 MURAYAMA, Y., OHBA, H., YASUNAGA, M., NONAKA, K., TAKEUCHI, R., NISHI, M., NAOKO, S., UCHIDA, H., SHOJI SHINKAI, S. and FU- JIWARA, Y., 2015. The effect of intergenerational programs on the men- tal health of elderly adults [online]. Aging and Mental Health, vol. 19, no. 4, pp. 306–314. [viewed 14 May 2018]. Available from: http://dx.doi.org/10 .1080/13607863.2014.933309 NARAT, T., BOŠKIĆ, R., RAKAR, T., BOLJKA, U. and KOBAL, T. B., 2012. Medgeneracijska solidarnost v skupnosti: analiza stanja in priprava pred- logov. Ljubljana: Social protection institute of Republic of Slovenia. NEWMAN, S. and HATTON-YEO, A., 2008. Intergenerational learning and the contributions of older people. Ageing horizons, no. 8, pp. 31–9. NEWMAN, S. and RIESS, J., 1992. Older workers in intergenerational child care. Journal of Gerontological Social Work, vol. 19, no. 2, pp. 45–66. NEWMAN, S., 1989. A history of intergenerational programs. The Journal of Contemporary Social Services, vol 20, no. 3–4, pp. 1–16. SAKURAI, R., YASUNAGA, M., MURAYAMA, Y., OHBA, H., NONAKA, K., SUZUKI, H., SAKUMA, N., NISHI, M., UCHIDA, H. and SHINKAI, S., et al., 2016. Long-term effects of an intergenerational program on func- 3 tional capacity in older adults: Results from a seven-year follow-up of the 14 REPRINTS study [online]. Archives of Gerontology and Geriatrics, vol. 64, no. May–June 2016, pp. 13–20. [viewed 15 May 2018]. Available from: lderly http://dx.doi.org/10.1016/j.archger.2015.12.005 he ef t SCHROEDER, K., RATCLIFFE, S. J., PEREZ, A., EARLEY, D., BOWMAN, C. n o and LIPMAN T. H., 2017. Dance for Health: An Intergenerational Program latio to Increase Access to Physical Activity [online]. Journal of Pediatric Nursing, so vol. 37, no. Nov – Dec 2017, pp. 29 – 34. [viewed 14 May 2018]. Available from: cial io http://dx.doi.org/10.1016/j.pedn.2017.07.004 he s TEATER, B., 2016. Intergenerational programs to promote active aging: the ex- o t periences and perspectives of older adults [online]. Activities, adaptation n t & aging, vol. 40, no. 1, pp. 1–19. [viewed 14 May 2018]. Available from doi: lutioo 10.1080/01924788.2016.1127041. s a s VARMA, V. R., CARLSON, M. C., PARISI, J. M., TANNER, E. K., MCGILL, s a S., FRIED, L. P., SONG, L. H. and GRUENEWALD, T. L., 2015. Experi- gram ence corps Baltimore: exploring the stressors and rewards of high-inten- ro sity civic engagement [online]. The Gerontologist, vol. 55, no. 6, pp. 1038– nal p 49. [viewed 14 May 2018]. Available from doi:10.1093/geront/gnu011. WILSON, N. L., CAMP, C. J., JUDGE, K. S., BYE, C. A., FOX, K. M., BOWDEN, J., BELL, M., VALENCIC, K. and MATTERN, J. M., 1997. An intergener- intergeneratio ational program for persons with dementia using Montessori methods. The Gerontologist, vol. 37, no. 5, pp. 688–692. YASUNAGA, M., MURAYAMA, Y., TAKAHASHI, T., OHBA, H., SUZUKI, H., NONAKA, K., KURAOKA, M., SAKURAI, R., NISHI, M. and SA- KUMA, N., et al., 2016. Multiple impacts of an intergenerational program in Japan: Evidence from the Research on Productivity through Inter- generational Sympathy Project [online]. Geriatrics & Gerontology Inter- national, vol. 16 no. 1, pp. 98–109. [viewed 14 May 2018]. Available from: http://dx.doi.org/10.1111/ggi.12770 Conference Sponsors Programski in organizacijski odbor konference se zahvaljujeta sponzorjem konference za vso podporo in sodelovanje Scientific and Organising Committee would like to thank all the sponsors whose sponsorship helps to support our conference 414 Vaš partner za zdravje. lderly e f the o alth ikov | he stn taroe s zdravj 514 s sor pone s encfer con Media sponsor of the Conference Zdravje starostnikov / Health of the Elderly Znanstvena monografija / Proceedings Uredila / Edited by Ana Petelin and Nejc Šarabon Recenzenti / Reviewers ■ Katarina Babnik, Darja Barlič-Maganja, Marjana Benigar Manias, Ester Benko, Katja Bezek, Tjaša Hrovat, Boris Kovač, Sabina