Senile anorexia in acute-ward and rehabilitations settings

Constipation: a neglected condition in older emergency department patients

Constipation and fecal impaction are common issues with the potential for significant morbidity in older people presenting to the Emergency Department (ED). While many of these patients present with classical symptoms of constipation or fecal impaction, atypical presentations are also frequent. These atypical presentations may include paradoxical diarrhea, fecal incontinence, urinary retention or overflow incontinence, hyperactive or hypoactive delirium, anorexia/dysphagia, and syncope. In addition, various clinical conditions (such as dementia, Parkinson's disease, dehydration, and hypothyroidism) and medications (such as opiate analgesics, anticholinergics, diuretics, calcium channel blockers, anti-parkinsonian drugs, and oral iron supplements) are associated with constipation and should be considered during the diagnostic process in the ED. This narrative review specifically focuses on the prevalence, presentation, diagnoses, and management of constipation in older ED patients.

Consequences of Anorexia of Aging in Hospital Settings: An Updated Review

The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.

Severity of Inflammation Is Associated with Food Intake in Hospitalized Geriatric Patients-A Merged Data Analysis

The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged ≥65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 ± 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0-4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of ≥3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.

Mood and physical activity are associated with appetite in hospitalised older men and women

BACKGROUND

The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies.

DESIGN

Cross sectional observational study.

SETTING

Eleven wards in one large hospital in England.

SUBJECTS

Older inpatients aged ≥70 years, admitted non-electively.

METHODS

Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances.

RESULTS

200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained.

CONCLUSION

In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.

Nutritional status and quality-of-life of older adults in aged care: A systematic review and meta-analysis

The effect of malnutrition beyond morbidity and mortality has become a critical area of investigation in older people with an increased focus on quality-of-life (QoL), but as yet the relationship between malnutrition and QoL remains to be reviewed in older people from aged care settings. The current study conducted a systematic review and meta-analyses of studies published between the years 1995 and 2020 examining the relationship between nutritional status and QoL or the effects of a nutrition-based intervention on QoL in older people in residential aged care. Based on searches of the databases MEDLINE, PsycINFO, Emcare, and Embase, 21 studies were identified. Meta-analyses of the cross-sectional and quasi-experimental studies revealed a significant positive relationship between nutritional status and QoL and that nutritional intervention significantly improved QoL. By contrast, meta-analysis of randomised controlled trials revealed a non-significant but improved trend post-intervention in QoL. Although the effect sizes were small, the present findings indicate that nutrition-based interventions improve QoL in older people in residential aged care and align with previous reviews based on findings from other aged settings. Future research is needed to determine causality and to better identify and control for confounding factors which may influence both nutritional status and QoL.

Sarcopenia

Objective: To assess the prevalence of sarcopenia and associated factors among older women from the local community and older women living in Long-Term Care (LTC) institutions.Methods: A cross-sectional study conducted with 423 older women aged 60 or more, from the local community and older women aged 60 or more, living in LTC institutions. Sarcopenia was defined, according to the consensus of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), including three criteria: low muscle strength (LMS) (<16kg); low muscle mass (LMM) (≤6.75kg/m2) assessed by a skeletal muscle mass index, and low physical performance (LPP) (≤0,8m/s) assessed by gait speed test. Older women who only showed LMS were considered to have pre-sarcopenia, those with LMS associated with LMM were diagnosed with sarcopenia and those who met all three criteria, were diagnosed with severe sarcopenia.Results: Among the community-dwelling older women, the prevalence of sarcopenia was 2.0% (from 60 to 69), 8.6% (from 70 to 79) and 12.9% (80 or more) and among the ones living in LTC Institutions, 3.3% (from 60 to 69), 14.8% (from 70 to 79) and 34.2% (80 or more). After multivariate logistic regression, age and low body mass index (BMI) were associated with sarcopenia in both groups.Conclusion: The prevalence of sarcopenia is higher among LTC older women. However, this is not an independent factor. In addition, regardless of residence, low BMI and advanced age are predictive for sarcopenia.

Functional Constipation and Anorexia in Community-Dwelling Older Adults: Korean Frailty and Aging Cohort Study (KFACS)

Anorexia is a relevant geriatric syndrome because it accounts for most malnutrition in older adults. Constipation has been suggested as a risk factor for anorexia. This study aimed to examine the association between anorexia and functional constipation in community-dwelling older adults. Data on 899 subjects aged 72–86 years were obtained from a follow-up survey of the Korean Frailty and Aging Cohort Study in 2018. Anorexia was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ), while functional constipation was diagnosed based on Rome IV criteria. Anorexia and functional constipation were present in 30.9% and 19.6% of the participants, respectively. Age, female sex, chewing problems, malnutrition, polypharmacy, low Mini-Mental Status Examination (MMSE) score, depressed mood, low serum albumin, and functional constipation were associated with anorexia in the univariate analysis. In the multivariate logistic regression, functional constipation was associated with anorexia (OR 1.478, 95% CI 1.038–2.104) after adjusting for age, female sex, and MMSE score. However, after further adjusting for depressed mood (OR 2.568) and chewing problems (OR 2.196), the relationship was no longer significant. This study showed that functional constipation is associated with anorexia in community-dwelling older adults, but this association is confounded by depressed mood and chewing problems.

