Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment

Protein intake, weight loss, dietary intervention, and worsening of quality of life in older patients during chemotherapy for cancer

Decreased health-related quality of life (HRQoL) is common in patients with cancer. We investigated the effects of dietary intervention and baseline nutritional status on worsening of HRQoL in older patients during chemotherapy. In this randomized control trial assessing the effect on mortality of dietary advice to increase dietary intake during chemotherapy, this post hoc analysis included 155 patients with cancer at risk of malnutrition. The effects of dietary intervention, baseline Mini Nutritional Assessment item scores, weight loss, and protein and energy intake before treatment on the worsening of HRQoL (physical functioning, fatigue) and secondary outcomes (Timed Up and Go test, one-leg stance time, depressive symptoms, basic (ADL), or instrumental (IADL) activities of daily living) were analyzed by multinomial regressions. Dietary intervention increased total energy and protein intake but had no effect on any examined outcomes. Worsening of fatigue and ADL was predicted by very low protein intake (< 0.8 g kg^-1 day^-1) before chemotherapy (OR 3.02, 95% CI 1.22-7.46, p = 0.018 and OR 5.21, 95% CI 1.18-22.73, p = 0.029 respectively). Increase in depressive symptomatology was predicted by 5.0-9.9% weight loss before chemotherapy (OR 2.68, 95% CI 1.10-6.80, p = 0.038). Nutritional intervention to prevent HRQoL decline during chemotherapy should focus on patients with very low protein intake along with those with weight loss.

A visual analogue scale for food intake as a screening test for malnutrition in the primary care setting: Prospective non-interventional study

INTRODUCTION AND AIMS

The Self-Evaluation of Food Intake (SEFI®) is a simple tool to assess food intake that correlates well with the diagnosis of malnutrition in the hospital setting.

AIMS

to evaluate the validity of SEFI® for the diagnosis of malnutrition among adults in the primary care setting (primary aim); to assess the prevalence of malnutrition, the feasibility of the SEFI® and the variables associated with malnutrition (secondary aims).

METHODS

A non-interventional prospective study on consecutive patients at three primary care practices. Primary endpoint: confrontation of a SEFI® visual analogue scale score <7/10 with the diagnosis of malnutrition as defined by the Global Leadership Initiative on Malnutrition criteria. Secondary endpoints: the proportion of patients for whom a SEFI® score was collected. Multivariate analysis: threshold α = 0.20 in univariate analyses, step-by-step logistic regression.

RESULTS

Among 747 eligible patients, 505 were included: mean age (±SD) 56 ± 19 yrs, 61% female, 49% presenting with acute medical problems, 15.8% (n = 80) with SEFI® score <7/10, and 4.2% (n = 21) with malnutrition. The predictive performance of the SEFI® score <7 for the diagnosis of malnutrition was good (AUC = 0.82 [95% confidence interval (CI), 0.72-0.92]): sensitivity 76.2% (n = 16/21, [58.0-94.4]), specificity 86.8% (n = 420/484, [83.8-89.8]), positive predictive value 20.0% (n = 16/80, [11.2-28.8]), and negative predictive value 98.8% (n = 420/425, [97.8-99.8]). The feasibility of the SEFI® 10-point visual analogue scale was 100% (505/505). The variables independently associated with malnutrition were: female gender (odds ratio 4.9 [95% CI, 1.7-14.2], P = 0.003), cancer (4.8 [1.4-15.9], P = 0.011) and chronic alcohol consumption (7.4 [1.3-41.4], P = 0.023).

CONCLUSIONS

The prevalence of malnutrition was 4.2% in this primary care setting. The SEFI® visual analogue scale for food intake is feasible and could be helpful for the diagnosis of malnutrition in this setting.

Dietary supplement use by older adults with chronic venous leg ulcers: A retrospective, descriptive study

Nearly 70% of older adults in the U.S. report using ≥1 dietary supplements (DSs) daily. While DSs may have health benefits, there is risk for toxicity or harmful drug-supplement interactions if not taken correctly. Older adults with chronic wounds who use DSs are at increased risk of adverse drug-supplement interactions because they usually have comorbidities requiring polypharmacy management. However, no studies have evaluated DS use in this population. The aim of this retrospective pilot study was to describe DS use by a sample of older adults (n = 40) with chronic venous leg ulcers (CVLUs) who participated in a clinical trial testing the effects of fish oil supplementation on wound healing. At baseline, study personnel assisted all participants in completing an electronic questionnaire about DS use. Descriptive statistics were used to characterize the data. Twenty-five of the 40 participants (62.5%) reported taking ≥1 DS daily. On average, DS users were 65.16 years (SD = 8.51) and the majority were men (64.0%), white (68.0%), and had at least some college education (72.0%). Fifteen (60.0%) reported taking 1-2 DSs/day, and 10 (40.0%) reported taking ≥3/day. The most frequently reported DSs used were multivitamin/mineral complex (60.0%), vitamin D (36.0%), vitamin B complex (28.0%) and calcium (28.0%). Reasons for using DSs were to maintain or improve health (44.0%), improve bone density (12%), and boost the immune system (12%). Supplement users reported consuming an average of 9.12 (SD = 6.46) prescription drugs daily and 21 (84.0%) reported ≥3 chronic health conditions. In summary, DS use in this sample of chronic wound patients was high. Moreover, DS users reported using multiple prescription drugs (2-23/day) concomitantly with DSs. While older adults with CVLUs may benefit from targeted DS therapy, monitoring their DS use to reduce risk for adverse drug-supplement interactions is best practice.

Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China

BACKGROUND/OBJECTIVES

To evaluate the prevalence of malnutrition and its related factors in elderly patients with COVID-19 in Wuhan, China.

SUBJECTS/METHODS

In a cross-sectional study, we evaluated the nutritional status of elderly inpatients with COVID-19 using the Mini Nutritional Assessment (MNA). Based on MNA scores, patients were divided into non-malnutrition group (MNA ≥ 24), the group with risk of malnutrition (MNA 17-23.5) and malnutrition group (MNA score < 17). Regression analysis was conducted to screen for risk factors for malnutrition.

RESULTS

A total of 182 patients were included in the study, of which 27.5% were in the group with malnutrition risk and 52.7% were in the malnutrition group. There were statistical differences in the incidence of comorbid diabetes mellitus, body mass index (BMI), calf circumference,albumin, hemoglobin, and lymphocyte counts among the three groups. Further regression analysis suggested that combined diabetes, low calf circumference, and low albumin were independent risk factors for malnutrition.

CONCLUSIONS

The prevalence of malnutrition in elderly patients with COVID-19 was high, and nutritional support should be strengthened during treatment, especially for those with diabetes mellitus, low calf circumference, or low albumin.

Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial

OBJECTIVE

To evaluate the effectiveness of a shared decision-making and patient engagement (SDM-PE) program concerning in-hospital stay during acute exacerbation of COPD and determine its impact on patients' perceived health status.

METHODS

Patients were randomly allocated to a control group that received standard treatment or an intervention group that received an individualized SDM-PE program in addition to standard treatment. The SDM-PE program included personalized health care focused on information about the disease, healthcare management, and reinforcement of behaviors regarding nutrition and exercise taking into account patients' preferences.

RESULTS

A comparative analysis between groups showed a significant improvement in perceived health status at discharge in patients included in the experimental group compared to those in the control group (60.28 ± 21.65 vs. 54.13 ± 22.69, p = 0.036). In addition, perceived health status, COPD knowledge, adherence to pharmacological treatment, general functionality, and healthy lifestyle measures were significantly better at 3-month follow-up in the intervention group.

CONCLUSION

An SDM-PE program significantly enhanced all the clinical measures assessed during hospitalization at 3-month follow-up.

PRACTICE IMPLICATIONS

COPD patients and professionals need to work together to select the best care and treatment model for patients, taking into account individual values and preferences.

Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.

The geriatric nutrition risk index versus the mini-nutritional assessment short form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: a prospective cohort study

Backgrounds

Malnutrition has been shown to be associated with poor prognosis in older surgical patients. Several tools are available for detecting malnutrition. But little is known about their ability to assess risks of postoperative adverse outcomes. The study aimed to compare the ability of the Geriatric Nutritional Risk Index (GNRI) and the Mini-Nutritional Assessment Short Form (MNA-SF) in predicting postoperative delirium (POD) and length of stay (LOS) among older non-cardiac surgical patients.

Methods

Prospective study of 288 older non-cardiac surgical patients from the West China Hospital of Sichuan University. Preoperative nutritional status was assessed using the GNRI and MNA-SF, and patients were followed for the occurrence of POD and LOS. Multivariable logistic regression and linear regression analyses were used to identify predictors of these outcomes. The relative performance of the GNRI and MNA-SF as predictors of these outcomes were determined by Receiver Operating Characteristic curves (ROC) analyses and the area under the curve (AUC).

Results

Multivariable analysis revealed that preoperative malnutrition by the MNA-SF was significantly associated with POD. Linear regression analysis showed that preoperative low/high nutritional risk of the GNRI and malnutrition by the MNA-SF were independent predictors of prolonged LOS. Moreover, the area under the curve (AUC) of MNA-SF scores for POD was better than GNRI scores (AUC = 0.718, 95%CI: 0.64–0.80, P < 0.001 vs AUC = 0.606, 95%CI: 0.52–0.69, P = 0.019; Delong’s test, P = 0.006), but the AUC of GNRI scores and MNA-SF scores have no significant difference when predicting prolonged LOS (AUC = 0.611, 95%CI: 0.54–0.69, P = 0.006 vs AUC = 0.533, 95%CI: 0.45–0.62, P = 0.421; Delong’s test, P = 0.079).

