Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

Vitamin D and Sarcopenia in the Senior People: A Review of Mechanisms and Comprehensive Prevention and Treatment Strategies

This article reviews the mechanisms and prevention strategies associated with vitamin D and sarcopenia in older adults. As a geriatric syndrome, sarcopenia is defined by a notable decline in skeletal muscle mass and strength, which increases the risk of adverse health outcomes such as falls and fractures. Vitamin D, an essential fat-soluble vitamin, is pivotal in skeletal muscle health. It affects muscle function through various mechanisms, including regulating calcium and phosphorus metabolism, promoting muscle protein synthesis, and modulation of muscle cell proliferation and differentiation. A deficiency in vitamin D has been identified as a significant risk factor for the development of sarcopenia in older adults. Many studies have demonstrated that low serum vitamin D levels are significantly associated with an increased risk of sarcopenia. While there is inconsistency in the findings, most studies support the importance of vitamin D in maintaining skeletal muscle health. Vitamin D influences the onset and progression of sarcopenia through various pathways, including the promotion of muscle protein synthesis, the regulation of mitochondrial function, and the modulation of immune and inflammatory responses. Regarding the prevention and treatment of sarcopenia, a combination of nutritional, exercise, and pharmacological interventions is recommended. Further research should be conducted to elucidate the molecular mechanism of vitamin D in sarcopenia, to study genes related to sarcopenia, to perform large-scale clinical trials, to investigate special populations, and to examine the combined application of vitamin D with other nutrients or drugs. A comprehensive investigation of the interconnection between vitamin D and sarcopenia will furnish a novel scientific foundation and productive strategies for preventing and treating sarcopenia. This, in turn, will enhance the senior people's quality of life and health.

Relationship between Improvement in Physical Activity and Three Nutritional Assessment Indicators in Patients Admitted to a Convalescent Rehabilitation Ward

We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge.

Implementation of nutritional screening tools, nutritional assessment tools, and diagnostic criteria for malnutrition in convalescent rehabilitation wards: A nationwide survey

BACKGROUND & AIMS

The utilization of recommended nutritional assessment measures in rehabilitation settings remains unclear. This study explored methods for identifying nutritional disorders using data from a nationwide survey conducted in convalescent rehabilitation wards.

METHODS

This cross-sectional study analyzed the annual survey, including methods for identifying malnutrition, the risk of malnutrition, and overnutrition in Kaifukuki (convalescent) rehabilitation wards. Methods identifying malnutrition and risk of malnutrition were grouped into nutritional screening tools (NSTs), nutritional assessment tools (NATs), diagnostic criteria for malnutrition (DCM), and suboptimal methods (e.g., hypoalbuminemia). NSTs, NATs, and DCM were further categorized as "acceptable tools." The association between applying acceptable tools, hospital-based data (e.g., the number of beds), and ward-based data (e.g., assessor for nutritional status) was analyzed by logistic regression analysis with multiple imputations.

RESULTS

In total, 885 hospitals with Kaifukuki rehabilitation wards responded to the survey, and 754 hospitals were included in the analysis. Registered dietitians assessed the nutritional status in 88% of the hospitals, whereas other professionals (e.g., nurses) evaluated the nutritional status in the remainder. NSTs (e.g., Mini Nutritional Assessment Short-Form), NATs (e.g., Subjective Global Assessment), DCM (e.g., Global Leadership Initiative on Malnutrition criteria), and suboptimal tools were used in 13.1%, 5.4%, 4.8%, and 74.6% of cases, respectively. Most hospitals used acceptable measures (e.g., body mass index) for overnutrition (91.2%). Multiple logistic regression analysis showed that assessments by registered dietitians (adjusted odds ratio[OR]: 2.20.95% confidence interval[CI]: 1.09-4.45) and hospital-owned food services, a proxy for limited clinical practice time of dietitians, were associated with a low likelihood of implementing acceptable measures (adjusted OR: 0.64, 95%CI: 0.43-0.97).

CONCLUSIONS

Acceptable malnutrition measures, including the NSTs, NATs, and DCM, have not been widely applied in convalescent rehabilitation settings. The implementation of recommended tools for identifying malnutrition may be promoted when registered dietitians assess the patients' nutritional status.

Body Weight and Composition Changes in Geriatric Rehabilitation Are Dependent on Sarcopenia and Malnutrition: RESORT

OBJECTIVES

Body weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients.

DESIGN

RESORT is an observational, longitudinal cohort.

SETTING AND PARTICIPANTS

Geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006).

METHODS

Changes in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ.

RESULTS

A total of 1006 patients [median age: 83.2 (77.7-88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia.

CONCLUSIONS AND IMPLICATIONS

In geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients' nutritional risk.

Malnutrition among the older adult: an additional challenge for the rehabilitation team-insights of a small population of Switzerland

Introduction

Nutritional deficiency among the older adult is a widespread concern, significantly affecting their health. The prevalence of malnutrition increases with age, concurrent health conditions, and the level of care provided. Hospital stays can affect as 90% of the older adult. Malnutrition can hinder efforts to improve health and regain function in individuals undergoing rehabilitation. This study aims to assess the frequency of malnutrition among geriatric rehabilitation patients.

Materials and methods

A retrospective quantitative analysis was conducted on 357 patients admitted to the geriatric unit at Lucerne Cantonal Hospital Wolhusen in Switzerland. The patients' nutritional status was evaluated using the standardized Mini Nutritional Assessment Long Form questionnaire.

Results

The initial analysis indicated a considerable prevalence of malnutrition among the geriatric population: 31.1% were identified as malnourished (MNA < 17), while an additional 35.8% were at risk of malnutrition (MNA 17-23.5), totaling 66.9% of patients. The Kruskal-Wallis ANOVA test revealed a statistically significant difference in MNA scores among different age groups (p = 0.035). Statistical analysis also suggested a slightly higher prevalence of malnutrition among female patients. The duration of rehabilitation varied from 20.07 ± 6.93 to 22.20 ± 7.50 days, with longer durations associated with lower MNA scores. A correlation analysis between MNA values and body mass index (BMI) showed a positive correlation coefficient (r = 0.56), indicating that lower MNA scores were associated with lower BMI and vice versa.