Poor Appetite Is Associated with Six Month Mortality in Hospitalised Older Men and Women

OBJECTIVES

Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women.

DESIGN

Longitudinal observational study with six month follow up.

SETTING

Acute hospital wards in a single large hospital in England.

PARTICIPANTS

Older inpatients aged over 70 years.

MEASUREMENTS

Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) during hospital stay. Deaths during six month follow-up period were recorded. Association between SNAQ score during hospital admission and death 6 months post-discharge was assessed using binary logistic regression in unadjusted and adjusted analysis.

RESULTS

296 participants (43% female, mean age 83 years (SD 6.9)) were included in this study. Prevalence of poor appetite (SNAQ score <14) was 41%. In unadjusted analysis a SNAQ score of <14 was associated with a 2.47 increase in odds of mortality at six months (OR 2.47 (95% CI 1.27,4.82)). This association remained after adjusting for number of comorbidities (Charlson index), length of stay and gender (OR 2.62 (95% CI 1.30, 5.27)). In unadjusted continuous analysis, every one point decrease in SNAQ score led to a 1.20 fold increase in odds of mortality at six months (OR 1.20 (95% CI 1.06-1.36)). This association remained in adjusted analysis (OR 1.22 (95% CI 1.07-1.39)).

CONCLUSION

Poor appetite is common in hospitalised older people. We have confirmed the association, previously reported in older women, between poor appetite during hospital stay and greater mortality at six months post-discharge but in a larger study including older men and women. Further research is needed to understand the mechanisms of poor appetite, which lead to increased mortality.

The cause of anorexia and proportion of its recovery in older adults without underlying disease: Results of a retrospective study

Aim

It is difficult to determine whether or not end-of-life care is necessary for frail older adults complaining of anorexia without underlying disease, such as cancer or organ failure. The main reason for this is the lack of the specification of the anorexia cause and no understanding of the cause-providing factor and the prognostic factor. This study aimed to clarify the cause of anorexia, and the determinant of the cause and recovery from anorexia.

Methods

Retrospective chart reviews were conducted on patients with anorexia without an underlying disease who were aged ≥65 years and visited the emergency department of a single tertiary care center between 2016 and 2017. Patient characteristics at hospital visit, the cause of anorexia, and diagnostic modalities were summarized. The diagnosis-providing rate, recovery rate, and the association between them were analyzed.

Results

Eighty-three patients (mean age 82.3 years; 50.6% male) were investigated. In 67 patients (81%), the causes of anorexia were identified, including 18 patients (22%) with infection, 13 (16%) with benign gastrointestinal diseases, and 7 (8%) with cardiovascular diseases. In 16 patients (19%), the causes of anorexia were not identified despite examinations. The modality that most contributed to diagnosis was plain computed tomography followed by blood tests. The value regarding information in history-taking and physical examinations was limited. Sixty-five patients (78%) recovered. Only 73% of patients with a definite cause recovered; all patients with an unknown cause recovered.

Conclusions

Older adults with anorexia are not always at the end of life, and efforts to identify the cause are crucial. Moreover, it is vital to realize the limitations associated with the treatment of infections and cardiovascular diseases.

Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults

Objectives

We aimed to evaluate the association of nutritional status and health-related quality of life (HRQOL) among elderly Iranian residents.

Methods

We used the 36-item Short Form Health Survey (SF-36) to assess HRQOL among participants with normal nutrition status, at risk of malnutrition, and malnourished.

Results

Mean group scores for the Physical Component Summary (PCS) of the SF-36 were 44, 36.5, and 29.0 for normal, at-risk, and malnourished groups, respectively; for the Mental Component Summary (MCS), these were 47.1, 40.7, and 34.8, respectively. The PCS and MCS displayed significant positive correlation with malnutrition in three models: crude (I); age- and sex-adjusted (II); and adjusted for age, sex, education, occupation, marital status, and residence. Standardized beta coefficients of PCS in Models I–III were 1.35, 1.27, and 1.14, respectively; for MCS, these were 1.11 in all three models; all results were statistically significant. Estimated results of logistic regression were −6.023 for malnourished versus well-nourished and −2.652 for malnourished versus at risk of malnutrition.

Conclusion

Our analyses revealed the crucial impact of nutritional status on both mental and physical components of HRQOL.

Factors associated with poor socioeconomic status among Malaysian older adults: an analysis according to urban and rural settings

Background

Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings. The aim of this study was to identify dietary, nutritional, physical and cognitive factors associated with poor socioeconomic status (SES) among older adults according to urban and rural settings in Malaysia.

Methods

An analysis was conducted among 2237 older adults who participated in a longitudinal study on aging (LRGS TUA). This study involved four states in Malaysia, with 49.4% from urban areas. Respondents were divided into three categories of SES based on percentile, stratified according to urban and rural settings. SES was measured using household income.