Conclusion

The MNA-SF was more effective than the GNRI at predicting the development of POD, but the two nutrition screening methods have similar performance in predicting prolonged LOS among older non-cardiac surgical patients.

Role of comprehensive geriatric assessment in low surgical risk older patients with aortic stenosis

BACKGROUND

Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients.

AIMS

To evaluate predictors of TAVI procedure and clinical outcomes among these patients.

METHODS

For each patient ≥ 65 years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance.

RESULTS

Among 154 subjects (mean age 82.9 years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups.

DISCUSSION

Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group.

CONCLUSIONS

We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.

[Assessing the implementation of a nutritional screening protocol in patients admitted to the Medicine Department of a local hospital]

Introduction

Background: the techniques for screening and nutritional intervention in hospitalized patients are a cost-effective measure. In clinical practice the problem lies in their administration. Objective: to evaluate the implementation of a nutritional screening tool in patients admitted to our Medicine Ward (M). Material and methods: a single-center, prospective, observational study in patients admitted to M. Exclusion criteria: end-stage cancer patients, inpatient stay less than 72 h, and hospital readmission of previously included patients. One out of every 2 hospital admissions was selected. We assessed the following: whether nurses performed the screening test, the Short Nutritional Assessment Questionnaire (SNAQ); the score obtained; consultations with dieticians (ICD); prescribed nutritional support; and coding of malnutrition in the discharge report. Dieticians repeated the SNAQ for one in every 3 patients. Results: during the study period 726 patients were admitted, 377 were selected, and 315 were included. The nursing staff administered the SNAQ to 93.6% of patients and malnutrition was present in 19%. Dieticians detected malnutrition in 37.8%. In 41.9% of patients with severe malnutrition an ICD was performed, whereas in 40% of them no nutritional intervention was implemented. The diagnosis of malnutrition was recorded in the discharge report of 42.1% of our cases. Conclusion: Compliance with screening test administration was good, but there is disagreement with the assessment made by dieticians. For most malnourished patients nutritional support fals to be prescribed, no ICDs are performed, and a malnutrition diagnosis is not included in the discharge report.

Clinical, functional, mental and social profile of the Nicoya Peninsula centenarians, Costa Rica, 2017

BACKGROUND

In Latin America, knowledge about the demography and health status of adults aged 100 years and over is scarce. Insufficient studies of the elderly population in Costa Rica exist despite having a "Blue Zone" (geographical area with a high concentration of centenarians) in the Peninsula of Nicoya, with a high percentage of centenarians in the districts of Santa Cruz, Nicoya, Hojancha, Nandayure and Carrillo.

AIMS

To describe the clinical, functional, mental and social profile of centenarians residing in the Blue Zone of the Peninsula of Nicoya, Costa Rica.

METHODS

This is a cross-sectional study using a population base of 43 community-dwelling centenarians. A comprehensive geriatric assessment was performed, including sociodemographic information, health status, electrocardiogram and laboratory tests.

RESULTS

The mean age of centenarians was 101.93 years, of whom 18 (42%) were men and 25 (58%) women. Two (4.6%) resided in nursing homes. Women had worse results than men in the evaluation of dependence on basic and instrumental activities of daily living, and the short physical performance battery performance test. A high prevalence of low Vitamin D levels (87.3%), atrial fibrillation (9.3%) and visual impairment (46.5%) was found.

CONCLUSIONS

This is the first study describing the medical, functional, mental and social profile of centenarians in the Peninsula of Nicoya (Blue Zone) in Costa Rica. This population has a high prevalence of malnutrition and hypertension with dependence on the basic activities of daily living, and a low prevalence for diabetes, depression, ischemic heart disease, chronic obstructive pulmonary disease, and polypharmacy.

Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions

Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.

Locally Advanced Rectal Cancer: Treatment Approach in Elderly Patients

Independently of age, evidence-based guidelines recommend a multidisciplinary treatment approach in patients with locally advanced rectal cancer (LARC). But actually, elderly patients are grossly underrepresented in clinical trials, accounting < 10% of enrolled cases. Therefore, LARC management in elderly patients remains a crucial issue in daily practice, especially due to their frailty. Multiple clinical factors, including general health status, cognitive status, co-morbidity, disability, and life expectancy should be considered to understand the complexities of geriatric assessment and then define therapy. We use a patient-centered approach in order to tailor the optimal treatment strategy. We treat fit elderly patients as younger patients, including neoadjuvant chemoradiotherapy (CRT), surgery, and adjuvant chemotherapy. Whereas, in vulnerable and frail patients, we propose standard CRT (vulnerable patients) or radiotherapy alone (frail patients).

HoSAGE: Sarcopenia in Older Patients before and after Treatment with Androgen Deprivation Therapy and Radiotherapy for Prostate Cancer

BACKGROUND

Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many factors may contribute to sarcopenia as cancer and/or androgen deprivation therapy (ADT).

