
Margot A GosneyRoyal Berkshire NHS Foundation Trust | Royal Berkshire Hospital · Elderly Care Medicine
Margot A Gosney
MB ChB FRCP MD
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186
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Publications (186)
Purpose
Many cancer patients have problems eating which are usually connected to taste and smell alterations due to side effects of cancer treatment. These problems have consequences both in terms of malnutrition and reduced quality of life. In order to explore social and psychological consequences of eating problems in cancer patients, qualitative...
Background
In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to...
Background
Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL).
Methods
A multicentre, o...
Background
Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy.
Methods
A multicentre, prospective, observational study was performed to determine chemotherapy...
Objectives
Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET...
Background
Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy.
Methods
This was a multicentre, prospective, observational cohort study of surgery or prima...
Background
Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, an...
Introduction
Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in old...
Background
Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET.
Methods
Multicentre, prospective, UK, observational cohort...
Although there are numerous high protein products on the market, they are typically not designed with, or for, older consumers. This is surprising considering that dietary guidelines recognise the need for higher protein intake in later life. Protein fortified products are, however, associated with negative sensory attributes and poor consumer acce...
Protein fortified products are regularly recommended to older adults to improve nutritional status and limit sarcopenia. However protein fortification can elicit negative sensory attributes such as mouthdrying. Sensitivity to mouthdrying can increase with age, yet the influence of saliva flow and mucoadhesion remain uncertain. Here, two studies tes...
Aims: Malnutrition causes a huge burden on health and social services; wastage of hospital food is high and intake poor, particularly in older patients. This study looks at the lunch choices of older patients and considers how hospital meals could be altered to improve consumption. Study Design: Over a four week period, the food choices of patients...
As we age our sensory perception alters partly as a result of normal ageing but also due to coexisting medical conditions. Threshold changes become particularly important for individuals at high risk of nutritional insufficiencies. Genetic differences, medication, diet and zinc levels all alter sensory perception. Odour perception is both ortho and...
Introduction: Malnutrition is a significant problem amongst hospitalized older people, and can impede recovery. Oral nutritional supplements (ONS) may be poorly tolerated; food fortification could be a better alternative. We aimed to establish the acceptability of fortified foods to older inpatients including those who have dementia and frailty. Me...
Natural killer (NK) cells are an important component of the immune response to influenza infection, but are subject to alteration during aging, which may play a role in impaired response to infection and vaccination in older people. Enhancement of NK cell activity could, therefore, present a means to improve the immune response to vaccination in ol...
Increasing life expectancy has led to a higher incidence and prevalence of cancer in older people, with the largest increase in the 75 and over age group. This group is much more likely to develop cancer than younger people. The incidence rate is higher for older males and varies by cancer type. The rate begins to decline in the 85 and over age gro...
Background & aims:
Ageing increases risk of respiratory infections and impairs the response to influenza vaccination. Pre- and pro-biotics offer an opportunity to modulate anti-viral defenses and the response to vaccination via alteration of the gut microbiota. This study investigated the effect of a novel probiotic, Bifidobacterium longum bv. inf...
Background:
Ageing increases risk of respiratory infections and impairs the response to influenza vaccination. Pre- and probiotics offer an opportunity to modulate anti-viral defenses and the response to vaccination via alteration of the gut microbiota. This study investigated the effect of a novel probiotic, Bifidobacterium longum bv. infantis CC...
There are potential nutritional and sensory benefits of adding sauces to hospital meals. The aim of this study was to develop nutrient fortified sauces with acceptable sensory properties suitable for older people at risk of undernutrition. Tomato, gravy, and white sauce were fortified with macro- and micronutrients using food ingredients rich in en...
Taste and smell detection threshold measurements are frequently time consuming especially when the method involves reversing the concentrations presented to replicate and improve accuracy of results. These multiple replications are likely to cause sensory and cognitive fatigue which may be more pronounced in elderly populations. A new rapid detecti...
Undernutrition in older adults is widespread. Oral nutritional supplement beverages (ONS) are prescribed, yet consumption by older people is often insufficient. A variety of supplement formats may improve nutrient intake. This study developed protein and micronutrient fortified biscuits and evaluated their sensory attributes and liking by older peo...
Objective:
To determine the prevalence of occult hearing loss in elderly inpatients, to evaluate feasibility of opportunistic hearing screening and to determine subsequent provision of hearing aids.
Materials and methods:
Subjects (>65 years) were recruited from five elderly care wards. Hearing loss was detected by a ward-based hearing screen comp...
Taxonomic free sorting ( TFS ) is a fast, reliable and new technique in sensory science. The method extends the typical free sorting task where stimuli are grouped according to similarities, by asking respondents to combine their groups two at a time to produce a hierarchy. Previously, TFS has been used for the visual assessment of packaging wherea...