Results

The prevalence of low SES was higher among older adults in the rural area (50.6%) as compared to the urban area (49.4%). Factors associated with low SES among older adults in an urban setting were low dietary fibre intake (Adj OR:0.91),longer time for the Timed up and Go Test (Adj OR:1.09), greater disability (Adj OR:1.02), less frequent practice of caloric restriction (Adj OR:1.65), lower cognitive processing speed score (Adj OR:0.94) and lower protein intake (Adj OR:0.94). Whilst, among respondents from rural area, the factors associated with low SES were lack of dietary fibre intake (Adj OR:0.79), lower calf circumference (Adj OR: 0.91), lesser fresh fruits intake (Adj OR:0.91), greater disability (Adj OR:1.02) and having lower score in instrumental activities of daily living (Adj OR: 0.92).

Conclusion

Lower SES ismore prevalent in rural areas. Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings. Factors associated with low SES identifiedin both the urban and rural areas in our study may be useful inplanning strategies to combat low SES and its related problems among older adults.

Adherence to Mediterranean Diet, Malnutrition, Length of Stay and Mortality in Elderly Patients Hospitalized in Internal Medicine Wards

: This investigation aimed to explore the adherence to a Mediterranean Diet and its relationship with length of stay and in-hospital mortality, circulating interleukins, body composition, and frailty, in elderly patients hospitalized in internal medicine wards. Thus, a cross-sectional study in 194 acute hospitalized, community-dwelling elderly patients was performed. Adherence to a Mediterranean Diet was evaluated by the Italian Mediterranean Index (IMI). Length of stay, but not in-hospital mortality rate, was higher in patients with a low IMI score, as compared to subjects with high IMI score. Markers of systemic inflammation, as well as circulating interleukin-6 and tumor necrosis factor alpha, were higher in patients with a low IMI score, with respect to patients with high IMI score. Furthermore, patients with low IMI score had increased fat mass and reduced lean mass, together with a higher prevalence of frailty, as compared to those presenting with high IMI score. In a multivariate logistic regression model, an IMI score < 3 resulted as an independent predictor of longer length of stay. In conclusion, low adherence to a Mediterranean Diet in elderly patients hospitalized in internal medicine wards is associated with higher length of stay and related to unfavorable changes in circulating pro-inflammatory markers and body composition.

Prevalence and associated factors of sarcopenia, dynapenia, and sarcodynapenia in community-dwelling elderly in São Paulo - SABE Study

OBJECTIVES

To estimate the prevalence of sarcopenia, dynapenia, and sarcodynapenia and associated factors in older adults in the city of São Paulo, Brazil.

METHODS

A population-based, cross-sectional study was conducted with 1,168 older adults who participated in the third wave of the Health, Well-being, and Aging study in 2010 (SABE study). Men and women with skeletal muscle mass ≤ 8.90 and ≤ 6.37 kg/m2, respectively, were considered sarcopenic. Men and women with grip strength < 30 and < 20 kg, respectively, were considered dynapenic. Those with both conditions were considered sarcodynapenic. Sociodemographic, behavioral, clinical, nutritional, and biochemical characteristics were investigated as factors associated with each of the three conditions using multinomial logistic regression.

RESULTS

Theprevalence of sarcopenia, dynapenia, and sarcodynapenia was 4.8% (95%CI 3.6 - 6.3), 30.9% (95%CI 27.5 - 34.6) and 9.0% (95%CI 7.2-11.3), respectively. An increase in age and malnutrition was associated with all the three conditions. Cognitive impairment was associated with both dynapenia and sarcodynapenia. Schooling, current smoking habit, and not having a marital life were associated with sarcopenia. Osteoarthritis, schooling, being an ex-smoker, and low hemoglobin were associated with dynapenia. Smoking habit and the risk of malnutrition were associated with sarcodynapenia.

CONCLUSION

Dynapenia is more prevalent among older adults, followed by sarcodynapenia, and sarcopenia. With the exception of age, schooling, and malnutrition, the factors associated with sarcopenia and dynapenia are different. However, there are similarities in some associations regarding the presence of sarcodynapenia.

Anorexia of Aging - An Updated Short Review

The anorexia of aging affects approximately a quarter of older people and is a major contributor to the development of under-nutrition and many other adverse health outcomes in older people. Despite the high prevalence, the anorexia of aging is frequently overlooked by clinicians and, of even more concern, it is commonly accepted as inevitable and a part of 'normal' aging. Early identification of risk coupled with efforts to mitigate these risks through appropriate interventions might stem the deleterious consequences of the anorexia of aging. This review aims to provide an update on the current knowledge base whilst making some practical suggestions that may be of use in clinical practice. Interventions such as exercise and good nutrition remain the preferred treatment while pharmacological options, whilst they continue to be trialed, are not currently recommended for routine clinical use.

Are the therapeutic strategies in anorexia of ageing effective on nutritional status? A systematic review with meta-analysis

BACKGROUND

Anorexia of ageing (AA) may be considered as a risk factor for frailty and has an important impact on quality of life, morbidity and mortality.

METHODS

A systematic review and a meta-analysis were performed to summarise the results from several trials on the effectiveness of treatments in AA, as associated with depression, sensory impairment of taste and smell, decreased appetite or early satiety, and disability. Eligible studies were required to report baseline and follow-up values, the mean change (∆-change) from baseline, and/or the mean difference among intervention groups versus control group, concerning food intake (kcal/daily) and/or nutritional outcomes, such as body weight, body mass index, albumin and Mini Nutritional Assessment.

