1
|
Wang W, Tang W, Yao W, Lv Q, Ding W. Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients. Front Med (Lausanne) 2024; 11:1366012. [PMID: 39076765 PMCID: PMC11284060 DOI: 10.3389/fmed.2024.1366012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/10/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs. Methods A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs. Results The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23-4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14-0.17; OR 2.11, 95% CI 1.07-4.15), Q3 (0.17-0.21; OR 3.36, 95% CI 1.74-6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84-14.83) patients had significantly higher odds of UTIs. Conclusion GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| |
Collapse
|
2
|
Wang J, Bai J, Wang H, Xu G, Yao R, Li J, Zhang W, Wang H, Yao J, Ren X. 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. Front Nutr 2024; 10:1327832. [PMID: 38268672 PMCID: PMC10806060 DOI: 10.3389/fnut.2023.1327832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Juan Wang
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Jinjia Bai
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Huimin Wang
- Endoscopy Center, Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Guofen Xu
- Department of Gastroenterology, Jincheng General Hospital, Shanxi Medical University, Taiyuan, China
| | - Ruoyu Yao
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Jing Li
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Wenrui Zhang
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Han Wang
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Jia Yao
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| | - Xiaojing Ren
- Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China
| |
Collapse
|
3
|
Calder PC. Nutrition and immunity: lessons from coronavirus disease-2019. Proc Nutr Soc 2023:1-16. [PMID: 37886807 DOI: 10.1017/s0029665123004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.
Collapse
Affiliation(s)
- Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
| |
Collapse
|
4
|
Yao W, Tang W, Wang W, Lv Q, Ding W. Correlation between admission hypoalbuminemia and postoperative urinary tract infections in elderly hip fracture patients. J Orthop Surg Res 2023; 18:774. [PMID: 37838687 PMCID: PMC10576304 DOI: 10.1186/s13018-023-04274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE This study aimed to evaluate the correlation between hypoalbuminemia upon admission and the incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures. METHODS A retrospective analysis was performed on the medical records of elderly patients who underwent surgical treatment for hip fractures at a level I trauma center from 2013 to 2023. Serum albumin levels were measured upon admission, and hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression and propensity score matching analysis were utilized to control and reduce potential confounding factors, aiming to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CI) for UTIs to determine the strength of the association. RESULTS This observational cohort study included 1279 patients, among whom 298 (23.3%) developed UTIs. Patients with albumin levels < 35 g/L had significantly greater odds of developing UTIs compared to those with albumin levels ≥ 35 g/L (OR 1.86, 95% CI 1.28-2.70). Further analysis, dividing albumin levels into quartiles, demonstrated that patients in the Q2 group (38.0-40.9 g/L; OR 1.38, 95% CI 0.88-2.17), Q3 group (35.0-37.9 g/L; OR 1.69, 95% CI 1.06-2.71), and Q4 group (15.3-34.9 g/L; OR 2.67, 95% CI 1.61-4.43) had notably higher odds of developing UTIs compared to those in the Q1 group (41.0-52.0 g/L). CONCLUSIONS The presence of hypoalbuminemia upon admission in elderly patients undergoing hip fracture surgery is strongly correlated with the occurrence of postoperative UTIs. Furthermore, this association exhibits a clear dose-response relationship.
Collapse
Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, People's Republic of China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China.
| |
Collapse
|
5
|
Yanagita Y, Arizono S, Tawara Y, Oomagari M, Machiguchi H, Yokomura K, Katagiri N, Iida Y. The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: A retrospective observational study. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:522-532. [PMID: 35789107 PMCID: PMC9329015 DOI: 10.1111/crj.13521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yorihide Yanagita
- Department of Physical Therapy, School of Health Science Toyohashi Sozo University Toyohashi City Aichi Prefecture Japan
- Department of Rehabilitation Seirei Mikatahara General Hospital Hamamatsu City Shizuoka Prefecture Japan
| | - Shinichi Arizono
- Department of Physical Therapy, School of Rehabilitation Science Seirei Christopher University Hamamatsu City Shizuoka Prefecture Japan
| | - Yuichi Tawara
- Department of Physical Therapy, School of Rehabilitation Science Seirei Christopher University Hamamatsu City Shizuoka Prefecture Japan
| | - Masaki Oomagari
- Department of Rehabilitation Seirei Mikatahara General Hospital Hamamatsu City Shizuoka Prefecture Japan
| | - Hikaru Machiguchi
- Department of Rehabilitation Seirei Mikatahara General Hospital Hamamatsu City Shizuoka Prefecture Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine Seirei Mikatahara General Hospital Hamamatsu City Shizuoka Prefecture Japan
| | - Norimasa Katagiri
- Department of Rehabilitation Medicine Seirei Mikatahara General Hospital Hamamatsu City Shizuoka Prefecture Japan
| | - Yuki Iida
- Department of Physical Therapy, School of Health Science Toyohashi Sozo University Toyohashi City Aichi Prefecture Japan
| |
Collapse
|
6
|
Bellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients 2022; 14:nu14040910. [PMID: 35215559 PMCID: PMC8880030 DOI: 10.3390/nu14040910] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
Collapse
|
7
|
Poisson J, Martinez-Tapia C, Heitz D, Geiss R, Albrand G, Falandry C, Gisselbrecht M, Couderc AL, Boulahssass R, Liuu E, Boudou-Rouquette P, Chah Wakilian A, Gaxatte C, Pamoukdjian F, de Decker L, Antoine V, Cattenoz C, Solem-Laviec H, Guillem O, Medjenah H, Natella PA, Canouï-Poitrine F, Laurent M, Paillaud E. Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer). J Cachexia Sarcopenia Muscle 2021; 12:1477-1488. [PMID: 34519440 PMCID: PMC8718093 DOI: 10.1002/jcsm.12776] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. METHODS A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. RESULTS Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. CONCLUSIONS More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.