Conclusion

Malnutrition is prevalent among individuals over 65 years old, highlighting the importance of regular and timely nutritional assessments for geriatric patients to mitigate the complications and enhance prognoses in both acute care and rehabilitation settings. Such assessments can also improve the efficacy of rehabilitation programs and potentially reduce the duration of rehabilitation, thus carrying significant economic implications.

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason

BACKGROUND AND PURPOSE

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason.

METHODS

This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors.

RESULTS AND DISCUSSION

In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization.

CONCLUSIONS

Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Geriatric Syndromes Frequently (Co)-Occur in Geriatric Rehabilitation Inpatients: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR)

OBJECTIVE

To determine the prevalence and co-occurrence of common geriatric syndromes in geriatric rehabilitation inpatients.

DESIGN

Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR) are observational, longitudinal cohorts.

SETTING

Geriatric rehabilitation.

PARTICIPANTS

Geriatric rehabilitation inpatients (N=1890 and N=200).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Geriatric syndromes included polypharmacy, multimorbidity (Cumulative Illness Rating Scale), cognitive impairment, depression (Hospital Anxiety and Depression Scale/Geriatric Depression Scale), malnutrition (Global Leadership Initiative on Malnutrition), functional limitation (Katz index), falls, physical frailty (Fried), and sarcopenia (European Working Group on Sarcopenia in Older People 2).

RESULTS

Inpatients in RESORT (R) (N=1890, 56% females) had a median age of 83.4 years (interquartile range [IQR], 77.6-88.4) and in EMPOWER-GR (E) (N=200, 57% females) of 79.8 years (IQR, 75.0-85.9). Polypharmacy (R, 82.2%; E, 84.0%), multimorbidity (R, 90.4%; E, 85.5%), functional limitation (R, 96.0%; E, 76.5%), and frailty (R, 91.8%; E, 92.2%) were most prevalent. Most inpatients had ≥5 geriatric syndromes at admission in both cohorts (R, 70.0%; E, 72.4%); few inpatients had only 1 (R, 0.4%; E, 1.5%) or no geriatric syndrome (R, 0.2%; E, 0.0%). Geriatric syndromes did not occur in isolation (without other syndromes), except for multimorbidity (R, 1%; E, 5%), functional limitation (R, 3%; E, 2%), falls (R, 0%; E, 4%), and frailty (R, 2%; E, 5%), which occurred in isolation in some inpatients; sarcopenia did not.

CONCLUSIONS

Geriatric syndromes are highly prevalent at admission to geriatric rehabilitation, with a median of 5 co-occurring syndromes. Implications for diagnosis and intervention potential should be further addressed.

The nutritional support to prevent sarcopenia in the elderly

Sarcopenia has been described as a muscle disease, with multiple adverse consequences on human health. Recommendations aimed at supporting awareness, prevention, early detection and treatment of this disease are needed. This review focuses on the epidemiology, pathophysiology and early detection of elderly sarcopenia. As far as treatment is concerned, physical activity and nutritional support are specifically evaluated. An individually tailored resistance exercise training program appears to be crucial for a positive outcome of the sarcopenia prevention and treatment. The nutritional intervention is mostly based on the supplementation with high-quality proteins (i.e., whey protein) in order to increase the intake of essential amino acids and in particular of leucine. In addition, of relevant importance appears to be the supplementation with vitamin D, with omega-3 fatty acids and probiotics. This review evaluates the results of the most qualified studies on the nutritional supplementation of sarcopenic elderly subjects and shows that promising results have been achieved in community elderly subjects, or subjects followed in rehabilitation centers and in nursing homes, with additional resistance exercise programs.

The Validity of Quadriceps Muscle Thickness as a Nutritional Risk Indicator in Patients with Stroke

This study aimed to investigate whether quadriceps muscle thickness (QMT) is useful for nutritional assessment in patients with stroke. This was a retrospective cohort study. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), with GNRI < 92 indicating a risk of malnutrition and GNRI ≥ 92 indicating normal conditions. Muscle mass was assessed using QMT and calf circumference (CC). The outcome was Functional Independence Measure (FIM) effectiveness. The cutoff values of QMT and CC for discriminating between high and low GNRI were determined using the receiver operating characteristic curve. The accuracy of the nutritional risk discrimination model was evaluated using the Matthews correlation coefficient (MCC). Multiple regression analysis was performed to assess the relationship between nutritional risk, as defined by QMT and CC, and FIM effectiveness. A total of 113 patients were included in the analysis. The cutoff values of QMT and CC for determining nutritional risk were 49.630 mm and 32.0 cm for men (MCC: 0.576; 0.553) and 41.185 mm and 31.0 cm for women (MCC: 0.611; 0.530). Multiple regression analysis showed that only nutritional risk defined by QMT was associated with FIM effectiveness. These findings indicate that QMT is valid for assessing nutritional risk in patients with stroke.

Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial

BACKGROUND

Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation.

METHODS

The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge.

DISCUSSION

The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.

Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review

Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.

Transparency in hip fracture recovery over institutional boundaries: The transmural monitoring pathway

OBJECTIVES

To develop a transmural pathway for healthcare professionals across institutions to monitor the recovery of hip fracture patients. The secondary objectives were to evaluate the pathway's feasibility and initial outcomes.

DESIGN

Prospective cohort study.

METHOD

Stakeholders of the hospital and geriatric rehabilitation institutions implemented a transmural monitoring pathway in which different geriatric health domains were monitored during three phases: The in-hospital, inpatient rehabilitation, and outpatient follow-up phase. The outcomes for the first 291 patients and the feasibility of the pathway were evaluated. If the outcomes of the clinimetrics significantly improved over time, progress in functional recovery was assumed. Feasibility was assessed according to the rate of adherence to the clinimetric tests.

RESULTS

During the in-hospital phase, patients showed a decline in functional level (the Katz index of independence in Activities of Daily Living (Katz-ADL) pre-fracture vs. discharge: 0 (0-2) vs. 4 (4-5), P < 0.001). Patients, in which 78.6% (n = 140) had cognitive impairment and 41.2% had malnutrition, showed the most progress (Katz-ADL 2 (1-3)) during the inpatient rehabilitation phase. In the outpatient follow-up phase, recovery remained ongoing, but most patients had not returned to their pre-fracture functional levels (Katz-ADL 1 (1-3)). The pathway feasibility during the first phase was excellent (>85%), whereas room for improvement existed during other phases (<85%).