RESULTS

The systematic review included 20 papers based on different therapeutic approaches concerning food intake and/or nutritional outcomes. The results of the meta-analysis indicate that the interventions for AA have an important impact on body weight [+1.59 kg; 95% confidence interval (CI) = 1.48-+1.71 kg; P < 0.001) and on energy intake (+56.09 kcal; 95% CI = -54.05 to +166.25 kcal; P = 0.32). Regarding secondary outcomes, it was not possible to meta-analyse the limited amount of data availab le.

CONCLUSIONS

The different variants of AA need to be defined because diverse therapeutic approaches are available. A more precise definition of the functional impairments associated with AA may allow a more correct decision about the most appropriate therapy to be prescribed. Moreover, this may allow for a more effective performance of the different therapeutic approaches once they are better targeted to the different scenarios of AA.

Relationship between mortality and Council of Nutrition Appetite Questionnaire scores in Japanese nursing home residents

OBJECTIVE

This 1-y cohort study examined whether Council of Nutrition Appetite Questionnaire (CNAQ) scores predicted mortality in 316 elderly Japanese residents of five nursing homes (60 men, 256 women; mean age: 84.9 ± 8.3 y).

METHODS

The baseline survey included participant characteristics (e.g., age, sex, height, weight, and medical history), and Barthel Index (BI), Clinical Dementia Rating (CDR), Mini Nutritional Assessment-Short Form (MNA^®-SF), CNAQ, Simplified Nutritional Appetite Questionnaire (SNAQ; simplified CNAQ), and SNAQ for the Japanese elderly (SNAQ-JE) scores.

RESULTS

Following the baseline survey, mortality data were collected for 1 y; during this time, 62 participants (19.6%) died. The deceased group's CNAQ scores (25.1 ± 4.8) were significantly lower than those of the survival group (28 ± 3.6; P < 0.001). After adjusting for age, sex, medical history, BI, CDR, and MNA^®-SF scores in Cox proportional regression, CNAQ (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.85-0.97; P = 0.004), SNAQ (HR, 0.84; 95% CI, 0.75-0.93; P = 0.001), and SNAQ-JE (HR, 0.84; 95% CI, 0.76-0.92; P < 0.001) scores were related to mortality.

CONCLUSIONS

This study showed that CNAQ scores were inversely associated with 1-y mortality. Furthermore, appetite assessment using the CNAQ predicted the death of Japanese nursing home residents. Similarly, the SNAQ and SNAQ-JE scores were inversely associated with 1-y mortality.

Does reduced mastication influence cognitive and systemic health during aging?

There is a growing body of literature which suggests that oral health and mastication can influence cognitive and systemic health during aging. However, it is currently unclear whether oral health, masticatory efficiency, cognitive health and systemic health merely deteriorate independently with age, or whether mechanisms exist linking mastication to cognitive and systemic health directly. The aim of this paper is to review the extent to which reduced mastication influences cognitive and systemic health during aging because this knowledge may underpin future interventions that improve quality of life. Current evidence suggests that a deterioration in mastication and oral health during aging can have: 1) direct effects on systemic health through mechanisms such as the migration of the oral microbiota into the systemic environment, and 2) indirect effects on systemic health through changes nutrient intake. A loss of teeth and reduction in masticatory efficiency during aging can have: 1) direct effects on cognitive performance and potentially impact cognitive health through mechanisms such as enhanced adult hippocampal neurogenesis, and 2) indirect effects on cognitive health through changes in nutrient intake. It is concluded that oral health and masticatory efficiency are modifiable factors which influence the risk poor cognitive and systemic health during aging, although it is currently premature to propose chewing-based interventions to slow the rate of cognitive decline and improve cognitive health during aging. Future research should include large-scale longitudinal studies which control for the types of confounding factors which concurrently influence the association between mastication and cognitive and systemic health.

Determinants of Health Related Quality of Life in Home Dwelling Elderly Population: Appetite and Nutritional Status

OBJECTIVE

The present study aimed to examine nutritional risk factors such as poor appetite, malnutrition or obesity affecting health related quality of life in elderly.

DESIGN AND PARTICIPANTS

This is a cross-sectional population-based study consisted of 407 elderly (142 men and 265 women) mean aged 71.7±6.54 years.

MEASUREMENTS

Questionnaire including the demographic and general characteristics, health information, nutritional habits was performed by face-to-face interviews. Daily food consumption was assessed using 24-hour dietary recall. Mini Nutrition Assessment (MNA) and Mini Nutrition Assessment-Short Form (MNA-SF) were used for assessment of nutrition status. Appetite was evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ). Health related life quality scale (Short Form Health Survey -SF36) was used for evalution health related quality of life.

RESULTS

According to MNA and MNA-SF 6.1%; 4.2% of elderly people were malnutrition and 40.3%; 21.9% of them were at risk of malnutrition respectively. Accordingly, SNAQ 28.7% of elderly were risk at loss of weight. Health related quality of life scores of women were significantly lower than men. Good nutritional (MNA-SF) and good appetite (SNAQ) status, increased 1.69, 1.48 fold in the mental component summary scale scores respectively. SNAQ was the best determinant of physical component summary scale score had the greatest positive effect, good appetite status increased approximately 2.2 fold in physical scores. Polypharmacy and high BMI decreased health related quality of life in elderly.