Collapse
Affiliation(s)
- Johanne Poisson
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France
| | - Claudia Martinez-Tapia
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
| | - Damien Heitz
- Oncology and Hematology Unit, Strasbourg University Hospital Center - Hautepierre Hospital, Strasbourg, France
| | - Romain Geiss
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Gilles Albrand
- Geriatric Oncology Unit, Antoine Charial hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Geriatrics Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mathilde Gisselbrecht
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Anne-Laure Couderc
- AP-HM, Division of Internal Medicine, Geriatric Medicine and Therapeutic, Sainte Marguerite Hospital, Marseille, France
| | | | - Evelyne Liuu
- Geriatric Department, CHU La Milétrie, Poitiers, France
| | | | - Anne Chah Wakilian
- Geriatric Department, Broca Hospital, Paris Centre Hospitals, Paris Descartes University, Paris, France
| | - Cedric Gaxatte
- Geriatric Oncology Unit, Lille University Hospital, Lille, France
| | - Fréderic Pamoukdjian
- AP-HP, Geriatric Oncology Unit, Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Laure de Decker
- Clinical Gerontology Department, Nantes University Hospital Center, Nantes, France
| | - Valery Antoine
- Department of Geriatric Medicine, Nimes University Hospital, Nimes, France
| | | | - Heidi Solem-Laviec
- Geriatric Oncology Unit, Oncology Supportive Care Department, François Baclesse Regional Cancer Center, Caen, France
| | - Olivier Guillem
- Geriatric Medicine Unit, Inter-communal Hospital Center from Southern Alps, Gap, France
| | - Hayat Medjenah
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Pierre André Natella
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Florence Canouï-Poitrine
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France.,Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Marie Laurent
- Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France.,INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
| |
Collapse
|
8
|
Fluck D, Fry CH, Gulli G, Affley B, Robin J, Kakar P, Sharma P, Han TS. Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: A multicenter, registry-based cohort study. Nutr Clin Pract 2021; 37:1233-1241. [PMID: 34664741 DOI: 10.1002/ncp.10790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Malnutrition in hospitals remains highly prevalent. As part of quality improvement initiatives, the Royal College of Physicians recommends nutrition screening for all patients admitted with acute stroke. We aimed to examine the associations of patients at risk of malnutrition with poststroke outcomes. METHODS We analyzed prospectively collected data from four hyperacute stroke units (HASUs) (2014-2016). Nutrition status was screened in 2962 acute stroke patients without prestroke disability (1515 men, [mean ± SD] 73.5 years ± 13.1; 1447 women, 79.2 ± 13.0 years). The risk of malnutrition was tested against stroke outcomes and adjusted for age, sex, and comorbidities. RESULTS Risk of malnutrition was identified in 25.8% of patients). Compared with well-nourished patients, those at risk of malnutrition had, within 7 days of admission, increased risk of stay on the HASU of >14 days (odds ratio [OR]: 9.9 [7.3-11.5]), disability on discharge (OR: 8.1 [6.6-10.0]), worst level of consciousness in the first 7 days (score ≥ 1) (OR: 7.5 [6.1-9.3]), mortality (OR: 5.2 [4.0-6.6], pneumonia (OR: 5.1 [3.9-6.7]), and urinary tract infection (OR: 1.5 [1.1-2.0]). They also required palliative care (OR: 12.3 [8.5-17.8]), discharge to new care home (OR: 3.07 [2.18-4.3]), activities of daily living support (OR: 1.8 [1.5-2.3]), planned joint care (OR: 1.5 [1.2-1.8]), and weekly visits (OR: 1.4 [1.1-1.8]). CONCLUSION Patients at risk of malnutrition more commonly have multiple adverse outcomes after acute stroke and greater need for early support on discharge.