Oral nutritional supplement drinks (ONS) are beverages high in dairy proteins that are prescribed to individuals at risk of malnutrition. Consumption of ONS is poor in elderly care facilities, with patients commenting that the sensory attributes of these drinks reduce their enjoyment and willingness to consume. Mouth drying is an attribute of ONS f...
Effects of a novel probiotic, Bifidobacterium longum bv. infantis CCUG 52486 with prebiotic on the B-cell response to influenza vaccination - Volume 73 Issue OCE1 - S. M. Enani, C. E. Childs, A. Przemska, C. Maidens, H. Dong, I. Rowland, K. Tuohy, S. Todd, M. Gosney, P. Yaqoob
To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment.
Oral nutritional supplement drinks have positive benefits on increasing nutritional status in undernourished older people leading to weight gain. However, consumption of these drinks is low and therefo...
Objectives:
Investigate the impact of the provision of ONS on protein and energy intake from food and ability to meet protein and calorie requirements in people with dementia.
Design:
After consent by proxy was obtained, participants took part in a cross over study comparing oral intake on an intervention day to an adjacent control day.
Setting...
High protein dairy beverages are considered to be mouth drying. The drying sensation may be due to the product protein content; however the mechanism of this mouth drying is uncertain. This study investigated the potential adhesion of milk proteins to porcine oral mucosa in vitro. Purified casein and β-lactoglobulin were fluorescently labelled, pla...
Umami taste in foods is elicited predominantly by the presence of glutamic acid and 5′-ribonucleotides, which act synergistically. This study aimed to use natural ingredients to maximise umami taste of a meat formulation and determine effects on liking of older consumers. Cooked meat products with added natural ingredients (yeast extract, mycoscent...
Sensory perception has been found to change during ageing. The perception of mouthfeel by older adults, and the role of ageing on the sensory perception of texture attributes is uncertain. This study investigated perception of the textural attributes of thickness, mouth coating and mouth drying, in the context of dairy beverages, by older and young...
Age is a risk factor for dementia, and also for most cancers. Surprisingly, rates of cancer appear to be lower in individuals with dementia and vice versa. Genetic mechanisms could underpin this inverse relationship and are outlined, but underdiagnosis must also be taken into account. Individuals with cancer and dementia pose unique challenges to h...
Background & aims:
Malnutrition is prevalent in people diagnosed with dementia however ensuring adequate oral intake within this group is often problematic. It is important to determine whether providing nutritionally complete oral nutritional supplements (ONS) drinks is an effective way of improving clinical outcomes for older people with dementi...
A state-of-the-art, multidisciplinary approach to cancer and aging. With the majority of cancers occurring in individuals over the age of 65 against a backdrop of an expanding aging population, there is an urgent need to integrate the areas of clinical oncology and geriatric care. This timely work tackles these issues head-on, presenting a truly mu...
Effects of Bifidobacteriumlongumbv.infantisCCUG 52486 combined with glucooligosaccharideon immune cell populations in healthy young and older subjects receiving an influenza vaccination - Volume 72 Issue OCE1 - A. Przemska, C. Maidens, C. Childs, H. Dong, K. Tuohy, I. Rowland, M. Gosney, S. Todd, P. Yaqoob
Effects of Bifidobacteriumlongum bv. Infantis CCUG 52486 combined with glucooligosaccharide on immune cell populations in healthy young and older subjects receiving an influenza vaccination - Volume 72 Issue OCE1 - A. Przemska, C. Maidens, C. Childs, H. Dong, K. Tuohy, I. Rowland, M. Gosney, S. Todd, P. Yaqoob
We live within an ageing population, and those over the age of 85 years will continue to make up increasing numbers and overall total proportion of populations across the world. In the UK, the number of older people aged 85 years and above will more than double in the next 25 years. In 2034, it is predicted that over 3.5 million of the UK populatio...
Taste perception has been studied frequently in young and older adult groups. This paper systematically reviews these studies to determine the effect of ageing on taste perception and establish the reported extent of sensory decline. Five databases were searched from 1900 to April 2012. Articles relating to healthy ageing in human subjects were inc...
As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heter...
Starch-based thickening agents may be prescribed for patients with dysphagia. Thickened fluids alter variables of the swallow reflex, allowing more time for bolus manipulation without compromising airway closure. This investigation explored the variation in viscosity and physical characteristics of thickened drinks prepared in different media under...
Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population.
Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative
therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommendin...