CONCLUSION

Determinants of quality of life are preventable and treatable with early and appropriate interventions in elderly.

Anorexia of Aging: Assessment and Management

Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults.

Malnutrition in Acutely Unwell Hospitalized Elderly - "The Skeletons Are Still Rattling in the Hospital Closet"

INTRODUCTION

Malnutrition is common in hospitalized patients with prevalence rates of up to 30% in Australian hospitals with adverse consequences for both the patients and health care services. Despite formulation of nutritional screening protocols, not all hospitalized patients get nutritional screening. Real life screening rates of hospitalized elderly patients are unknown.

AIM

The present study explored nutrition screening rate in acutely unwell elderly patients admitted in a large tertiary hospital and how these patients fared depending upon their nutrition status.

METHODS

A prospective cross-sectional study involving 205 general medical patients ≥60years recruited between November 2014 and November 2015. The number of patients who missed nutrition screening were noted and all patients underwent nutritional assessment by a qualified dietitian using PG-SGA and quality of life was measured using EQ-5D 5L. A survival curve was plotted and multivariate cox proportional hazard model was used to adjust for confounders.

RESULTS

Only 99 (49.7%) patients underwent nutritional screening. One hundred and six (53.5%) patients were confirmed as malnourished by PG-SGA. Malnourished patients had significantly longer length of hospital stay and had worse quality of life. Mortality was significantly higher in malnourished patients at one year (23 (21.7%) vs 4 (4.3%); p<0.001) and cox proportional hazard model suggests that malnutrition significantly affects survival even after adjustment for confounders like age, sex, Charlson index and polypharmacy.

CONCLUSION

This study confirms that nutrition screening is still suboptimal in elderly hospitalized patients with adverse consequences and suggests need for review of policies to improve screening practices.

Mechanisms of the anorexia of aging-a review

Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.

Seniors’ Body Weight Dissatisfaction and Longitudinal Associations With Weight Changes, Anorexia of Aging, and Obesity

Objective: We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009. Method: Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions. Results: Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men’s subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed. Discussion: Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors’ weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors’ weight dissatisfaction may impact health.

Prevalence and associated factors of sarcopenia among elderly in Brazil: findings from the SABE study

OBJECTIVES

The aim of the present study was to examine the prevalence and factors associated with sarcopenia in older residents in São Paulo, Brazil.

DESIGN

Cross-sectional study.

SETTING

São Paulo, Brazil.

PARTICIPANTS

1,149 older individuals from the second wave of the Saúde, Bem-Estar e Envelhecimento (SABE) study from 2006.

MEASUREMENTS

The definition of sarcopenia was based on the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which include three components: low muscle mass, assessed by a skeletal muscle mass index of ≤8.90 kg/m2 for men and ≤6.37 kg/m2 for women; low muscle strength, assessed by handgrip strength <30 kg for men and <20 kg for women; and low physical performance, assessed by gait speed <0.8 m/s. Diagnosis of sarcopenia required presence of low muscle mass plus low muscle strength or low physical performance. Socio-demographic and behavioral characteristics, medical conditions and nutritional status were considered as independent variables to determine the associated factors using a logistic regression model.

RESULTS

The prevalence of sarcopenia was 16.1% in women and 14.4% in men. Advanced age with a dose response effect, cognitive impairment, lower income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia.

CONCLUSIONS

The EWGSOP algorithm is useful to define sarcopenia. The prevalence of sarcopenia in the Brazilian elderly population is high and several associated factors show that this syndrome is affected by multiple domains. No differences were observed by gender in any age groups.

Comparing Adult Males and Females in the United States to Examine the Association between Body Mass Index and Frequent Mental Distress: An Analysis of Data from BRFSS 2011

Background. There is conflicting evidence regarding the association of body mass index (BMI) with mental distress. Studies have focused on different dimensions of mental health and used different definitions and many of them have not controlled for confounding factors. The aim of this study was to examine the relationship between frequent mental distress (FMD) and BMI among adults in the United States, with special emphasis on gender differences. Methods. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for the year 2011 were used in logistic regression models to predict FMD, defined as having 14 or more days of poor mental health in the previous month. Sociodemographic factors, tobacco and alcohol use, diet and physical activity, and number of chronic diseases were controlled for. Results. 11.95% (n = 53,715) of the participants with valid responses (n = 496,702) had FMD. The adjusted ORs of having FMD among underweight, overweight, and obese females were 1.13 (95% CI: 1.10, 1.60), 1.10 (95% CI: 1.03, 1.19), and 1.21 (95% CI: 1.13, 1.31), respectively, but they were not statistically significant for males. Conclusions. These findings suggest a relationship between BMI and FMD, independent of other variables. It may be useful to explore longitudinal trend in this association.