OBJECTIVES

The aims of this study are to describe the prevalence of sarcopenia in older prostate cancer patients before initiation of treatment with ADT and radiotherapy, and to evaluate the impact of ADT on the occurrence or aggravation of sarcopenia in this population.

DESIGN

longitudinal study.

PARTICIPANTS AND SETTING

Sarcopenia was prospectively evaluated in 31 consecutive patients aged 70 to 88 years, referred in one hospital unit of south eastern France, for a comprehensive geriatric assessment (CGA) before cancer treatment initiation.

MEASUREMENTS AND RESULTS

CGA, measures of muscle strength and physical performances were performed at baseline (T0) and at the end of cancer treatment (T1). Appendicular skeletal muscle mass was measured by Dual-energy X-ray absorptiometry (DXA) at the end of treatment. At T0, 8 patients (among 31) had a probable sarcopenia according to European consensus, and 18 had altered physical performance. At T1, 15 patients (among 19) had abnormal one leg balance test. Finally, only one patient had a sarcopenia confirmed by DXA.

CONCLUSION

This preliminary study showed a high prevalence of muscle disorders before initiation of ADT in a population of elderly cancer prostate patients with intermediate frailty status, and an increased risk of falls at the end of ADT. This highlighted the importance of screening for sarcopenia before treatment initiation, to prevent the occurrence or aggravation of sarcopenia by possible adjustment of treatment, and implementation of appropriate exercise and nutrition interventions.

Nutrition as a Health Determinant in Elderly Patients

BACKGROUND

An adequate caloric intake is a major determinant for the health status especially when degenerative conditions become a predominant risk for difficult-to-treat diseases as in aging.

METHODS

A structured search of literature on the major databases was performed using terms as nutrition, elderly and malnutrition.

RESULTS

According to most referenced articles, it appears to be unquestionable that both organic and social risk factors [economic hardship, loneliness, institutionalization] are important as determining causes of protein-caloric malnutrition. Some anthropometric, clinical and laboratory parameters can help to make diagnosis and quantify malnutrition. However, most of them are not cheap or are not simple to perform especially in the setting of General Practice. The application of a simple questionnaire [Mini Nutritional Assessment, MNA] allows to obtain in a fast, easy and non-invasive way a valid assessment of the nutritional status in geriatric patients. The maintenance of the nutritional status is the best measure to counteract the risk of proteincaloric malnutrition and its complications which often sneakily affects elderly population and in particular frail patients.

CONCLUSION

This review, based on updated concepts, examines all the above mentioned points together with some aspects associated with malnutrition as an indicator of disease severity and health costs in the elderly population. Finally, the impact of nutritional intervention and nutrients supplementation on general indices of malnutrition are discussed as a promising strategy.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73–6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25–6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86–9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29–11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73-6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25-6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86-9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29-11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia-A Randomized Controlled Trial

OBJECTIVES

To test the long-term effects of whey-enriched protein supplementation on muscle and physical performance.

DESIGN

A 12-month randomized controlled double blind trial with a 43-month of post-trial follow-up.

SETTING

Porvoo, Finland.

PARTICIPANTS

A total of 218 older (>74 years of age) community-dwelling people with sarcopenia.

INTERVENTION

(1) Control with no supplementation; (2) isocaloric placebo; and (3) 20 g × 2 whey-enriched protein supplementation. All participants were given instructions on home-based exercise, dietary protein, and vitamin D supplementation of 20 μg/d.

MEASUREMENTS

Physical performance was assessed by short physical performance battery and continuous summary physical performance scores. Hand grip strength and calf intracellular resistance based skeletal muscle index were measured by bioimpedance spectroscopy. The measurements were performed at 0, 6, and 12 months. The post-trial follow-up was performed by a postal questionnaire and national census record data.

RESULTS

The participants were older (75-96 years of age) and mostly women (68%). The test supplements had no significant effects on physical performance; the 12-month changes for short physical performance battery were -0.55, -.05, and 0.03 points in control, isocaloric, and protein groups (P = .17), respectively. The changes in continuous summary physical performance scores were similar between the intervention groups (P = .76). The hand grip strength decreased significantly in all intervention groups, and the 12-month changes in calf intracellular resistance-based skeletal muscle index were minor and there were no differences between the intervention groups. One-half of the patients (56%) in both supplement groups reported mild gastrointestinal adverse effects. Differences were found neither in the all-cause mortality nor physical functioning in the post-trial follow-up.

CONCLUSIONS

The whey-enriched protein supplementation in combination with low intensity home-based physical exercise did not attenuate the deterioration of muscle and physical performance in community-dwelling older people with sarcopenia.

Relationship Between Performance Improvement in Activities of Daily Living and Energy Intake in Older Patients With Hip Fracture Undergoing Rehabilitation

Objective

To analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown.