Collapse
Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK.,Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
| |
Collapse
|
9
|
Abstract
The role of the immune system is to protect the individual against pathogenic organisms. Nutrition is one of multiple factors that determines the immune response and good nutrition is important in supporting the immune response. Immunity can be impaired in older people, particularly those who are frail, in those living with obesity, in those who are malnourished and in those with low intakes of micronutrients. The immune impairments associated with nutritional inadequacy increase susceptibility to infection and permit infections to become more severe, even fatal. The adverse impact of poor nutrition on the immune system, including its inflammatory component, may be one of the explanations for the higher risk of more severe outcomes from infection with SARS-CoV-2 seen in older people and in those living with obesity. Studies of individual micronutrients including vitamin D and zinc suggest roles in reducing severity of infection with SARS-CoV-2. Good nutrition is also important in promoting a diverse gut microbiota, which in turn supports the immune system. The importance of nutrition in supporting the immune response also applies to assuring robust responses to vaccination. There are many lessons from the study of nutrition and immunity that are relevant for the battle with SARS-CoV-2.
Collapse
|
10
|
Nutrition and immunity: lessons for COVID-19. Eur J Clin Nutr 2021; 75:1309-1318. [PMID: 34163017 PMCID: PMC8220366 DOI: 10.1038/s41430-021-00949-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 01/30/2023]
Abstract
The role of the immune system is to protect the individual against pathogenic organisms. Nutrition is one of multiple factors that determines the immune response and good nutrition is important in supporting the immune response. Immunity can be impaired in older people, particularly those who are frail, in those living with obesity, in those who are malnourished and in those with low intakes of micronutrients. The immune impairments associated with nutritional inadequacy increase susceptibility to infection and permit infections to become more severe, even fatal. The adverse impact of poor nutrition on the immune system, including its inflammatory component, may be one of the explanations for the higher risk of more severe outcomes from infection with SARS-CoV-2 seen in older people and in those living with obesity. Studies of individual micronutrients including vitamin D and zinc suggest roles in reducing severity of infection with SARS-CoV-2. Good nutrition is also important in promoting a diverse gut microbiota, which in turn supports the immune system. The importance of nutrition in supporting the immune response also applies to assuring robust responses to vaccination. There are many lessons from the study of nutrition and immunity that are relevant for the battle with SARS-CoV-2.
Collapse
|
11
|
Watson A, Wilkinson TMA. Respiratory viral infections in the elderly. Ther Adv Respir Dis 2021; 15:1753466621995050. [PMID: 33749408 PMCID: PMC7989115 DOI: 10.1177/1753466621995050] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13-31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential.The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Alastair Watson
- Faculty of Medicine, Clinical & Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Tom M. A. Wilkinson
- Faculty of Medicine, Clinical and Experimental Sciences, Southampton University, Mailpoint 810, Level F, South Block, Southampton General Hospital, Southampton, Hampshire, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
12
|
Avgerinou C, Bhanu C, Walters K, Croker H, Tuijt R, Rea J, Hopkins J, Kirby-Barr M, Kharicha K. Supporting nutrition in frail older people: a qualitative study exploring views of primary care and community health professionals. Br J Gen Pract 2020; 70:e138-e145. [PMID: 31932297 PMCID: PMC6960002 DOI: 10.3399/bjgp20x707861] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/08/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Malnutrition is associated with increased morbidity and mortality, and is very common in frail older people. However, little is known about how weight loss in frail older people can be managed in primary care. AIMS To explore the views and practices of primary care and community professionals on the management of malnutrition in frail older people; identify components of potential primary care-based interventions for this group; and identify training and support required to deliver such interventions. DESIGN AND SETTING Qualitative study in primary care and community settings. METHOD Seven focus groups and an additional interview were conducted with general practice teams, frailty multidisciplinary teams (MDTs), and community dietitians in London and Hertfordshire, UK (n = 60 participants). Data were analysed using thematic analysis. RESULTS Primary care and community health professionals perceived malnutrition as a multifaceted problem. There was an agreement that there is a gap in care provided for malnutrition in the community. However, there were conflicting views regarding professional accountability. Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition. Community MDT professionals and dietitians thought that an intervention to tackle malnutrition would be best placed in primary care and suggested opportunistic screening interventions. Education was an essential part of any intervention, complemented by social, emotional, and/or practical support for frailer or socially isolated older people. CONCLUSIONS Future interventions should include a multifaceted approach. Education tailored to the needs of older people, carers, and healthcare professionals is a necessary component of any intervention.