Anorexia of aging: a modifiable risk factor for frailty

Anorexia of aging, defined as a loss of appetite and/or reduced food intake, affects a significant number of elderly people and is far more prevalent among frail individuals. Anorexia recognizes a multifactorial origin characterized by various combinations of medical, environmental and social factors. Given the interconnection between weight loss, sarcopenia and frailty, anorexia is a powerful, independent predictor of poor quality of life, morbidity and mortality in older persons. One of the most important goals in the management of older, frail people is to optimize their nutritional status. To achieve this objective it is important to identify subjects at risk of anorexia and to provide multi-stimulus interventions that ensure an adequate amount of food to limit and/or reverse weight loss and functional decline. Here, we provide a brief overview on the relevance of anorexia in the context of sarcopenia and frailty. Major pathways supposedly involved in the pathogenesis of anorexia are also illustrated. Finally, the importance of treating anorexia to achieve health benefits in frail elders is highlighted.

Anorexia and eating patterns in the elderly

Objectives

To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia.

Design

Cross- sectional, observational.

Setting

Community, nursing homes and rehabilitation or acute care facilities in four Italian regions.

Participants

A random sample of 526 subjects, aged 65 years and older (217 free living individuals, 213 residents in nursing homes, and 93 patients in rehabilitation and acute wards).

Measurements

All subjects underwent a multidimensional geriatric evaluation of: nutritional status, anthropometric parameters, health and cognitive status, depression, taste, chewing and swallowing function, and some hormones related to appetite. Diet variety was assessed, considering the frequency of consumption of different food groups (milk and dairy products; meat, fish, and eggs; cereals and derivatives; fruit and vegetables).

Results

In anorexic elderly subjects the global food intake was reduced, and the eating pattern was characterized by the reduced consumption of certain food groups (“meat, eggs and fish” and “fruit and vegetables”) whereas the frequency of consumption of milk and cereals remained almost unchanged. Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety.

Conclusion

Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status, further research should be prompted to establish an intervention. protocol allowing the early diagnosis of anorexia of aging, aimed at identifying its causes and at optimizing treatment of anorexic patients.

An investigation into the association between nutritional status and quality of life in older people admitted to hospital

BACKGROUND

Malnutrition is prevalent in acute hospitals and malnourished patients have an increased risk of morbidity and mortality. Studies of malnutrition and quality of life (QoL) are generally limited by both the nutritional and QoL assessment methods employed. The present study aimed to evaluate the relationship between malnutrition, as assessed using a range of nutritional assessment methods, and QoL, as measured by EuroQol-5D-3L and Short-Form (SF)-36 questionnaires.

METHODS

The study comprised a prospective cross-sectional study of malnutrition and QoL in 149 inpatients aged 65-99 years. Exclusion criteria were: terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Spearman's rank correlation coefficient was used to test the association between QoL indices and nutritional markers. QoL scores for those scoring above and below thresholds for nutritional risk were compared. Regression models were created to identify nutritional indices contributing to the variability of QoL.

RESULTS

There were significant associations between QoL scores and the Mini Nutritional Assessment (MNA)-SF. Clear differences were evident between malnourished and well-nourished patients (on the MNA-SF), those with low and normal arm muscle circumference and those with good and poor physical function. Regression analysis showed that nutritional scores and functional status made independent contributions to the prediction of QoL. The effect on food intake, mobility and psychological stress/acute disease also had a significant influence.

CONCLUSIONS

Malnutrition risk is linked to a poorer QoL in older people on admission to hospital. Functional status and eating-related factors are major influencers on QoL in this group. These findings reinforce the role of nutrition as a priority with respect to achieving improvements in QoL.

Malnutrition and quality of life in older people: a systematic review and meta-analysis

Although the effects of malnutrition on morbidity and mortality of older people is well established, there has been little work done to investigate the relationship between malnutrition and quality of life (QoL) in this population. In order to facilitate further research and to aggregate existing evidence into a clear overview, a systematic review was conducted. The objective was to identify the literature on the topic, review the findings systematically, and assess the association between nutritional status and QoL. MEDLINE, EMBASE, CINAHL and Web of Science were searched for relevant studies published up to April 2011. References within identified studies also searched. The primary author extracted all data using a purpose-built form, and evaluated the quality of the studies using a published checklist. A second reviewer checked a random sample of articles independently. Evidence in the current review comes from both cohort studies and intervention trials. Results from the former suggested that individuals with malnutrition are more likely to experience poor QoL (OR: 2.85; 95% CI: 2.20-3.70, p<0.001). Consistent with this, interventions designed to improve nutritional status can also lead to significant improvements in QoL, both physical (standard mean difference 0.23, CI: 0.08-0.38, p=0.002) and mental aspects (standard mean difference 0.24, CI: 0.11-0.36, p<0.001). However, the results should be interpreted with caution in view of the poor quality of the included studies and the heterogeneity of methods employed in the assessment of both nutritional status and QoL. Future studies should carefully characterise their participants and use standardised parameters for nutritional and QoL assessments in order to achieve better evaluation and comparability of study results.

Nutritional status in the oldest elderly and associated factors

OBJECTIVE

To verify factors associated with nutritional status in an oldest elderly communitydwelling population in Southern Brazil.