Methods

This retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m². Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score.

Results

The final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain.

Conclusion

Among elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

BACKGROUND

One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.

OBJECTIVE

The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status.

METHODS

Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use.

RESULTS

Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant.

CONCLUSIONS

The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.

Severity of both neuropsychiatric symptoms and dementia is associated with quality of life in nursing home residents

PURPOSE

The primary focus in long-term care is to maintain quality of life. The aim of this study was to investigate the association of severity of neuropsychiatric symptoms (NPS) and health-related quality of life (HRQoL) and their interaction with dementia severity among institutionalized older people with dementia.

METHODS

352 long-term care residents aged 65 years or over with dementia participated in this cross-sectional study. NPS were measured with Neuropsychiatric Inventory (NPI). HRQoL was measured with 15D. Dementia severity was measured with Clinical Dementia Rating (CDR).

RESULTS

The severity of NPS was significantly associated with better HRQoL in 15D. Residents with severe dementia (CDR 3) had worse HRQoL than residents with mild-moderate dementia (CDR < 3). There was a significant interaction between NPI and CDR (p = 0.037 for NPI, p < 0.001 for CDR, p < 0.001 for interaction). HRQoL correlated positively with all NPS subgroups in residents with severe dementia, but in residents with mild-moderate dementia, no significant correlation existed. In severe dementia, higher NPI correlated positively with such dimensions of 15D as mobility, vision, eating, speech, excretion, usual activities, mental functions, and vitality, whereas in residents with mild-moderate dementia only with mobility. In mild-moderate dementia, NPI correlated negatively with depression, distress and vitality.

CONCLUSION

Dementia severity and NPS burden are important determining factors of HRQoL in long-term care. NPS have a distinct impact on HRQoL at different stages of dementia. In severe dementia, higher NPS and better HRQoL indicate better functioning and higher vitality.

Nutritional Status is Associated With Severe Dementia and Mortality: The Cache County Dementia Progression Study

PURPOSE

Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample.

PATIENTS

A maximum of 300 PWD were assessed annually for up to 8.6 years.

METHODS

Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver.

RESULTS

Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P<0.001). Those "at risk for malnutrition" had twice the hazard of severe dementia (HR, 1.98; P=0.064) and 1.5 times the hazard of death (HR, 1.46; P=0.015). mMNA subcomponents of food group intake, weight loss, body mass index, mobility, health status, protein consumption, and mid-arm circumference predicted one or both outcomes.

CONCLUSIONS

Nutritional status is an important predictor of clinical outcomes in dementia and may provide an avenue for intervention.

Posterior occluding pairs of teeth or dentures and 1-year mortality in nursing home residents in Japan

BACKGROUND

Associations between tooth loss and mortality have been reported in older individuals. However, limited information is available regarding the association between occlusion and mortality in nursing home residents.

OBJECTIVE

We investigated the association between posterior occluding pairs (POPs) of teeth or dentures and 1-year mortality in nursing home residents.

METHODS

The subjects of this study were residents from four nursing homes in Aichi prefecture, Japan, who were capable of eating and were enrolled in baseline examinations. We examined the number of present teeth and POPs (0-8 pairs), defined as pairs of occluding natural, restored or fixed prosthetic post-canine teeth. Then, we defined prosthetic POPs (0-8 pairs) as pairs of occluding natural, restored or fixed prosthetic post-canine teeth and removable dentures. Nutritional status, activities of daily living, cognitive function and comorbid conditions were assessed. One year later, we followed up the subjects. Ultimately, we analysed 173 elderly people (mean age ± SD: 87.1 ± 8.6 years; the survival group: N = 145, the deceased group: N = 28).

RESULTS

In univariate analyses, mortality was significantly associated with age, peripheral vascular disease, nutritional status, diet texture and POPs. In multivariate logistic regression analysis, subjects who had 0 prosthetic POPs had significantly higher odds of a high mortality, compared with 8 prosthetic POPs.

CONCLUSION

Lack of properly occluding posterior teeth, whether remaining teeth or dentures, is associated with 1-year mortality. (228 words/250).

Prevalence and Characteristics Associated with Modified Texture Food Use in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project

Purpose: To describe the prevalence and characteristics of modified-texture food (MTF) consumers when applying standard diet terminology.

Methods: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study including 32 long-term care (LTC) homes located in 4 Canadian provinces. Resident characteristics were collected from health records using a defined protocol and extraction form. Since homes used 67 different terms to describe MTFs, diets were recategorized using the International Dysphagia Diet Standardization Initiative Framework as a basis for classification.

Results: MTFs were prescribed to 47% (n = 298) of participants (n = 639) and prevalence significantly differed among provinces (P < 0.0001). Various resident characteristics were significantly associated with use of MTFs: dysphagia and malnutrition risk, dementia diagnosis, prescription of oral nutritional supplements; lower body weight and calf circumference; greater need for physical assistance with eating; poor oral health status; and dependence in all activities of daily living.