Collapse
Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London
| | - Cini Bhanu
- Department of Primary Care and Population Health, University College London, London
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London
| | - Helen Croker
- Health Behaviour Research Centre, University College London, London
| | - Remco Tuijt
- Department of Primary Care and Population Health, University College London, London
| | - Jennifer Rea
- Department of Primary Care and Population Health, University College London, London
| | - Jane Hopkins
- Patient and Public Involvement representative, London
| | | | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London
| |
Collapse
|
13
|
Abdoli A, Ardakani HM. Helminth infections and immunosenescence: The friend of my enemy. Exp Gerontol 2020; 133:110852. [PMID: 32007545 DOI: 10.1016/j.exger.2020.110852] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/13/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
Age-associated alterations of the immune system, which known as "immunosenescence", is characterized by a decline in innate and adaptive immunity, which leading to increased susceptibility to age-associated diseases, such as infectious diseases, rheumatic disease and malignancies. On the other hand, helminth infections are among the most prevalent infections in older individuals, especially in the nursing homes. Most of helminth infections have minor clinical symptoms and usually causing chronic infections without treatment. Nevertheless, chronic helminthiasis alters immune responses somewhat similar to the immunosenescence. Some similarities also exist between helminth infections and immunosenescence: 1) both of them led to declining the immune responses; 2) undernutrition is a consequence of immunosenescence and helminthiasis; 3) vaccine efficacy declines in aging and individuals with helminth infections; 4) increase incidence and prevalence of infectious diseases in the elder individuals and patients with helminth infections; and 5) both of them promote tumorigenesis. Hence, it is probable that helminth infections in the elderly population can intensify the immunosenescence outcomes due to the synergistic immunoregulatory effects of each of them. It would be suggested that, diagnosis, treatment and prevention of helminth infections should be more considered in older individuals. Also, it would be suggested that helminths or their antigens can be used for investigation of immunosenescence because both of them possess some similarities in immune alterations. Taken together, this review offers new insights into the immunology of aging and helminth infections.
Collapse
Affiliation(s)
- Amir Abdoli
- Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran; Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran; Research Center for Noncommunicable Diseases, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Hoda Mirzaian Ardakani
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
14
|
Lisk R, Uddin M, Parbhoo A, Yeong K, Fluck D, Sharma P, Lean MEJ, Han TS. Predictive model of length of stay in hospital among older patients. Aging Clin Exp Res 2019; 31:993-999. [PMID: 30191455 PMCID: PMC6589144 DOI: 10.1007/s40520-018-1033-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/29/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Most National Health Service (NHS) hospital bed occupants are older patients because of their frequent admissions and prolonged length of stay (LOS). We evaluated demographic and clinical factors as predictors of LOS in a single NHS Trust and derived an equation to estimate LOS. METHODS Stepwise logistic and linear regressions were used to predict prolonged LOS (upper-quintile LOS > 17 days) and LOS respectively, from demographic factors and acute and pre-existing conditions. RESULTS Of 374 (men:women = 127:247) admitted patients (20% to orthogeriatric, 69% to general medical and 11% to surgical wards), median age of 85 years (IQR = 78-90), 77 had acute first hip fracture; 297 had previous hip fracture (median time since previous fracture = 2.4 years) and 21 (7.1%) had recurrent hip fracture, with median time since first fracture = 2.4 years. Median LOS was 6.5 days (IQR = 1.8-14.8), and 38 (10.2%) died after 4.8 days (IQR = 1.6-14.3). Prolonged LOS was associated with discharge to places other than usual residence: OR = 3.1 (95% CI 1.7-5.7), acute stroke: OR = 10.1 (3.7-26.7), acute first hip fractures: OR = 6.8 (3.1-14.8), recurrent hip fractures: OR = 9.5 (3.2-28.7), urinary tract infection/pneumonia: OR = 4.0 (2.1-8.0), other acute fractures: OR = 9.8 (3.0-32.3) and malignancy: OR = 15.0 (3.1-71.8). Predictive equation showed estimated LOS was 11.6 days for discharge to places other than usual residence, 15 days for pre-existing or acute stroke, 9-14 days for acute and recurrent hip fractures, infections, other acute fractures and malignancy; these factors together explained 32% of variability in LOS. CONCLUSIONS A useful estimate of outcome and LOS can be made by constructing a predictive equation from information on hospital admission, to provide evidence-based guidance for resource requirements and discharge planning.