Sensory changes and preservation with age: Hope for the undernourished - Volume 71 Issue OCE2 - C. Withers*, M. Dermiki, M. A. Gosney, R. Crabtree, O. B. Kennedy, L. Methven
To review perceived emotional well-being in older people with visual impairment and perceived factors that inhibit/facilitate psychosocial adjustment to vision loss.
The databases of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for studies published from January 1980 to December 2010, which recruited older people with irreversible vision loss...
The ACTION trial was initiated to provide evidence from a randomised trial on the effects of chemotherapy in women aged over 70 years where evidence for risk and benefit are lacking.
This was a randomised, phase III clinical trial for high risk, oestrogen receptor (ER) negative/ER weakly positive early breast cancer. The trial planned to recruit 10...
Clare Payne's study found large variations in the consistency of thickened drinks, which can cause aspiration or dehydration. Here she discusses what to consider when thickening drinks.
This review describes the fact that many elderly people enjoy an active sex life and examines the evidence against the general perception of an 'asexual' old age. It offers an overview of the evidence for healthcare professionals who had not previously considered the sexuality of their older patients. It also describes some of the sexual problems f...
Diminished sensory ability, and specifically smell and taste deterioration caused by ageing or due to medication and illness, is one common factor which contributes to malnutrition within older adults (1) . However, it has been shown from previous studies that flavour enhancement of food using monosodium glutamate and/or added flavours resulted in...
Umami has been recognised for over a century and is now known as the fifth taste, alongside, salty, sweet, sour and bitter (1) . Monosodium glutamate (MSG), a glutamate salt, is the most common source of umami and is known to increase palatability of foods through flavour enhancement (2,3) , increase food intake (4) , improve immunity and physical...
Impaired sensorial perception is very common in older people and low sensorial quality of foods is associated with decreased appetite and dietary intake. Hospital undernutrition in older patients could be linked to sensorial quality of hospital food if the quality were low or inappropriate for older people. The aim of this study was to examine chan...
A comparison of the amount of Oral Nutritional Supplement drinks consumed between two randomly allocated drinking methods - Volume 70 Issue OCE5 - V. J. Allen, L. Methven, M. A. Gosney
Oral nutrition supplements (ONS) are routinely prescribed to those with, or at risk of, malnutrition. Previous research identified poor compliance due to taste and sweetness. This paper investigates taste and hedonic liking of ONS, of varying sweetness and metallic levels, over consumption volume; an important consideration as patients are prescrib...
Epidemiological studies show us that the aging population, which is well known to clinicians and healthcare planners, will
continue to increase in number. With increasing age, the development of cancer becomes more likely, and many older individuals
will be diagnosed with a malignancy in later life or may survive from a younger age with such a diag...
sip feeds are oral nutritional supplements (ONSs) that are commonly prescribed to malnourished patients to improve their nutritional and clinical status. However, ONSs are poorly consumed and frequently wasted, with sweetness being identified as one of the factors leading to patients' dislike of ONSs.
to investigate if age affects sweetness thresho...
Literature that is not peer-reviewed and distributed through a publisher is known as ‘grey’. As it is used to inform policy and practice we reviewed the grey literature concerning emotional well-being in people with sight loss. We consulted and searched the websites of UK voluntary organizations, and scanned reference lists of previous reviews for...
This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, particip...
Our series Prescribing in older people gives practical advice for successful management of the special problems face by this age group. Here, the authors describe the diagnosis and recommended management of pneumonia in the community. Copyright © 2010 Wiley Interface Ltd
Consideration of sweetness, sweetness thresholds and repeat consumption on the liking of oral nutritional supplements by older cohorts - Volume 69 Issue OCE2 - L. Methven, O. B. Kennedy, L. Ladbrooke-Davies, L. Kinneavy, M. A. Gosney
Using a mixed-method approach to understand older adults' liking and potential barriers to consumption of oral nutritional supplements - Volume 69 Issue OCE1 - O. B. Kennedy, L. Methven, K. Rahelu, N. Economou, M. A. Gosney
Malnutrition screening; can measurement of prealbumin aid detection? - Volume 69 Issue OCE1 - E. Ito, W. K. Cheung, J. Opsypiw, O. B. Kennedy, M. A. Gosney
Previous studies found serving temperature to affect the acceptability of oral nutritional supplements (ONS) (1). However, air incorporated into ONS in order to produce ice cream unacceptably increased consumption volume (2). The present study aimed to manufacture ice cream of higher energy, mineral and vitamin composition by weight in order to ach...
Hospital patients over the age of 80 have five times higher undernutrition prevalence than patients under the age of 50, and 60 % of older patients are at risk of becoming malnourished, or their situation deteriorating (1). The aim of the project was to investigate whether the processes that take place between food production and meal consumption b...