METHODS

This cross-sectional epidemiological and household-based study involved all subjects (n = 134) aged > 80 years who were living in Antônio Carlos (Santa Catarina state, Brazil). Nutritional status was assessed by body mass index (BMI < 22.0 kg/m², underweight; BMI > 27.0 kg/m², overweight). Explanatory variables in the study were: gender (women/ men), literacy (knows how to write and read - yes/no), living conditions (lives alone/with company), cognitive function (normal/altered), eating difficulty (yes/no), medication use (none to two/three or more), morbidity (none to two/three or more diseases), alimentary pattern (adequate/inadequate), alcohol consumption (none to one day a week, two or more days a week), cigarette smoking (never/current or former smoker), physical activity level (< 150 min/week; > 150 min/week), and sitting time (< 4 hours/day; > 4 hours but < 6 hours/ day; > 6 hours/day).

RESULTS

Prevalence of underweight was 27.3% in men and 12.8% in women (p < 0.01), and was positively associated with altered cognitive function (OR: 3.52) and inversely related with greater medication use (OR: 0.34). Overweight affected 25.5% of men and 53.8% of women. It was negatively associated with illiteracy (OR: 0.12) and positively associated with female gender (OR: 2.58).

CONCLUSION

There are differences between men and women regarding nutritional status. The factors associated to nutritional status of the oldest elderly from Antônio Carlos are specific to the vulnerability condition (underweight and overweight).

Pathophysiology of the anorexia of aging

PURPOSE OF REVIEW

Anorexia represents a major problem for older persons leading to weight loss, sarcopenia, functional decline, and mortality. There is increasing information on the pathophysiological mechanisms that lead to anorexia.

RECENT FINDINGS

Increasing evidence has shown the importance of gastrointestinal hormones (ghrelin, cholecystokinin, and glucagon-like peptide) and adipokines in producing the anorexia of aging. Numerous neurotransmitters have been shown to be involved in this aging anorexia, but evidence in humans is lacking.

SUMMARY

The early recognition of anorexia of aging is important to allow intervention and prevent functional deterioration in older persons. Screening tests for anorexia have been developed. New approaches to managing anorexia are being tested.

Malnutrition in elderly: social and economic determinants

Malnutrition occurs frequently in the frailest groups of the population, especially in people who are on a low income and elderly subjects, overall if they are institutionalized. The aim of this study was to assess the prevalence of malnutrition in a sample of elderly people living in different settings and to identify the determinants of malnutrition.

METHODS

A total of 718 subjects, 472 females (F) and 246 males (M), were recruited from nursing homes or were free living in three different regions in Italy. Nutritional status, depression, social, functional and cognitive status, were evaluated.

RESULTS

According to the Mini Nutritional Assessment (MNA), a high prevalence of malnutrition was found out in both genders: 26% of F and 16.3% of M were classified as being malnourished (MNA<17); 40.9% of F and 35% of M were at risk of malnutrition (MNA 17-23,5). The prevalence of malnutrition was significantly higher in NH subjects in both sexes. Moreover, a relationship was shown between malnutrition and inability to shop, prepare and cook meals because of a low income, distance from markets or supermarkets as well as impossibility to drive the car or to use public transportation. This study confirms the necessity to routinely perform nutritional status evaluation in elderly subjects, to carry out training courses for health workers (doctors, nurses, psychologists, dietitians), to implement nutritional education of the geriatric population, to develop tools and guidelines for health workers and caregivers, to identify and reduce clinical, functional, social or economic risk factors for malnutrition.

Prevalence and potentially reversible factors associated with anorexia among older nursing home residents: results from the ULISSE project

OBJECTIVE

The principal aims of the present study were to explore the prevalence of anorexia and the factors correlated to anorexia in a large population of older people living in nursing home. Secondary, we evaluated the impact of anorexia on 1-year survival.

METHODS

Data are from baseline evaluation of 1904 participants enrolled in the Un Link Informatico sui Servizi Sanitari Esistenti per l'Anziano study, a project evaluating the quality of care for older persons living in an Italian nursing home. All participants underwent a standardized comprehensive evaluation using the Italian version of the inter Resident Assessment Instrument Minimum Data Set (version 2.0) for Nursing Home. We defined anorexia as the presence of lower food intake. The relationship between covariates and anorexia was estimated by deriving ORs and relative 95% CIs from multiple logistic regression models including anorexia as the dependent variable of interest. Hazard ratios and 95% CIs for mortality by anorexia were calculated.

RESULTS

More than 12% (240 participants) of the study sample suffered from anorexia, as defined by the presence of decreased food intake or the presence of poor appetite. Participants with functional impairment, dementia, behavior problems, chewing problems, renal failure, constipation, and depression, those treated with proton pump inhibitors and opioids had a nearly 2-fold increased risk of anorexia compared with participants not affected by these syndromes. Furthermore, participants with anorexia had a higher risk of death for all causes compared with nonanorexic participants (hazard ratio 2.26, 95% CI: 2.14-2.38).

CONCLUSIONS

The major finding is that potentially reversible causes, such as depression, pharmacologic therapies, and chewing problems, were strongly and independently associated with anorexia among frail older people living in nursing home. Furthermore, anorexia was associated with higher rate of mortality, independently of age and other clinical and functional variables.

Is the optimal level of protein intake for older adults greater than the recommended dietary allowance?