Collapse
Affiliation(s)
- Radcliffe Lisk
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Mahir Uddin
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
| | - Anita Parbhoo
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Keefai Yeong
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
| | - Michael E J Lean
- School of Medicine, Dentistry and Nursing, New Lister Building, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
| |
Collapse
|
15
|
Hu W, Xie S, Yu F, Hao W. Characteristics of pathogens and mortality predictors of older Chinese patients with nosocomial urinary tract infections. Geriatr Gerontol Int 2019; 19:541-546. [PMID: 30950159 DOI: 10.1111/ggi.13661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 02/05/2023]
Abstract
AIM The aim of the present study was to investigate predominant pathogens and predictors of 28-day mortality of older Chinese patients with nosocomial urinary tract infections (NUTI). METHODS We retrospectively studied 1122 older patients (aged ≥60 years) with culture-positive NUTI in Guangdong General Hospital, Guangzhou, China, from January 2009 to December 2014. The clinical features, microbial distributions and outcomes of these patients were recorded and compared between survival and death patients. Multivariate logistic regression was carried out to identify independent predictors of 28-day mortality. RESULTS The present results showed the all-cause mortality was 8.3%, and NUTI mortality was 1.43%. The proportions of Candida albicans (P = 0.004), Acinetobacter baumannii (P = 0.045) and Candida tropicalis (P < 0.001) in the death group were significantly higher than those in the survival group. Multivariate analysis showed two novel risk factors for mortality of older patients with NUTI, which were higher Charlson Comorbidity Index (odds ratio [OR] 1.205, 95% confidence interval (CI) 1.088-1.334] and lower level of serum prealbumin (OR 0.995, 95% CI 0.990-0.999). Furthermore, previous use of antibiotics (OR 1.984, 95% CI 1.106-3.559), inappropriate antimicrobial therapy (OR 1.883, 95% CI 1.144-3.098), intensive care unit stay (OR 4.082, 95% CI 2.469-6.749) and higher concentration of serum C-reactive protein (OR 1.005, 95% CI 1.001-1.010) were independent prognostic factors for 28-day mortality in older patients with NUTI. CONCLUSIONS NUTI is associated with a high 28-day in-hospital mortality rate in older patients. We should evaluate the comorbidity, nutritional status, inflammatory markers, department staying and drug sensitivity test, and choose systematic therapy strategies for these older patients with NUTI. Geriatr Gerontol Int 2019; 19: 541-546.
Collapse
Affiliation(s)
- Wenxue Hu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Shaoling Xie
- Department of Nephrology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Feng Yu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Wenke Hao
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| |
Collapse
|
16
|
[Undernutrition of the elderly]. Rev Med Interne 2019; 40:664-669. [PMID: 31113647 DOI: 10.1016/j.revmed.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/17/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
Malnutrition remains a particularly important issue in elderly. Physiological ageing induces many changes but ageing cannot entirely explain a Protein-Energy Malnutrition (PEM). Nutritionnal screening is indicated once a year in community medicine or in the first 48hours in case of an acute disease or of hospitalization. The Mini Nutritional Assessment is recommended for screening and for the diagnostic of malnutrition. Possible aetiologies are large and must be investigated in order to be careful not to dismiss curable disease and to be able to take corrective actions. PEM is associated to functional decline, length of stay in hospital and to morbi-mortality. Recommendations for dietary intakes in healthy old subjects are about 30 kcal/kg/day and 1 g/kg/day of protein and are strongly enhanced in case of acute or chronic diseases. The nutritional strategy depends on spontaneous food intake, medical situation, patient profile and opinion. Appropriate nutritional care could reduce morbidity-mortality and prevent functional decline in various disease contexts.
Collapse
|
17
|
Dent E, Hoogendijk EO, Visvanathan R, Wright ORL. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging 2019; 23:431-441. [PMID: 31021360 DOI: 10.1007/s12603-019-1176-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
Collapse
Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
| | | | | | | |
Collapse
|
18
|
Dadet S, Mulliez A, Ducher G, Bohatier J, Bonnefoy M, Lesourd B, Boirie Y. A new marker for nutritional assessment in acute care geriatric units: The phase angle measured by bioelectrical impedance analysis. Exp Gerontol 2018; 111:162-169. [DOI: 10.1016/j.exger.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 05/28/2018] [Accepted: 07/02/2018] [Indexed: 11/15/2022]
|
19
|
Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr 2018; 38:644-651. [PMID: 29789167 DOI: 10.1016/j.clnu.2018.04.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevention and management of malnutrition is increasingly recognised as a significant element of cancer care. By identifying and comparing cancer malnutrition in two large cross-sectional cancer populations, this study aims to provide a greater understanding of clinical characteristics and trajectories relating to cancer malnutrition. METHODS A multi-centre point prevalence study was conducted in Victoria, Australia at two time points (March 2012, May 2014). Adults with cancer receiving ambulatory chemotherapy, radiotherapy and multi-day inpatients were included. The presence of malnutrition was determined using Patient Generated-Subjective Global Assessment (PG-SGA). Demographic, clinical information and 30-day outcomes were collected. RESULTS The study included 1677 patients in 2012 (17 sites) and 1913 patients in 2014 (27 sites). Older age, ≥5% weight loss, hospital admission and metastatic disease were factors significantly associated with malnutrition. Patients with upper gastrointestinal, head and neck and lung cancers were more likely to be malnourished. Malnutrition was associated with infection and poor outcomes at 30-days. Malnutrition prevalence reduced from 31% in 2012 to 26% in 2014 (p = 0.002). This reflects a reduction in patients with malnutrition receiving ambulatory chemotherapy, those with upper gastrointestinal or colorectal cancers and those residing in regional areas. CONCLUSION The study has provided a comprehensive description of cancer malnutrition prevalence representative of all treatment settings, tumour types and stages of disease. This provides valuable insight into cancer malnutrition enabling oncology services to identify opportunities to embed identification and prevention strategies into models of care, resulting in improved patient outcomes and reduced health care costs.