CONCLUSION

The transmural monitoring pathway provides insight into the entire recovery process for all involved healthcare professionals. Patients showed the most progress during the rehabilitation phase. The pathway feasibility was excellent during the in-hospital phase, but improvements could be made during other phases.

Usability and feasibility of a tablet-based e-coach for older adults in rehabilitation units to improve nutrition and physical activity: a prospective pilot study

BACKGROUND

For older adults (≥ 70 years), it is often challenging to maintain new nutrition and physical activity behaviours learned in rehabilitation. To minimize the risk of negative health consequences when returning home, an e-coach can be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behaviour Change (TTM) and guidance from healthcare professionals can optimize behaviour change.

OBJECTIVE

This prospective single-arm pilot study aimed to assess the usability and feasibility of a nutrition and mobility e-coach for older adults during and after rehabilitation for a period of 9 weeks. In addition, we examined the change in the TTM phase as an indicator of the participant's readiness to change or the changes made.

METHODS

Older adults (≥ 70 years) with nutrition deficits and/ or mobility limitations were recruited in a rehabilitation centre. Participants' phases of behaviour change in the TTM were identified by comparing current nutrition and physical activity habits via self-report with age-specific nutrition and physical activity recommendations. They received a tablet with the e-coach containing educational and interactive elements on the topics of nutrition and physical activity in older age. Participants used the e-coach and received support from healthcare professionals. The TTM phases were assessed at five times; the e-coach content was adjusted accordingly. Usability was assessed using the System Usability Scale (SUS, Score range: 0-100). Timestamps were used to evaluate how frequently participants used the e-coach: high (≥ 67% of the days), medium (66 - 33% of the days), and low (< 33% of the days).

RESULTS

Approximately 140 patients were approached and n = 30 recruited. Complete data sets of n = 21 persons were analysed (38% female, mean age 79.0 ± 6.0 years). The SUS was 78.6 points, 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (baseline: 33%, n = 7). Nutrition recommendations were achieved by 14 participants (66%) after nine weeks (baseline: 24%, n = 5).

CONCLUSION

The e-coach seems to be usable and feasible for older adults. We identified some optimization potentials for our application that can be transferred to the development of comparable e-health interventions for vulnerable older adults.

Prevalence and correlates of malnutrition risk among Chinese centenarians and oldest-old adults

This study was to explore epidemiological characteristics of malnutrition and factors associated with malnutrition in centenarians and oldest-old adults, so as to provide a reference for family members and government departments to take effective measures and promote healthy aging. Median age of all 1,654 participants was 100 (85, 102) years old, and prevalence of high malnutrition risk was 65.54% in all participants. Proportion of high-malnutrition risk was higher, and proportion of normal physical function was lower, in centenarians than those in oldest-old adults (p < 0.05 for all). Univariate and multivariate Poisson regression analyses showed that normal physical function was negatively associated with malnutrition risk in all participants, centenarians, and oldest-old adults (p < 0.05 for all). In conclusion, proportion of centenarians at malnutrition risk was significantly higher than that of oldest-old adults, and the independent factor associated with malnutrition in people aged over 80 years was physical function.

Nutritional Care Practices in Geriatric Rehabilitation Facilities across Europe: A Cross-Sectional Study

Many patients in geriatric rehabilitation (GR) are physically frail at the time of admission and suffer from malnutrition and sarcopenia, which may worsen rehabilitation outcomes. This study aims to obtain insight into the current nutritional care practices in GR facilities across Europe.

METHODS

In this cross-sectional study, a questionnaire focused on nutritional care practices in GR was distributed across experts in EUGMS member countries. Data were analyzed by using descriptive statistics.

RESULTS

In total, 109 respondents working in 25 European countries participated, and the results showed that not all GR patients were screened and treated for malnutrition, and not all participants used (inter)national guidelines when performing nutritional care. The results also showed variations across European geographical areas related to screening and treatment of malnutrition, sarcopenia, and frailty. Even though the participants underlined the importance of dedicating time to nutritional care, they experienced barriers in its implementation, which were mostly due to a lack of resources.

CONCLUSION

As malnutrition, sarcopenia, and frailty are often present in patients admitted to GR, in addition to being interrelated, it is recommended to develop an integrated approach to screening and treatment of all three clinical problems.

Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review

BACKGROUND & AIMS

Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation.

METHODS

MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman.

RESULTS

Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I²:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low).

CONCLUSION

Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.

Current Understanding of Sarcopenia and Malnutrition in Geriatric Rehabilitation

Malnutrition and sarcopenia are different but common conditions in older adults that share some underlying causes, including age-related physiological changes, decreased food intake, acute or chronic inflammation [...]

Effects of Undernutrition on Swallowing Function and Activities of Daily Living in Hospitalized Patients: Data from the Japanese Sarcopenic Dysphagia Database

This retrospective cohort study examined the effects of undernutrition on swallowing function and activities of daily living in hospitalized patients. Data from the Japanese Sarcopenic Dysphagia Database were used, and hospitalized patients aged ≥20 years with dysphagia were included in the analysis. Participants were assigned to the undernutrition or normal nutritional status group based on the Global Leadership Initiative on Malnutrition criteria. The primary outcome was the Food Intake Level Scale change, and the secondary outcome was the Barthel Index change. Among 440 residents, 281 (64%) were classified under the undernutrition group. The undernutrition group had a significantly higher Food Intake Level Scale score at baseline and Food Intake Level Scale change (p = 0.001) than the normal nutritional status group. Undernutrition was independently associated with the Food Intake Level Scale change (B = -0.633, 95% confidence interval = -1.099 to -0.167) and the Barthel Index change (B = -8.414, 95% confidence interval = -13.089 to -3.739). This was defined as the period from the date of admission to the hospital until discharge or 3 months later. Overall, our findings indicate that undernutrition is associated with reduced improvement in swallowing function and the ability to perform activities of daily living.

Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis

BACKGROUND & AIMS

Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients.

METHODS

The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical.

TRIALS

gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios.

RESULTS

We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination.

CONCLUSION

Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.