Conclusions: This is the first study that used a diverse sample of LTC residents to determine prevalence of MTF use and described consumers. The prevalence of prescribed MTFs was high and diverse across provinces in Canada. Residents prescribed MTFs were more vulnerable than residents on regular texture diets. These findings add value to our understanding of MTF consumers.

Assessment of nutritional status of older patients attending a tertiary hospital in Middle Eastern country

BACKGROUND AND PURPOSE

In hospitals, poor nutritional status could be associated with a higher incidence of nosocomial infections, postoperative complications and mortality. Subsequently the costs of providing health care and social services will increase. Malnutrition has often been described as the skeleton in the hospital closet, as it is often ignored, undiagnosed and untreated. Our study aimed to describe the nutritional status of hospitalized patients aged 60 years or more and to evaluate the associated risk factors.

MATERIALS AND METHODS

This was an observational cross-sectional study conducted at a major tertiary teaching hospital in Beirut city. During a 7 months period, patients aged 60 and over and admitted in the medical and surgical units of the hospital were invited to participate in the study. Data were collected by means of a questionnaire including sociodemographic and medical characteristics, the Arabic version of the Mini Nutritional Assessment (MNA), the Activity of Daily Living (ADL) scale, and the American Society of Anesthesiologists (ASA) score.

RESULTS

171 participants aged 73.15 ± 8.06 years were included in the study. 52% of them were at risk of malnutrition and 13.5% were malnourished. Prevalence of malnutrition was higher in medical compared to surgical departments (16.2% vs. 10.5%, p = 0.003). Moreover, malnutrition was significantly associated with low level of education, high age, prolonged hospital stay, high number of medical comorbidities, polymedication, high ASA score and low ADL score (p < 0.05).

CONCLUSIONS

Malnutrition or risk of malnutrition are found in 2 out of 3 hospitalized patients aged 60 years or more, and is associated with several specific risk factors. Screening and management of malnutrition should be considered a priority in order to improve the overall medical status of older people, reduce hospital stay and improve outcome and quality of life.

Malnutrition in Older Adults with Cancer

PURPOSE OF REVIEW

Malnutrition is a common and under-recognized geriatric condition in older adults with cancer. This review describes the public health burden, malnutrition prevention, and the relationship among cancer cachexia, malnutrition, and sarcopenia. Finally, clinical practice recommendations on malnutrition and prevention are presented.

RECENT FINDINGS

Advanced age and cancer stage, frailty, dementia, major depression, functional impairment, and physical performance are important risk factors for malnutrition in older adults with cancer. The Mini Nutrition Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Patient Generated Subjective Global Assessment (PG-SGA) are the most commonly used assessment tools in older adults with cancer. In addition, malnutrition is independently associated with poor overall survival and quality of life, longer hospital stays, greater hospital cost, and hospital readmission. Comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.

The validity of three malnutrition screening markers among older patients with cancer

Background

Malnutrition is common in older adults with cancer and is associated with adverse clinical outcomes. We assessed and compared the validity of three tools commonly used to screen for malnutrition: The Mini Nutritional Assessment (MNA), weight loss and body mass index (BMI).

Methods

In this retrospective study, we reviewed patients over age 65 with a diagnosis of cancer who were treated at the MD Anderson Cancer Center between 1 January 2013 and 31 March 2017. All patients in this study were evaluated by a trained geriatrician as part of a comprehensive geriatric assessment (CGA). Malnutrition was diagnosed by both CGA and clinical examination. The sensitivity, specificity and Cohen’s κ of each tool was also compared with the clinical diagnosis.

Results

A total of 454 older patients with cancer who had malnutrition information available were included in the analyses. The median age was 78%, and 42% (n=190) were clinically diagnosed with malnutrition at baseline. When the MNA was performed, 105 out of 352 patients (30%) were malnourished, and 122 (35%) at risk of malnutrition. Weight loss >3 kg was seen in 183 out of 359 (51%) patients, and BMI <20 kg/m2 was found in 30 of the 454 (7%) patients. MNA had the highest validity (area under curve (AUC)=0.83) and reliability (κ=0.67), weight loss had moderate validity (AUC=0.73) and reliability (κ=0.46), while BMI had the lowest validity (AUC=0.55) and reliability (κ=0.55).

Conclusions

For clinical practice, MNA should be incorporated for standard assessment/screening for these older patients with cancer.

The Effects of Preventive Home Visits on Older People’s Use of Health Care and Social Services and Related Costs

Background

We use data from a randomized controlled trial on preventive home visits exploring effectiveness on health-related quality of life. In this article, we examine the intervention’s cost-effectiveness and effects on quality-adjusted life years in older home-dwelling adults.