Collapse
|
20
|
Cairns S, Gibbons C, Milne A, King H, Llano M, MacDonald L, Malcolm W, Robertson C, Sneddon J, Weir J, Reilly J. Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections? J Hosp Infect 2018; 99:312-317. [PMID: 29621601 DOI: 10.1016/j.jhin.2018.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. AIM To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. METHODS A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. FINDINGS The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. CONCLUSION HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.
Collapse
Affiliation(s)
- S Cairns
- National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - C Gibbons
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A Milne
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - H King
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - M Llano
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - L MacDonald
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - W Malcolm
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - C Robertson
- National Services Scotland, Health Protection Scotland, Glasgow, UK; University of Strathclyde, Glasgow, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - J Weir
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - J Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, UK; Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
21
|
Mills SR, Wilcox CR, Ibrahim K, Roberts HC. Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review. J Hum Nutr Diet 2018; 31:379-389. [DOI: 10.1111/jhn.12529] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S. R. Mills
- Academic Geriatric Medicine; University of Southampton; Southampton General Hospital Mailpoint; Southampton UK
| | - C. R. Wilcox
- Academic Geriatric Medicine; University of Southampton; Southampton General Hospital Mailpoint; Southampton UK
| | - K. Ibrahim
- Academic Geriatric Medicine; University of Southampton; Southampton General Hospital Mailpoint; Southampton UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex; University of Southampton; Southampton UK
| | - H. C. Roberts
- Academic Geriatric Medicine; University of Southampton; Southampton General Hospital Mailpoint; Southampton UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex; University of Southampton; Southampton UK
| |
Collapse
|
22
|
Abstract
The increasing older adult population guarantees that healthcare providers are more likely to encounter patients requiring treatment for unintended weight loss. Due to physiologic changes that occur in the older adult, it is important to know how to assess for, and diagnose unintended weight loss, as well as understand the treatment options. In addition to the use of enteral and parenteral nutrition, appetite stimulants have been used in older adults. Understanding the dosage, side effects, and proper usage of appetite stimulants, such megestrol acetate, mirtazapine, and dronabinol, is crucial in order to provide safe and effective patient care.
Collapse
Affiliation(s)
- Avi Levitt
- Avi Levitt, BSN, RN, is an MSN Student, Family Nurse Practitioner Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California. Jean O'Neil, DNP, RN, FNP-BC, is an Assistant Professor of Nursing, MSN Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California
| | | |
Collapse
|
23
|
Malnutrition and Oral Disease in the Elderly––Is There Any Bidirectional Relationship? ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40496-017-0127-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
24
|
Schultz L. Can Efficient Smoke Evacuation Limit Aerosolization of Bacteria? AORN J 2016; 102:7-14. [PMID: 26119605 DOI: 10.1016/j.aorn.2015.04.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/31/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
Preventing surgical site infections requires knowledge of the sources of wound contamination. One possible source of wound contamination is bacteria aerosolized in diathermy plume (ie, surgical smoke). This study used an experimental model of porcine tissue embedded with Serratia marcescens to determine the extent of viable bacteria present in surgical plume. The results showed that only blended current electrosurgery, not laser plume or coagulation electrosurgery, contains viable bacteria. Further, the study revealed that placing a suction device near the electrosurgical site reduced the number of aerosolized viable bacteria. Therefore, evacuating the electrosurgical plume may help reduce contamination of the surgical wound. Nurses may wish to advocate for the use of air suction devices as one way to protect patients from surgical site infections.
Collapse
|
25
|
Okabe Y, Furuta M, Akifusa S, Takeuchi K, Adachi M, Kinoshita T, Kikutani T, Nakamura S, Yamashita Y. Swallowing Function and Nutritional Status in Japanese Elderly People Receiving Home-care Services: A 1-year Longitudinal Study. J Nutr Health Aging 2016; 20:697-704. [PMID: 27499302 DOI: 10.1007/s12603-015-0645-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care. DESIGN Prospective observational cohort study with 1-year follow-up. SETTING Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012. PARTICIPANTS One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving home-care services because of physical disabilities, without malnutrition. MEASUREMENTS Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model. RESULTS Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65-16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition. CONCLUSION Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.