Feasibility of bioelectrical impedance analysis in routine clinical care to assess body composition in geriatric rehabilitation inpatients: RESORT

BACKGROUND

Sarcopenia is prevalent in 20-50% of geriatric rehabilitation inpatients, but it is often undiagnosed.

AIMS

The aim of the study is to evaluate the feasibility of bioelectric impedance analysis (BIA) to measure muscle mass in routine clinical care in a cohort of geriatric rehabilitation inpatients.

METHODS

REStORing Health of acutely unwell adulTs (RESORT) is an observational, longitudinal inception cohort of geriatric rehabilitation inpatients. BIA was implemented at admission and discharge as routine care performed by nursing staff. BIA feasibility was defined as completion rate (low ≤ 25%, moderate > 25- ≤ 50%, good > 50- ≤ 75%, excellent > 75%), reasons for non-completion and need for remeasurement. Clinical characteristics associated with BIA completion and remeasurements were assessed.

RESULTS

Patients (n = 1890, 56% females) had a median age of 83.4 years (interquartile range: [77.6-88.4]). Of the total cohort, 5.7% had a contraindication (pacemaker/other electronic medical device) for BIA at admission and 4.5% at discharge. BIA was completed in 77.1% of patients eligible for BIA at admission and 63.2% at discharge indicating good feasibility; remeasurement was required in 7.4 and 6.9%, respectively; 5.9% had a medical reason preventing BIA completion at admission and 3.7% at discharge. Refusal and technical issues occurred in 1.6 and 0.7% at admission and 2.1 and 1.8% at discharge. Reason for non-completion was unknown/missing in 14.7% at admission and 28.6% at discharge. Worse functional and physical performance was associated with BIA non-completion and remeasurement.

CONCLUSIONS

BIA in routine clinical care in geriatric rehabilitation inpatients is feasible; completion rates may be enhanced further by reviewing barriers and enablers.

Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle?

Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.

Nutrition Intervention Informed by Indirect Calorimetry Compared to Predictive Equations to Achieve Weight Goals in Geriatric Rehabilitation Inpatients: The NEED Study

OBJECTIVES

To assess if nutritional interventions informed by indirect calorimetry (IC), compared to predictive equations, show greater improvements in achieving weight goals, muscle mass, strength, physical and functional performance.

DESIGN

Quasi-experimental study.

SETTING AND PARTICIPANTS

Geriatric rehabilitation inpatients referred to dietitian.

INTERVENTION AND MEASUREMENTS

Patients were allocated based on admission ward to either the IC or equation (EQ) group. Measured resting metabolic rate (RMR) by IC was communicated to the treating dietitian for the IC group but concealed for the EQ group. Achieving weight goals was determined by comparing individualised weight goals with weight changes from inclusion to discharge (weight gain/loss: >2% change, maintenance: ≤2%). Muscle mass, strength, physical and functional performance were assessed at admission and discharge. Food intake was assessed twice over three-days at inclusion and before discharge using plate waste observation.

RESULTS

Fifty-three patients were included (IC n=22; EQ n=31; age: 84.3±8.4 years). The measured RMR was lower than the estimated RMR within both groups [mean difference IC -282 (95%CI -490;-203), EQ -273 (-381;-42) kcal/day)] and comparable between-groups (median IC 1271 [interquartile range 1111;1446] versus EQ 1302 [1135;1397] kcal/day, p=0.800). Energy targets in the IC group were lower than the EQ group [mean difference -317 (95%CI -479;-155) kcal/day]. There were no between-group differences in energy intake, achieving weight goals, changes in muscle mass, strength, physical and functional performance.

CONCLUSIONS

In geriatric rehabilitation inpatients, nutritional interventions informed by IC compared to predictive equations showed no greater improvement in achieving weight goals, muscle mass, strength, physical and functional performance. IC facilitates more accurate determination of energy targets in this population. However, evidence for the potential benefits of its use in nutrition interventions was limited by a lack of agreement between patients' energy intake and energy targets.

Assessing Nutritional Status and Functionality in Geriatric Population of Bangladesh: The Hidden Epidemic of Geriatric Malnutrition

The average life expectancy of the Bangladeshi population has risen over the last decade due to economic growth and improved medical care. Although the increased number of older adults and their health is a significant concern, there is scarce of data regarding that. A community-based cross-sectional study was conducted to analyze the association between nutritional status and functional ability among selected Bangladeshi geriatric populations living in their homes. Of 400 participants, the prevalence of malnutrition, and people at risk of malnutrition was 25.4% and 58.8%, respectively. Furthermore, almost 80% of participants are dependent in terms of activities of daily living. High risk of falling (OR = 10.82; 95% CI: 5.85-20.37; p ≤ .001), limited activities of daily living (IADL) (OR = 6.21; 95% CI: 4.02-9.58; p ≤ .001), along with dependency in performing IADL (OR = 4.48; 95% CI: 2.83-7.06; p ≤ .001) are significantly associated with malnutrition. Geriatric malnutrition can accelerate disability conditions, leading to early functional aging.

The association between sarcopenia and functional outcomes in patients undergoing convalescent rehabilitation

Sarcopenia is widely believed to be linked to poorer outcomes in inpatient rehabilitation. This study aimed to assess the impact of sarcopenia on functional outcomes and dietary intake during hospitalization in adults undergoing convalescent rehabilitation. We conducted a retrospective cohort analysis at a single rehabilitation institution. The Asian Working Group Consensus Criteria for Sarcopenia was used to diagnose. The Functional Independence Measure (FIM) score was used at hospital discharge to measure the primary functional outcome. Energy and protein intakes during hospitalization were calculated as part of the nutritional assessment. There were 126 patients in the research (median age, 73 yr;54% women). Stroke (n = 73;53.4% sarcopenia) and musculoskeletal disorders (n = 53;56.6% sarcopenia) were among the admission diagnoses. Multiple linear regression analysis revealed that the FIM total score at discharge was modestly associated with sarcopenia only in stroke patients (? = 0.1872, P = 0.09), as well as significantly and independently associated with protein intake during admission only in stroke patients (? = 0.3217, P < 0.05). In hospitalized stroke patients undergoing convalescent therapy, sarcopenia is related to lower functional results. Early identification of sarcopenia and treatment with rehabilitation nutrition should be implemented in this population. J. Med. Invest. 70 : 457-463, August, 2023.