Ličen, Melita Peršolja, Ana Petelin, Patrik Pucer, David Ravnik, Helena Skočir, Nejc Šarabon, Matej Voglar, Boštjan Žvanut Oblikovanje in prelom / Design and Typesetting ■ Jonatan Vinkler Izdajatelj / Published by ■ University of Primorska Press Titov trg 4, si-6000 Koper, Koper 2018 Glavni urednik/Editor-in-Chief ■ Jonatan Vinkler Vodja založbe/Managing Editor ■ Alen Ježovnik ISBN 978-961-7055-18-4 (www.hippocampus.si/ISBN/978-961-7055-18-4.pdf) ISBN 978-961-7055-19-1 (www.hippocampus.si/ISBN/978-961-7055-19-1/index.html) DOI: https://doi.org/10.26493/978-961-7055-18-4 © 2018 University of Primorska Press Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=296376064 ISBN 978-961-7055-18-4 (pdf) ISBN 978-961-7055-19-1 (html) Document Outline Petelin, Ana, and Šarabon, Nejc. 2018. Eds. Zdravje starostnikov / Health of the Elderly. Znanstvena monografija / Proceedings. Koper: University of Primorska Press. Monika Brglez, Tamara Poklar Vatovec, Nadja Plazar ▪︎ Nutrition disorders in the elderly living period Abstract Methods Review methods Results Nutrition in the elderly Nutrition and metabolic disorders Development factors of eating disorders Malnutrition prevention guidelines Discussion Conclusions References Kristina Drole, Petra Zaletel ▪︎ Dance and Exercise as Therapy in Patients with Parkinson’s Disease – Case Study Abstract Methods Intervention Results Posture Discussion Conclusions References Branko Gabrovec ▪︎ Role of physical activity and nutrition in prevention of frailty Abstract Methods Results Nutrition Physical activity Discussion and conclusions Literature Andreja Gerl, Tjaša Tkalec, Anita Dolšak Kos, Andrej Starc ▪︎ Positive ageing: the problem of young generation or challenge for modern society Abstract Methods Results Discussion Conclusions References Jasna Hrovatin, David Ravnik ▪︎ Adaptability in living space for elderly people Abstract Methods Results Discussion Conclusions References Samo Kotnik, Alja Mikec, Andrej Starc ▪︎ Effects of enough omega-3 fatty acids on cardiovascular system in the elderly Abstract Methods Results Discussion Conclusion References Urša Mršnik, Eva Žaberl, Miha Kranjc ▪︎ Nutritional Treatment of the Elderly in Nursing Homes Abstract Methods Results Literature review Implementing nutritional support in nursing homes Conclusions References Tatjana Novak, Zdenka Katkič ▪︎ Effects of regular exercise on elderly people Abstract Methods Results Discussion Conclusion References Helena Olenik, Milica Puklavec, Armina Šahman, Andrej Starc ▪︎ Physical activity of the elderly with a diabetic foot Abstract Methods Results Discussion and Conclusion References Marjeta Oplot, Gregor Štiglic, Mateja Lorber ▪︎ Physical activity and its importance for the elderly’s health Abstract Methods Results Discussion Conclusion References Vida Oražem, Danica Rotar Pavlič, Melita Peršolja ▪︎ Factors influencing hospital length of stay in non-acute care setting Abstract Methods Population, sample Instrument Data analysis Results Discussion Conclusions References Špela Selak, Branko Gabrovec ▪︎ Tackling frailty with the help of information-communication technology Abstract Methods Results and discussion Conclusions References Mitja Slapar, Anton Zupan ▪︎ Strategies for successful life in the home environment for elderly disabled people with neuromuscular disorders Abstract Methods Results SWOT analysis Disadvantages (D) Advantages (A) Challenges (C) Dangers (D) Discussion Conclusions References Nika Slokar, Nina Mohorko ▪︎ Nutritional status of older adults admitted to the Surgical Ward Abstract Methods Data collection Statistical analyses Results Discussion Limitations Conclusions References Anja Zagoričnik, Argresa Bylykbashi, Andrej Starc ▪︎ Intergenerational programs as a solution to the social isolation of the elderly Abstract Methods Results Discussion Conclusions References Conference Sponsors Colophone