Collapse
Affiliation(s)
- Y Okabe
- Yoshihisa Yamashita, Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Kyushu University Faculty of Dental Science, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bailly N, Maître I, Wymelbeke VV. Relationships between nutritional status, depression and pleasure of eating in aging men and women. Arch Gerontol Geriatr 2015; 61:330-6. [DOI: 10.1016/j.archger.2015.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
|
27
|
Rémond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron MA, Dos Santos CN, Walther B, Bordoni A, Dupont D, Tomás-Cobos L, Vergères G. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget 2015; 6:13858-98. [PMID: 26091351 PMCID: PMC4546438 DOI: 10.18632/oncotarget.4030] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/11/2022] Open
Abstract
Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.
Collapse
Affiliation(s)
- Didier Rémond
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Danit R. Shahar
- Department of Public Health, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Doreen Gille
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Paula Pinto
- Escola Superior Agrária, Insituto Politécnico de Santarém, 2001-904 Santarem, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
| | | | - Marie-Agnès Peyron
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Claudia Nunes Dos Santos
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
- Instituto de Biologia Experimental e Tecnológica, 2780-157 Oeiras, Portugal
| | - Barbara Walther
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Alessandra Bordoni
- Department of Agri-Food Sciences and Technologies, University of Bologna, 47521 Cesena, Italy
| | - Didier Dupont
- UMR 1253, Science et Technologie du Lait & de l'Œuf, INRA, 35000 Rennes, France
| | | | - Guy Vergères
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| |
Collapse
|
28
|
Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital. PLoS One 2015; 10:e0118980. [PMID: 25803860 PMCID: PMC4372354 DOI: 10.1371/journal.pone.0118980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/27/2015] [Indexed: 01/07/2023] Open
Abstract
Background Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting. Objectives The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI. Methods We conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios. Results The distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients. Conclusion The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.
Collapse
|
29
|
Laurent M, Bastuji-Garin S, Plonquet A, Bories P, Le Thuaut A, Audureau E, Lang P, Nakib S, Liuu E, Canoui-Poitrine F, Paillaud E. Interrelations of immunological parameters, nutrition, and healthcare-associated infections: Prospective study in elderly in-patients. Clin Nutr 2015; 34:79-85. [DOI: 10.1016/j.clnu.2014.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/05/2014] [Accepted: 01/16/2014] [Indexed: 01/15/2023]
|
30
|
|
31
|
Khalaf A, Westergren A, Ekblom Ö, Al-Hazzaa HM, Berggren V. Nurses' views and experiences of caring for malnourished patients in surgical settings in Saudi Arabia - a qualitative study. BMC Nurs 2014; 13:29. [PMID: 25317076 PMCID: PMC4196725 DOI: 10.1186/1472-6955-13-29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 10/06/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses' views and experiences of caring for malnourished patients in Saudi Arabia (KSA). METHODS Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis. RESULTS The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: 'Potentials for nurses to provide good nutrition and physical activity', and 'Having the ability but not the power to promote proper nutrition and physical activity'. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women's weight gain in KSA society. CONCLUSIONS The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses' views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.
Collapse
Affiliation(s)
- Atika Khalaf
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Elmetorpsvägen 15, S-291 88 Kristianstad, Sweden
- The Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Albert Westergren
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Elmetorpsvägen 15, S-291 88 Kristianstad, Sweden
| | - Örjan Ekblom
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Hazzaa M Al-Hazzaa
- Paediatric Exercise Physiology Research Laboratory, College of Education and Obesity Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Vanja Berggren
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| |
Collapse
|
32
|
Bories PN, Laurent M, Liuu E, Denjean L, Popovici T, Paillaud E. Interleukin-10 promoter (-1082) polymorphism in association with repeated hospital-acquired infections in elderly patients. Aging Clin Exp Res 2013; 26:25-31. [PMID: 24307577 DOI: 10.1007/s40520-013-0177-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 09/25/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Infections are frequent complications of hospitalization, particularly in the elderly. Pro- and anti-inflammatory cytokines are essential components of the host response to pathogens and polymorphisms in their genes may contribute to inter-individual variations of the inflammatory response. The aim of this study was to investigate whether cytokine polymorphisms, separately or in combination, could be determining factors in the development of repeated nosocomial infections in elderly hospitalized patients. METHODS Tumor necrosis factor-α (-308) and (-238), interleukin-6 (-174) and (-6331), interleukin-10 (-1082) and (-592) polymorphisms were genotyped by PCR and hybridization with fluorescent-labeled probes in 245 hospitalized elderly patients (mean age 85.2 years; SD 6) and compared with those in 145 healthy adults. RESULTS The distribution of genotypes did not differ between elderly patients and control subjects. The presence of the interleukin-10 A(592) or A(1082) allele was more frequent individually and after adjustment for multiple comparisons in patients who suffered from several infections (p = 0.012, odds ratio = 5.3; 95 % confidence interval = 1.2-23.1). CONCLUSION Our data support a determinant role for interleukin-10 (-1082) polymorphism in the development of nosocomial infections.