The concept of aggressive nutrition therapy and clinical indication: A position paper

Aggressive nutrition therapy is a nutritional management method that sets energy intake requirements by adding the amount of energy accumulated to energy consumption. It is used to treat patients with undernutrition and sarcopenia. However, evidence for aggressive nutrition therapy is insufficient, and validation through high-quality clinical research is essential. Therefore, this paper aimed to clarify the concept of aggressive nutrition therapy, present indications and contraindications; and describe the effects, limitations, and the need to individualize aggressive nutrition therapy for different pathological conditions. Aggressive nutrition therapy should be accompanied by the etiology of undernutrition, sarcopenia, and nutritional metabolism in various states. In addition to calculating nutritional requirements, the nutritional management methods of oral intake, tube feeding, and parenteral nutrition should be appropriately selected. A nutrition plan with the amount of energy accumulated should also be a vital issue. This position paper was authored by the Registered Dietitian Subcommittee of the Japanese Association of Rehabilitation Nutrition and was approved by the Japanese Association of Rehabilitation Nutrition.

Association of Objectively Measured Physical Activity with Physical Function in Patients with Sarcopenia during Hospitalized Rehabilitation

This study aimed to investigate the association between objectively measured physical activity and functional improvement in hospitalized patients with sarcopenia. In this retrospective cohort study, physical activity (light-intensity physical activity [LIPA]; moderate-to-physical activity [MVPA]) was measured using a triaxial accelerometer in patients with sarcopenia undergoing rehabilitation on hospital admission. The primary outcome was physical function measured with the SPPB and activity of daily living (ADL) measured with the functional independence measure scores for motor function (FIM-M) at hospital discharge. Multiple regression analysis was per-formed to investigate the relationship between the objectively measured physical activity and functional outcomes. A total of 182 patients with sarcopenia (aged 81; interquartile range (IQR) 13 years) were included in this study. In the multiple regression analysis, LIPA was associated with the SPPB score at discharge (β = 0.180, p = 0.015) but not with FIM-M at discharge. MVPA was not associated with SPPB or FIM-M scores at discharge. In conclusion, LIPA on admission is independently associated with physical function, but not ADL, in patients with sarcopenia undergoing hospitalized rehabilitation.

Prevalence of Malnutrition Assessed by the GLIM Criteria and Association with Activities of Daily Living in Older Residents in an Integrated Facility for Medical and Long-Term Care

Malnutrition is associated with poor functional outcomes in residents in long-term care facilities. The integrated facility for medical and long-term care (IFMLC) is a new Japanese long-term care facility where medical services can be provided. This study aimed to investigate the prevalence of malnutrition diagnosed based on the Global Leadership Initiative on Malnutrition (GLIM) criteria and its association with activities of daily living (ADL) in older residents in IFMLC. In this cross-sectional study of older residents, we diagnosed mild and severe malnutrition using the GLIM criteria and assessed ADLs using the Barthel index (BI). Multivariate regression analysis was used to investigate the relationship between BI score and GLIM-defined malnutrition. A total of 117 older residents (84 women; median age, 88 years) were analyzed in this study. The prevalence values of mild and severe malnutrition were 29% and 18%, respectively. Multivariate analyses for the BI score after adjusting for potential confounders showed that mild and severe malnutrition were independently associated with BI score (B = −6.113, p < 0.046; B = −8.411, p = 0.015, respectively). GLIM-defined malnutrition is negatively associated with ADLs in older residents in IFMLC.

Association of polypharmacy at hospital discharge with nutritional intake, muscle strength, and activities of daily living among older patients undergoing convalescent rehabilitation after stroke

Matsumoto A, Yoshimura Y, Shimazu S, Nagano F, Bise T, Kido Y, Shiraishi A, Sunahara T. Association of polypharmacy at hospital discharge with nutritional intake, muscle strength, and activities of daily living among older patients undergoing convalescent rehabilitation after stroke. Jpn J Compr Rehabil Sci 2022; 13: 41-48.

Objective

To investigate the association between polypharmacy at discharge and nutritional intake, muscle strength, and activities of daily living (ADL) among older patients undergoing convalescent rehabilitation after stroke.

Methods

This cross-sectional study involved hospitalized patients aged 65 or older who underwent convalescent rehabilitation after stroke. Polypharmacy was defined as the use of six or more medications. Study outcomes included energy intake, protein intake, handgrip strength (HG), and motor subscore of Functional Independence Measure (FIM-motor) at hospital discharge. Multiple linear regression analysis was used to examine the association between polypharmacy at discharge and outcomes.

Results

Of 361 eligible patients (mean [±SD] age, 78.3 ± 7.7 years; 49.3% male), 62.9% had polypharmacy. Multiple regression analysis revealed that polypharmacy at discharge was negatively associated with energy intake (β = -0.122, p = 0.003), protein intake (β = -0.133, p = 0.013), HG (β = -0.070, p = 0.022), and FIM-motor score (β = -0.069, p = 0.031) at discharge.

Conclusion

The impact of polypharmacy should be considered when designing nutritional management strategies for rehabilitation patients to maximize rehabilitation outcomes.

Better nutrition trajectory improves recovery following a hip fracture surgery for older persons with diabetes mellitus

BACKGROUND

Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported.

AIMS

To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM.

METHODS

A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge.

RESULTS

Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms.

DISCUSSION

Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery.

CONCLUSIONS

Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.

Malnutrition Screening and Assessment

Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.

