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

Frailty, polypharmacy, malnutrition, chronic conditions, and quality of life in the elderly: Large population-based study

BACKGROUND

Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes).

OBJECTIVE

To investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in the elderly (≥65 years) at the population level.

METHODS

A large representative sample was randomly selected from a county with 17 towns and 811,867 residents, with multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL assesses and compared between geriatric and nongeriatric populations and among subgroups of the elderly. Associations of demographic information and chronic conditions with geriatric conditions and QoL in the elderly were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines (RCS)-based multivariable-adjusted dose-response analysis.

RESULTS

Elderly people comprised 43.4% of the whole population, and prevalence of frailty, (pre-)malnutrition, polypharmacy, and impaired QoL among the elderly (median age, 73 years; male proportion, 51.0%) was 8.3%, 15.6%, 3.2%, and 10.8%, respectively. Prevalence of geriatric syndromes mostly did not significantly differ among different age subgroups of the elderly (except that frailty occurred more often with older age) or by gender. (Pre-)malnutrition was significantly associated with less often obesity and more frequent constipation, polypharmacy with more often diabetes and constipation, frailty with more frequent constipation and hernia, and impaired QoL with more often hypertension, diabetes, physical disability, and constipation. MNA-SF, GFI, and EQ-5D-5L scores and number of drugs used mostly significantly predicted the other geriatric syndromes and QoL. Impaired QoL was significantly associated with more often frailty, (pre-)malnutrition, and polypharmacy, and frailty with more frequent (pre-)malnutrition and polypharmacy. At 1.5-year follow-up, impaired QoL was significantly linked to polypharmacy and frailty at baseline; (pre-)malnutrition was significantly associated with frailty at baseline; polypharmacy was significantly linked to frailty at baseline; frailty was significantly linked to both (pre-)malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the linkage between polypharmacy and worse QoL, and also that polypharmacy mediated the linkage between frailty and worse QoL.

CONCLUSIONS

In this large population-based study of the elderly with prospective follow-up, multiple chronic conditions were associated with one or more of the investigated geriatric syndromes. Geriatric syndromes were mostly significantly intercorrelated with and well predictive of each other and QoL, and there existed causal relationships between geriatric syndromes and QoL with other geriatric syndromes being mediators. The findings might be subject to some bias due to residual confounding factors not available in the dataset. It would be important to perform personalized geriatric syndromes stratified by chronic conditions, and active prevention or intervention of any syndrome might help to reduce the others and improve QoL.

CLINICALTRIAL

Prevalence of malnutrition and impact on 30-day hospital readmission in adults receiving home care and ambulatory care: A descriptive cohort study

BACKGROUND

Little is known about the prevalence of malnutrition among patients receiving home care (HC) and ambulatory care (AC) services. Further, the risk of hospital readmission in malnourished patients transitioning from hospital to HC or AC is also not well established. This study aims to address these two gaps.

METHODS

A descriptive cohort study of newly referred HC and AC patients between January and December 2019 was conducted. Nutrition status was assessed by clinicians using the Mini Nutritional Assessment-Short Form (MNA-SF). Prevalence of malnutrition and at risk of malnutrition (ARM) was calculated, and a log-binomial regression model was used to estimate the relative risk of hospital readmission within 30 days of discharge for those who were malnourished and referred from hospital.

RESULTS

A total of 3704 MNA-SFs were returned, of which 2402 (65%) had complete data. The estimated prevalence of malnutrition and ARM among newly referred HC and AC patients was 21% (95% CI: 19%-22%) and 55% (95% CI: 53%-57%), respectively. The estimated risk of hospital readmission for malnourished patients was 2.7 times higher (95% CI: 1.9%-3.9%) and for ARM patients was 1.9 times higher (95% CI: 1.4%-2.8%) than that of patients with normal nutrition status.

CONCLUSION

The prevalence of malnutrition and ARM among HC and AC patients is high. Malnutrition and ARM are correlated with an increased risk of hospital readmission 30 days posthospital discharge.

Exploring the complex associations among risks of malnutrition, sarcopenia, and frailty in community-dwelling older adults

BACKGROUND

Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults.

METHODS

This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.

RESULTS

The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).

CONCLUSIONS

The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.

Preliminary evaluation of home-delivered meals for reducing frailty in older adults at risk for mal-nutrition

OBJECTIVE

To examine the potential benefit of home-delivered meals for reducing frailty levels among community-dwelling older adults at risk for malnutrition.