Methods

There were 422 independently home-dwelling participants in the randomized, controlled trial, all aged more than 75 years, with equal numbers in the control and intervention groups. The intervention took place in a municipality in Finland and consisted of multiprofessional preventive home visits. We gathered the data on health care and social services use from central registers and medical records during 1 year before the intervention and 2 years after the intervention. We analyzed the total health care and social services use and costs per person-years and the difference in change in health-related quality of life as measured using the 15D measure. We calculated quality-adjusted life years and incremental cost-effectiveness ratios.

Results

There was no significant difference in baseline use of services or in the total use and costs of health care and social services during the 2-year follow-up between the two groups. In the intervention group, health-related quality of life declined significantly more slowly compared with the control group (–0.015), but there was no significant difference in quality-adjusted life years gained between the groups. The cost-effectiveness plane showed 60% of incremental cost-effectiveness ratios lying in the dominant quadrant, representing additional effects with lower costs.

Conclusions

This multiprofessional preventive home visit intervention appears to have positive effects on health-related quality of life without accruing additional costs.

The clinical trial registration number

ACTRN12616001411437.

Masked Hypertension is Associated With Cognitive Decline in Geriatric Age-Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study

Background

Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions.

Methods

One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology.

Results

Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant.

Conclusion

This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.

Validity of simplified nutritional appetite questionnaire for Turkish community-dwelling elderly and determining cut-off according to mini nutritional assessment

BACKGROUND/OBJECTIVES

The aim of this study was to determine a cut-off value for the SNAQ according to both the MNA long and MNA short forms and to assess whether the SNAQ can predict malnutrition or risk of malnutrition in the elderly.

SUBJECTS/METHODS

Nutritional status was assessed both by the Mini Nutritional Assessment (MNA) long and short forms. All demographic characteristics, mental status, depressive mood, functional status, and frailty were determined. Receiver operating characteristic (ROC) curves were used to calculate the cut-off of the SNAQ according to both the MNA long and short forms for malnutrition or risk of malnutrition. Reliability and validation of the SNAQ was analysed.

RESULTS

We included 905 community-dwelling elderly, but those with middle-stage dementia (MMSE score <18, n = 30) were excluded. The mean age ± standard deviation (SD) was 71.4 ± 5.5 years (49.3% female and 50.7% male). The prevalence of well-nourished, risk of malnutrition or malnutrition were 55.2%, 44.8%, respectively according to the MNA-long form. The prevalence of elderly at risk of future weight loss (SNAQ score of ≤14) was 31.0% (n = 268; 66.0% female, 34.0% male). The area under the curve (AUC) for SNAQ was 0.725 (95% CI 0.690-0.760). The cut-off value of the SNAQ, according to both the MNA long and short forms, was 14 (sensitivity; 50%, 50% and specificity; 84%, 82%, respectively). The Cronbach's alpha reliability coefficient of SNAQ for internal consistency was 0.639.

CONCLUSION

The SNAQ was reliable and valid as an appetite screening tool in community-dwelling Turkish elderly.

Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults

OBJECTIVE

We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults.

DESIGN

A randomised controlled trial.

SUBJECTS

Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group.

SETTING

Hyvinkää town municipality, Finland.

MAIN OUTCOME MEASURES

We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers.

RESULTS

At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up.

CONCLUSION

Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end. Key points We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN12616001411437.

Geriatric assessment and 1-year mortality in older patients with cancer in the head and neck region: A cohort study

Background

The aim is to describe the association of functional capacity and cognitive functioning with 1‐year mortality in older patients with cancer in the head and neck region.

Methods

We performed a cohort study in which all patients aged 70 years and older received a geriatric screening before treatment. Main outcome was 1‐year mortality.

Results

A total of 102 patients were included. Median age was 78.7 years (interquartile range [IQR], 72.3‐84.5), 25% were cognitive impaired, 40% were malnourished, and 28.4% used a walking device. Overall, 1‐year mortality was 42.3%. Male sex (hazard ratio [HR], 4.30; 95% confidence interval [CI], 1.35‐13.67), malnutrition (HR, 2.55; 95% CI, 1.19‐5.16), and using a walking device (HR, 2.80; 95% CI 1.13‐6.93) were associated with higher mortality risk, independent of stage and comorbidities.

Conclusion

In older patients with head and neck cancer, the mortality rates are high. Nutritional status and mobility are determinants of 1‐year mortality, independent of tumor stage, age, and comorbidity.

The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients

BACKGROUND

One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD).

METHOD

The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded.

FINDINGS

Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001).

CONCLUSION

The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.