Whey Protein, Leucine- and Vitamin-D-Enriched Oral Nutritional Supplementation for the Treatment of Sarcopenia

Sarcopenia has been recognized as a muscle disease, with adverse consequences on health. Updated recommendations, aimed at increasing awareness of sarcopenia and its accompanying risks, have been produced to urge the early detection and treatment of this disease. Recommended treatment is based on an individually tailored resistance exercise training program, the optimization of protein intake using high-quality protein sources (i.e., whey protein) in order to provide a high amount of essential amino acids—particularly leucine—and addressing vitamin D deficiency/insufficiency. The purpose of this review is to collate and describe all of the relevant efficacy studies carried out with a muscle-targeted oral nutritional supplementation (MT-ONS)—namely a whey-protein-based, leucine- and vitamin D-enriched formula aimed at optimizing their intake and satisfying their requirements—in different patient populations and clinical settings in order to determine if there is enough evidence to recommend prescription for the treatment of sarcopenia or its prevention in high-risk patient populations. Trials using a MT-ONS with or without a concomitant physical exercise program were systematically searched (up to June 2021), and those addressing relevant endpoints (muscle mass, physical performance and function) were critically reviewed. In total, 10 articles providing efficacy data from eight trials were identified and narratively reviewed. As far as older patients with sarcopenia are concerned, MT-ONS has been pertinently tested in six clinical trials (duration 4–52 weeks), mostly using a high-quality randomized controlled trial design and demonstrating efficacy in increasing the muscle mass and strength, as well as the physical performance versus iso-caloric placebo or standard practice. Consistent results have been observed in various clinical settings (community, rehabilitation centers, care homes), with or without adjunctive physical exercise programs. A positive effect on markers of inflammation has also been shown. A muscle-protein-sparing effect, with benefits on physical performance and function, has also been demonstrated in patients at risk of losing skeletal muscle mass (three trials), such as older patients undergoing weight loss or intensive rehabilitation programs associated with neurological disability (Parkinson’s disease). MT-ONS has demonstrated not only a significant efficacy in clinical variables, but also a positive impact on healthcare resource consumption in the rehabilitation setting (length of stay and duration of rehabilitation). In summary, MT-ONS, alone or in association with an appropriate exercise program, is an effective therapy for older patients with sarcopenia and should be offered as a first-line treatment, not only to improve clinical outcomes but also to reduce healthcare resource consumption, particularly in patients admitted to a rehabilitation center.

Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study

BACKGROUND

Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one's nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely.

OBJECTIVE

This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting.

METHODS

Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS).

RESULTS

In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%).

CONCLUSIONS

The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change.

Combating sarcopenia in geriatric rehabilitation patients: study protocol of the EMPOWER-GR observational cohort, sarcopenia awareness survey and randomised controlled feasibility trial

INTRODUCTION

Sarcopenia is highly prevalent in geriatric rehabilitation patients. Resistance exercise training (RET) combined with protein supplementation is recommended to increase muscle mass and strength in older adults. However, sarcopenia awareness, feasibility to diagnose and treat sarcopenia, and efficacy of treatment in geriatric rehabilitation patients remain to be established.

METHODS AND ANALYSIS

Enhancing Muscle POWER in Geriatric Rehabilitation (EMPOWER-GR) encompasses four pillars: (1) an observational cohort study of 200 geriatric rehabilitation inpatients determining sarcopenia prevalence, functional and nutritional status at admission; (2) a survey among these 200 patients and 500 healthcare professionals and semistructured interviews in 30 patients and 15 carers determining sarcopenia awareness and barriers/enablers regarding diagnostics and treatment; (3) a feasibility, single-centre, randomised, controlled, open-label, two parallel-group trial in 80 geriatric rehabilitation patients with sarcopenia. The active group (n=40) receives three RET sessions per week and a leucine and vitamin D-enriched whey protein-based oral nutritional supplement two times per day in combination with usual care for 13 weeks. The control group (n=40) receives usual care. Primary outcomes are feasibility (adherence to the intervention, dropout rate, overall feasibility) and change from baseline in absolute muscle mass at discharge and week 13. Secondary outcomes are feasibility (participation rate) and change from baseline at discharge and week 13 in relative muscle mass, muscle strength, physical and functional performance, mobility, nutritional status, dietary intake, quality of life and length of stay; institutionalisation and hospitalisation at 6 months and mortality at 6 months and 2 years; (4) knowledge sharing on sarcopenia diagnosis and treatment.

ETHICS AND DISSEMINATION

Ethical exemption was received for the observational cohort study, ethics approval was received for the randomised controlled trial. Results will be disseminated through publications in scientific peer-reviewed journals, conferences and social media.

TRIAL REGISTRATION NUMBER

NL9444.

Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis

Background

Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke.

Methods

CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition.

Results

The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively.

Conclusion

INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.

Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke

Evidence is scarce regarding the polypharmacy in patients with sarcopenia. The aim of this study was to investigate the effect of deprescribing for polypharmacy on the improvement of nutritional intake and sarcopenia in older patients with sarcopenia. A retrospective cohort study was conducted with hospitalized older patients with sarcopenia undergoing rehabilitation after stroke. Study outcomes included energy intake, protein intake, handgrip strength (HG) and skeletal muscle mass index (SMI) at hospital discharge. To consider the effects of deprescribing for polypharmacy, we used multivariate analyses to examine whether the change in the number of medications during hospitalization was associated with outcomes. Of 361 patients after enrollment, 91 (mean age 81.0 years, 48.4% male) presented with sarcopenia and polypharmacy and were eligible for analysis. The change in the number of medications was independently associated with energy intake (β = −0.237, p = 0.009) and protein intake (β = −0.242, p = 0.047) at discharge, and was not statistically significantly associated with HG (β = −0.018, p = 0.768) and SMI (β = 0.083, p = 0.265) at discharge, respectively. Deprescribing was associated with improved nutritional intake in older sarcopenic patients with polypharmacy undergoing stroke rehabilitation.

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

PURPOSE OF REVIEW

We describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals.

RECENT FINDINGS

Recent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established.

SUMMARY

The International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence-practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.

What do geriatric rehabilitation patients and experts consider relevant? Requirements for a digitalised e-coach for sustainable improvement of nutrition and physical activity in older adults - a qualitative focus group study

Background

During geriatric rehabilitation, attempts are made to increase the patients’ health and functional capacity. In order to maintain these improvements in the medium- and long-term, behavioural changes regarding mobility and nutrition are also targeted, but these are often not sustainable. International studies show positive effects on the sustainability of the improvement of physical activity behaviour in healthy seniors through the use of electronic devices and software applications. Comparable approaches that include nutrition topics or combine them and were additionally developed for geriatric rehabilitation patients (≥70 years) to date are not known. The aim of this study was to identify what geriatric rehabilitation patients require from an electronic coaching system (e-coach) to support them in improving their nutritional and physical activity behaviour, and what content and features physiotherapists and dieticians consider relevant.