BACKGROUND

Protein is a macronutrient essential for growth, muscle function, immunity and overall tissue homeostasis. Suboptimal protein intake can significantly impact physical function and overall health in older adults.

METHODS

This article reviews the literature on the recommendations for protein intake in older adults in light of the new evidence linking protein intake with sarcopenia and physical function. Challenges and opportunities for optimal protein nutrition in older persons are discussed.

RESULTS

Recent metabolic and epidemiological studies suggest that the current recommendations of protein intake may not be adequate for maintenance of physical function and optimal health in older adults. Methodological limitations and novel concepts in protein nutrition are also discussed.

CONCLUSION

We conclude that new research and novel research methodologies are necessary to establish the protein needs and optimal patterns of protein intake for older persons.

Effects of anorexia on mortality among older adults receiving home care: an observation study

PURPOSE

We describe the prevalence of secondary anorexia in a population of older people living in community and receiving home care. In addition, we examined the relationship between secondary anorexia and mortality.

METHODS

We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the present study. The main outcome measures were the prevalence of anorexia, weight loss and survival.

RESULTS

More than 25% (744 subjects) of the study sample suffered from anorexia. During a mean follow-up of 10 months from initial MDS-HC assessment, 468 patients (17%) died. There was uneven distribution of the risk. After adjusting for age, gender and for all other possible risk factors for death (living alone, physical and cognitive disability, behavior problems, urinary incontinence, pressure ulcer, hearing impairment, congestive heart failure, hypertension, depression, diabetes, renal failure, cancer), subjects with anorexia were more likely to die relative to patients without anorexia (RR, 1.83; 95% CI 1.45-2.31). Even though the risk of mortality was higher among subjects suffering from anorexia and weight loss, the anorexia per se was associated with higher risk compared with subjects without anorexia (RR, 1.45; 95% CI 1.01-2.19).

CONCLUSIONS

Anorexia is associated with a significant higher risk of all-cause mortality. The present findings support the possibility that anorexia has an independent effect on survival even among old people receiving home care.

Nutrition and the aging male

Numerous studies have now found that good nutrition coupled with exercise are key factors to aging successfully. In addition, it is now clear that men who drink 2 shots of alcohol (red wine or other) do better. Women are limited to only 1 drink a day. This article examines some key nutritional factors involved in successful aging and highlights different needs between men and women.

Nutritional status and nutritional rehabilitation of elderly living in long-term care

A dolgozat témája a tartós bentlakásos intézményekben élők táplálásához és táplálkozásához kapcsolódó legfontosabb tényezők feltérképezése, a szociális otthonokban élő időskorúak tápláltsági állapotának felmérése, és az eredmények alapján a táplálkozási rehabilitációra javaslattétel. Célkitűzések: A tartós bentlakásos intézményekben élő hatvanévesek és idősebbek (időskorúak) tápláltsági állapotának meghatározása. A tartós bentlakásos intézményekben élő időskorúak testtömegindexének (BMI) változása. Az elmúlt fél évtized során a tartós bentlakásos intézményekben élő időskorúak tápláltságiállapot-változásának megállapítása. Az akut és krónikus betegségek összefüggésének megállapítása a tápláltsági állapottal. A tartós bentlakásos intézményekben élő időskorúak klinikai tápszerrel való ellátottságának felmérése. Annak megállapítása, hogy milyen a feltárt vélelmezett befolyásoló tényezők és a MUST szerinti tápláltsági állapot közötti összefüggés. Módszerek: Összesen 4774 hatvanéves és idősebb (28,9–30,9%-át férfiak, 69,1–71,2%-át nők adták, az összes résztvevő átlagéletkora 77,8±8,9 év volt) tartós bentlakásos intézményben élő, önként jelentkező gondozott tápláltsági állapotát szűrtük 2004-ben és 2006-ban a Malnutrition Universal Screening Tool (MUST) kérdőívvel és az általunk összeállított kérdőívvel, 2008-ban a Nutrition Day 2008 nyomtatványait használtuk. Eredmények: Felméréseink eredményei szerint az alultápláltságra veszélyeztetett idős személyek aránya a szociális otthonokban igen nagy (26,8–77,0%). Az ellátottak 29,5%-ánál tápláltságiállapot-felmérés negyedévente vagy annál ritkábban történik. A tápláltsági állapot multifaktoriális, sok tényező határozza meg a tápláltsági állapotot (például mozgáskorlátozottság, láz). Az étvágytalanság és a nyelési nehezítettség 2,5-szer gyakoribb, a mozgáskorlátozottság, a dementia, valamint a hiányos fogazat a nagy rizikójú idősek csoportjában közel kétszer (1,6–1,7-szer) gyakoribb, mint az idős, szociális otthonban élők körében. Az idegrendszeri kórképek szignifikánsan függnek össze a tápláltsági állapottal. Az idegrendszeri betegségek előfordulási gyakorisága az elmúlt években szignifikánsan nőtt. Következtetések: A táplálkozási rehabilitáció nem ér véget a tápláltsági állapot szűrésével, ellenkezőleg, azzal kezdődik. Annak eredményei alapján elengedhetetlen a táplálkozási irányelvek és szükség esetén a személyre szabott étrend meghatározása.