Nutritional and hematological factors associated with the progression of Alzheimer's disease: a cohort study

SUMMARY OBJECTIVE: We studied the users of the Specialized Drug Distribution Program of the public health network. METHODS: A prospective cohort examined the elderly at two intervals of three years and included 30 patients in phase I and 16 in phase II. The methodology was composed of home visits, anthropometric, nutritional and hematological evaluation. For the progression of AD, the Clinical Dementia Rating (CDR) scale was used. RESULTS: According to the CDR, the disease evolved, since in 2014 most of the patients were in CDR 3. In the analysis of the micronutrients, only the B vitamins (B1, B2, B3, B5, B6) presented a significant reduction in 2014. The consumption of carbohydrates and lipids increased in the 2014 evaluation, and protein consumption decreased. As for the average weight of the elderly, there was an increase in 2014, 65.9 (± 15.6) Kg, with a BMI of 26.75 (± 4, 5), in 2011 the average weight was 62.44 kg (± 14, 36), BMI 24.64 (± 4.97). CONCLUSION: The hypothesis that patients are likely to be overweight or obese before the development of AD and that this may be associated with an increased risk of dementia is suggested.

Dietary Factors Associated with Frailty in Old Adults: A Review of Nutritional Interventions to Prevent Frailty Development

Frailty syndrome is a medical condition that is characterised by a functional decline, usually from 65 years old on, and creates the need for assistance to perform daily living activities. As the population ages, the need for specialised geriatric care will increase immensely, and consequently, the need for specialised services for the care of these people will increase accordingly. From a nutritional point of view, to control or balance the nutritional status of residents will be essential in order to prevent sarcopenia and, consequently, frailty development. In this line, previous studies have highlighted the association among low energy intake, inadequate intake of protein and vitamin D, and an increased risk of frailty development. However, there is a lack of intervention studies on frail patients, especially in the realm of quality clinical trials. The few studies performed to date seem to indicate that there is a protective role of protein supplementation against frailty syndrome. In this regard, it is tempting to suggest daily 30 g protein supplements to prevent frailty. However, it is well established that excess protein can also be harmful; therefore, specific individual characteristics should be considered before prescribing these supplements. On the other hand, the relevance of other nutritional interventions, such as vitamin D, omega-3, and medium-chain triglycerides, is much more scarce in the literature. Therefore, we encourage the development of new clinical trials to carry out effective therapies to prevent frailty development.

Nutritional Status and Cognitive Impairment among the Very Old in a Community Sample from Southern Brazil

OBJECTIVE

To determine which factors, especially those related to nutrition, are associated with cognitive function in the oldest old, here considered those at least 80 years of age.

DESIGN

A cross-sectional, population-based study.

SETTING

Veranópolis, Rio Grande do Sul, Brazil, and surrounding rural areas.

PARTICIPANTS

Individuals aged 80 years and older.

MEASUREMENTS

The Mini Nutritional Assessment, anthropometric measurements, and serum levels of albumin and vitamin B12 were associated with cognitive function according to the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT). Socio-demographic data were obtained through a structured questionnaire. Multivariate analysis was used to determine the associations.

RESULTS

According to the MMSE and the CDT, the prevalence of cognitive impairment was 47.7% [95%CI 39.7-55.7] and 58.2% [95%CI 50.3-66.1], respectively. In the adjusted analysis, the only positive linear association with MMSE scores indicating cognitive impairment was age. However, CDT scores indicating cognitive impairment were five times higher among those with low serum vitamin B12 concentrations. For the other variables, there was a positive association between age, being widowed, a low educational level and central nervous system drugs. Being single, living with children and living alone were protective factors for cognitive impairment.

CONCLUSIONS

Although cognitive impairment was positively associated with old age, being widowed and low educational level in this population, the only nutritional variable positively associated with cognitive impairment was a low vitamin B12 concentration.

Association between Orthostatic Hypotension and Frailty in Hospitalized Older Patients: a Geriatric Syndrome More Than a Cardiovascular Condition

OBJECTIVES

To explore the association between orthostatic hypotension (OH) and frailty for hospitalized older patients and their vulnerable subgroups.

DESIGN

A prospective, observational cross-sectional study.

PARTICIPANTS

693 older patients admitted to a geriatric evaluation and management unit.

MEASUREMENTS

Barthel Index, Lawton's instrumental activities of daily living, clinical frailty scale, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, and polypharmacy.

RESULTS

Overall, the prevalence of OH and frailty was 26% and 36%, respectively. Subjects with OH were older, thinner, more commonly to have weakness, slowness, poorer physical function and higher levels of frailty. The prevalence of OH was substantially increased as higher levels of CFS (p for trend <0.001). Multivariate logistic regression showed significant association between OH and frailty (OR: 1.8, 95% CI: 1.2-2.7), but the association attenuated after adjustment for physical function. (OR: 1.4, 95% CI: 0.7-2.6). Nevertheless, associations between OH and frailty remained significant among vulnerable subgroups like women, subjects having weakness, slowness, poor cognitive function, polypharmacy or any IADL limitation.

CONCLUSIONS

OH in hospitalized older patients was associated with frailty and multiple complex care needs, especially in the vulnerable subgroups. Further study is needed to clarify the roles of OH in clinical practice.