DESIGN

A retrospective, single-group observational approach.

SETTING

One large home-delivered meal agency in the Midwest United States.

PARTICIPANTS

1090 community-dwelling older adults who received home-delivered meal services, funded through the Older Americans Act, between June 2020 and December 2021.

MEASUREMENT

Frailty status was measured by the Home Care Frailty Scale (HCFS) which was routinely administered by agency staff to home-delivered meal clients as part of a quality improvement project. The HCFS was administered at the start of meal services, 3-months after meals began, and 6-months after meals began.

RESULTS

At baseline, 55.4% of clients were found to be at high risk for malnutrition. While there was a significant and consistent decline in HCFS throughout the follow-up period for both high and low nutritional risk groups, the reduction in frailty from baseline to 6-months was greater for the high nutritional risk group (Δ = -1.9; 95% CI: [-2.7, -1.1]; p < 0.001) compared to those with low nutritional risk (Δ = -1.5; 95% CI: [-2.3, -0.7]; p < 0.001). Compared to those who lived alone, clients who lived with other individuals presented with higher levels of frailty at baseline and 3-month follow-up for both low and high malnutrition risk groups.

CONCLUSION

Home-delivered meal clients are commonly at risk for both frailty and malnutrition. Home-delivered meal programs, which are intended to reduce malnutrition among older adults, may serve as a promising solution for reducing frailty in the vulnerable aging population.

Factors associated with frailty in geriatric patients with and without sarcopenia in Vietnam

OBJECTIVES

This study aimed to investigate the relationship between sarcopenia and frailty and examine factors associated with frailty among older patients with and without sarcopenia.

METHODS

This cross-sectional study was conducted on older inpatients and outpatients in Vietnam. Participants aged 60 years or older were consecutively enrolled in the study. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Fried's frailty phenotype was applied to define frailty. Logistic regression models with frailty as the dependent variable were applied.

RESULTS

A total of 835 patients (mean age: 71.3 years, SD 8.4) were recruited. The overall prevalence of frailty was 17%. Among participants with and without frailty, 92% and 47% had sarcopenia, respectively. In unadjusted analysis, sarcopenia was significantly associated with increased frailty (OR 12.3, 95% CI 6.7-22.6) and remained significant after adjustment for sociodemographic factors (OR 6.3, 95% CI: 3.0-12.6) and for both sociodemographic and clinical factors (OR 5.4, 95% CI: 2.4-12.2). Among participants with sarcopenia, older age, inpatient status, having a high risk for falls, malnutrition and a history of hospitalisation in the last year were significantly associated with frailty. Among participants without sarcopenia, the factors associated with frailty were older age, inpatient status, low educational level, high risk of falls and malnutrition.

CONCLUSIONS

Our study results highlighted that sarcopenia and frailty are two related but distinct geriatric syndromes.

Relationship between skeletal muscle index at the third lumbar vertebra with infection risk and long-term prognosis in patients with acute-on-chronic liver failure

Objective

Infection is a major cause of increased mortality in patients with acute-on-chronic liver failure (ACLF). This study aims to examine the potential correlation of the skeletal muscle index at the third lumbar vertebra (L3-SMI) with infections among ACLF patients and to evaluate its impact on the long-term survival.

Methods

This retrospective study included 126 patients who underwent abdominal computed tomography (CT) and were diagnosed with ACLF at our center between December 2017 and December 2021. L3-SMI was calculated using CT, and the clinical and biochemical data as well as MELD scores were also collected, so as to analyze the relationship between L3-SMI and infections in ACLF patients and the impact on long-term prognosis.

Results

Of the 126 ACLF patients enrolled, 50 had infections. In the multivariate logistic regression analysis, both L3-SMI [odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.81 - 0.97, P = 0.011] and hepatic encephalopathy (OR = 8.20, 95% CI = 1.70 - 39.59, P = 0.009) were independently associated with the risk of infection development. The overall survival (OS) estimates were obtained using Kaplan-Meier curves, and it was found that patients in the lowest tertile of L3-SMI had significantly lower 3-month, 6-month, 1-year, and 2-year survival rates than those in the highest tertile (P = 0.014; log-rank test).

Conclusion

Low L3-SMI is an independent risk factor for the development of infections and significantly influences the long-term survival in ACLF patients.

Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM).

METHODS

A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity).

RESULTS

The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47).

CONCLUSIONS

In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.