Method

Focus group interviews (09–11/2019) were conducted in a geriatric rehabilitation centre in Germany with patients aged 70 years and older, relatives and experts (physiotherapists and nutritionists). The focus groups were recorded, transcribed verbatim and analysed using content analysis.

Results

Three focus groups with patients and relatives (n = 17, 65% female, 16 (94%) in age category 70–99 years) and one focus group with experts (2 dieticians and 1 physiotherapist) were conducted. Relevant contents and feedback elements for nutrition and physical activity in old age were identified. The patients’ comments show that an e-coach must offer obvious benefits for the older persons and promote motivation in order to be used. The willingness to change nutrition and physical activity behaviour and the previous experiences in these areas are very heterogeneous, therefore content should be adaptable to different requirements.

Conclusion

Experts and patients identified quite similar contents, barriers and facilitators for a nutrition and physical activity e-coach. The e-coach needs to be able to address different points of behaviour change, enable adaptations to the individual patient and convince the older person that using it will help them to improve their nutrition and physical activity. It is also important that the e-coach is easy to use and can be easily integrated into the patient’s everyday life after rehabilitation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02692-y.

Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation

Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset–admission interval (OR = 1.04; 95% CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95% CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95% CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments.

Stored Energy Increases Body Weight and Skeletal Muscle Mass in Older, Underweight Patients after Stroke

We conducted a retrospective observational study in 170 older, underweight patients after stroke to elucidate whether stored energy was associated with gains in body weight (BW) and skeletal muscle mass (SMM). Energy intake was recorded on admission. The energy requirement was estimated as actual BW (kg) × 30 (kcal/day), and the stored energy was defined as the energy intake minus the energy requirement. Body composition was measured by bioelectrical impedance analysis. The study participants gained an average of 1.0 ± 2.6 kg of BW over a mean hospital stay of 100 ± 42 days with a mean stored energy of 96.2 ± 91.4 kcal per day. They also gained an average of 0.2 ± 1.6 kg of SMM and 0.5 ± 2.3 kg of fat mass (FM). This means about 9600 kcal were needed to gain 1 kg of BW. In addition, a 1 kg increase in body weight resulted in a 23.7% increase in SMM and a 45.8% increase in FM. Multivariate regression analyses showed that the stored energy was significantly associated with gains in BW and SMM. Aggressive nutrition therapy is important for improving nutritional status and function in patients with malnutrition and sarcopenia.

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

Risk of Weight Loss in Adult Patients and the Effect of Staffing Registered Dietitians in Kaifukuki (Convalescent) Rehabilitation Wards: A Retrospective Analysis of a Nationwide Survey

There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss.

Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT

Malnutrition is associated with poor functional performance in geriatric rehabilitation inpatients. However, it is unclear if malnourished patients have poor functional trajectories over time. This study aimed to determine the association between (the risk of) malnutrition at admission and trajectories of Activities of Daily Living (ADL) and Instrumental ADL (IADL) from pre-admission to post-discharge in geriatric rehabilitation inpatients. An observational, longitudinal study was conducted in the REStORing health of acutely unwell adulTs (RESORT) cohort of geriatric rehabilitation inpatients. A total of 618 patients (mean age 82.1 ± 7.8 years, 57.4 % females) were included. The prevalence of the risk of malnutrition, by Malnutrition Screening Tool (MST) was 41.3 % (n = 255) and malnutrition by the Global Leadership Initiative on Malnutrition (GLIM) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were 53.5 % (n = 331) and 13.1 % (n = 81) respectively. Malnutrition by the GLIM criteria but not the ESPEN criteria nor the risk of malnutrition, was associated with ADL trajectories of 'remained poor' (OR: 3.33, 95 %CI: 1.21-9.19) and 'deteriorated' (OR: 1.68, 95 %CI: 1.13-2.52) compared to the 'recovered' trajectory. The risk of malnutrition and malnutrition were not associated with IADL trajectories. Malnutrition at admission was associated with poor ADL trajectories but not IADL trajectories in geriatric rehabilitation inpatients.

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions. Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes. Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment ("prehabilitation" listed in keywords, title, or abstract). Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED. Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention. Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes. Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.

Predictive validity of the Mini Nutritional Assessment Short-Form for rehabilitation patients: A retrospective analysis of the Japan Rehabilitation Nutrition Database

BACKGROUND

Malnutrition is associated with worse outcome in rehabilitation patients; however, appropriate malnutrition screening tools for this population have not been investigated. We examined the predictive validity of specific cut-off values of the Mini Nutritional Assessment Short-Form version 2 (MNA-SFv2) for Japanese rehabilitation patients.

METHODS

This retrospective cohort study analyzed adult patients (≥ 20 years) in the Japan Rehabilitation Nutrition Database who were in convalescent rehabilitation wards after stroke or hip fracture. Patients were classified into three categories based on MNA-SFv2 original (0-7, 8-11 and 12-14 points, respectively) or modified (0-5, 6-7 and 8-14 points, respectively) cut-off values: malnutrition, at risk of malnutrition or well-nourished. Functional independence measure (FIM) and home discharge were compared between the categories.

RESULTS

Overall, 489 patients were analyzed. Based on the MNA-SFv2 original and modified cut-off values, 64.4% and 36.0% were malnourished, 32.3% and 28.4% were at risk of malnutrition, and 3.3% and 35.6% were well-nourished, respectively. Malnutrition defined by both cut-off values was significantly associated with the FIM at admission, whereas only those defined by modified cut-off values predicted the FIM at discharge (B, -7.1; 95% confidence interval = -12.3 to -1.9). Neither original, nor modified cut-off values predicted discharge to home and long-term care facilities.

CONCLUSIONS

An MNA-SFv2 score of 0-5 points may be useful to identify Japanese patients with poor outcomes in a rehabilitation setting.

Vitamin D Deficiency is Associated with Handgrip Strength, Nutritional Status and T2DM in Community-Dwelling Older Mexican Women: A Cross-Sectional Study

The aim of this study was to evaluate the association between handgrip strength, nutritional status and vitamin D deficiency in Mexican community-dwelling older women. A cross sectional study in women ≥ 60 years-old was performed. Plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured by a quantitative immunoassay technique. Handgrip strength was assessed using a dynamometer, while nutritional status was assessed through the Full Mini Nutritional Assessment (Full-MNA). A total of 116 women participated in the study, their mean age was 70.3 ± 5.8 years; 49.1% of the study group had plasma 25(OH)D levels lower than 40 nmol/L [16 ng/mL]. Meanwhile, 28.45% of participants had low handgrip strength (<16 kg), and 23.1% were identified at risk of malnutrition/malnourished according with Full-MNA score. Women with 25(OH)D deficiency (<40 nmol/L [16 ng/mL]) were more likely to have low handgrip strength (OR = 2.64, p = 0.025) compared with those with higher 25(OH)D values. Additionally, being malnourished or at risk of malnutrition (OR = 2.53, p = 0.045) or having type 2 diabetes mellitus (T2DM) (OR = 2.92, p = 0.044) was also associated with low 25(OH)D. The prevalence of low plasma 25(OH)D concentrations was high among Mexican active older women. Low handgrip strength, being at risk of malnutrition/malnourished, or diagnosed with T2DM was also associated with Vitamin D deficiency.

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

BACKGROUND & AIMS

Malnutrition and sarcopenia coexist in older adults, yet they remain largely undiagnosed and untreated, despite available interventions. This study aimed to assess the prevalence, the coexistence of, and the association between malnutrition and sarcopenia in geriatric rehabilitation inpatients.

METHODS

REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The association between malnutrition, diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2) (no sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia) was determined using multinomial logistic regression analyses, adjusted for age, sex, comorbidities and cognitive impairment.

RESULTS

Out of 506 geriatric rehabilitation inpatients, 51% were malnourished, 49% had probable sarcopenia, 0.4% had confirmed sarcopenia (non-severe) and 19% had severe sarcopenia. Malnutrition and probable sarcopenia and malnutrition and confirmed/severe sarcopenia coexisted in 23% and 13% of the 506 patients respectively. Malnutrition was not associated with probable sarcopenia (OR = 0.91, 95% CI = 0.58-1.42, p = 0.674) but with severe sarcopenia (OR = 2.07, 95% CI = 1.13-3.81, p = 0.019).

CONCLUSION

The prevalence, coexistence of, and the association between malnutrition and severe sarcopenia in geriatric rehabilitation inpatients warrant diagnosis at admission. Further research into feasible and effective interventions to counteract both conditions to improve geriatric rehabilitation outcomes is needed.

The associations between nutritional status, physical function and skeletal muscle mass of geriatric patients with colorectal cancer

BACKGROUND & AIMS

Nutritional status is associated with physical function and body composition. However, these relationships in patients with colorectal cancer remain poorly understood. This study aimed to investigate the association between nutritional status, physical function, and skeletal muscle mass in geriatric patients with colorectal cancer.

METHODS

Preoperative patients diagnosed with colorectal cancer were recruited for this cross-sectional observational study. The correlations were calculated using Spearman's rank correlation coefficient, and the intergroup differences in physical function and skeletal muscle mass between categories according to nutritional assessment were analyzed using the Mann-Whitney U test or Kruskal-Wallis test.

RESULTS

We recruited 127 patients (median age 71.0 years). Hand grip strength was correlated with geriatric nutritional risk index (GNRI) (male: p = 0.033; female: p = 0.014), albumin (male: p = 0.014; female: p = 0.003), and controlling nutritional status (CONUT) score (male: p = 0.004; female: p = 0.011) in both gender, and correlated with body mass index (BMI) (p = 0.027) in male patients. Psoas volume index (PVI) was positively correlated with BMI (male: p = 0.005; female: p < 0.001). In addition, intergroup comparisons for categories according to BMI showed PVI was significantly lower in the malnutrition category (male: p = 0.017; female: p < 0.001). Albumin and CONUT score were correlated with five-times sit-to-stand test (male: p = 0.011; female: p = 0.049, male: p = 0.031; female: p = 0.012, respectively) and short physical performance battery (male: p = 0.065; female: p = 0.028, male: p = 0.002; female: p = 0.006, respectively). Moreover, patients in lower albumin category had longer time on 5-times sit-to-stand test (male: p = 0.018; female: p = 0.009) and had lower scores on short physical performance battery (male: p = 0.027; female: p = 0.039).

CONCLUSIONS

Hand grip strength correlated with various nutritional assessment tools, and PVI was correlated with BMI in particular. Five-times sit-to-stand test and short physical performance battery were correlated with serum albumin concentration and CONUT score. Physical function and skeletal muscle mass are associated with nutritional status, and hand grip strength might be more strongly associated with nutritional status.

The effect of vitamin D plus protein supplementation on sarcopenia: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

The exact effect of vitamin D supplementation, either as monotherapy or in combination with protein, on musculoskeletal health in patients with sarcopenia is currently unknown. This study aimed to determine the effect of vitamin D alone or with protein supplementation on muscle strength, mass, and performance in this population.

METHODS

A comprehensive search was conducted in Medline, Cochrane Central and Scopus databases, up to March 31^st, 2020. Data were expressed as standardized mean difference (SMD) with 95 % confidence intervals (CI). I² index was employed for heterogeneity.

RESULTS

The initial search identified 1164 studies, eight of which met the eligibility criteria for qualitative and quantitative analysis, yielding a total of 776 patients. Vitamin D (100-1600 IU/day) plus protein (10-44 g/day) supplementation exhibited a beneficial effect on muscle strength, as demonstrated by an improvement in handgrip strength (SMD 0.38 ± 0.07, 95 % CI 0.18-0.47, p = 0.04; I² 76.2 %) and a decrease in the sit-to-stand time (SMD 0.25 ± 0.09, 95 % CI 0.06-0.43, p = 0.007; I² 0%) compared with placebo. However, the effect on muscle mass, assessed by skeletal muscle index, was marginally non-significant (SMD 0.25 ± 0.13, 95 % CI -0.006-0.51, p = 0.05; I² 0%). No effect on appendicular skeletal muscle mass or muscle performance (assessed by walking speed) was observed with vitamin D plus protein.

CONCLUSIONS

Vitamin D supplementation, combined with protein, improves muscle strength in patients with sarcopenia, but has no effect on muscle mass or performance.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.