Collapse
Affiliation(s)
- Phuong-Nhi Bories
- Service de Biochimie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75679 Paris cedex 04, France,
| | | | | | | | | | | |
Collapse
|
33
|
Kuyumcu M, Yeşil Y, Oztürk Z, Halil M, Ulger Z, Yavuz B, Cankurtaran M, Güngör E, Erdoğan G, Besler T, Arıoğul S. Challenges in nutritional evaluation of hospitalized elderly; always with mini-nutritional assessment? Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
34
|
Attitudes, Perceptions, and Knowledge Among Hospital Staff Concerning Postdischarge Nutritional Follow-up. TOP CLIN NUTR 2013. [DOI: 10.1097/tin.0b013e31829df124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Carlsson M, Håglin L, Rosendahl E, Gustafson Y. Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities. J Nutr Health Aging 2013; 17:186-91. [PMID: 23364500 DOI: 10.1007/s12603-012-0087-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate factors associated with poor nutritional status in older people living in residential care facilities. METHODS 188 residents (136 women, 52 men) with physical and cognitive impairments participated. Mean age was 84.7 y (range 65-100). The Mini Nutritional Assessment (MNA), Barthel ADL Index, Mini Mental State Examination (MMSE), and Geriatric Depression Scale were used to evaluate nutritional status, activities of daily living, cognitive status and depressive symptoms. Medical conditions, clinical characteristics and prescribed drugs were recorded. Univariate and multivariate regressions were used to investigate associations with MNA scores. RESULTS The mean MNA score was 20.5 ± 3.7 (range 5.5-27) and the median was 21 (interquartile range (IQR) 18.8-23.0). Fifteen per cent of participants were classified as malnourished and 66% at risk of malnutrition. Lower MNA scores were independently associated with urinary tract infection (UTI) during the preceding year (β = - 0.21, P = 0.006), lower MMSE scores (β = 0.16, P = 0.030), and dependent in feeding (β = - 0.14, P = 0.040). CONCLUSION The majority of participants were at risk of or suffering from malnutrition. Urinary tract infection during the preceding year was independently associated with poor nutritional status. Dependence in feeding was also associated with poor nutritional status as were low MMSE scores for women. Prospective observations and randomized controlled trials are necessary to gain an understanding of a causal association between malnutrition and UTI.
Collapse
Affiliation(s)
- M Carlsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
| | | | | | | |
Collapse
|
36
|
Krawinkel MB. Interaction of nutrition and infections globally: an overview. ANNALS OF NUTRITION AND METABOLISM 2013; 61 Suppl 1:39-45. [PMID: 23343946 DOI: 10.1159/000345162] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The interaction of nutrition and infections is known by experience by generations of medical doctors. Before the era of antibiotics, diet was an integral part of the management of infections. Now, it is necessary to take a fresh look at this interaction as the understanding of immune response has expanded considerably. Comparatively little research has addressed the impact of nutrition interventions on the management of infectious diseases. Most observations of the interaction between nutrition and infections are epidemiological in character. This holds especially true for measles as well as for tuberculosis. In AIDS, the deterioration of the nutritional status is an indicator of disease progression. Infections in undernourished children are a common cause of death, and taking this finding into account helps to reduce the case fatality rate in severely malnourished patients. Regarding the immune response, cellular as well as soluble components are affected by deficiencies of single nutrients or general undernutrition. The immunosuppressive effect of undernutrition starts during intrauterine life already: maternal nutrition status has been shown to impact on immune function in adult animals. Recent research suggests that not only undernutrition but also caloric overnutrition impacts on immune response to infections and immunization. This is partly due to the chronic inflammatory activity of the adipose tissue and partly due to neuroendocrine alterations. Infectious diseases also impact on the nutritional status, either specifically or through unspecific mechanisms, such as anorexia, tachypnea, and vomiting.
Collapse
Affiliation(s)
- M B Krawinkel
- Institute of Nutritional Sciences, Justus-Liebig University, Giessen, Germany
| |
Collapse
|
37
|
Mazière S, Couturier P, Gavazzi G. Impact of functional status on the onset of nosocomial infections in an acute care for elders unit. J Nutr Health Aging 2013; 17:903-7. [PMID: 24257575 DOI: 10.1007/s12603-013-0370-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the role of functional status as a risk factor for nosocomial infections in the elderly. DESIGN Prospective study. SETTING Acute care for elders units of university hospital of Grenoble. PARTICIPANT All patients over 75 years old consecutively hospitalized between January and April 2007. MEASUREMENT The main judgement criteria was the rate of nosocomial infection during the hospital stay, defined according to the French technical comity against nosocomial infections. Other data included functional status at baseline and admission (Katz' ADL), usual risk factors for nosocomial infections, demographic and geriatric assessment data. RESULTS The study included 223 patients. The mean age was 86.7±6.5 years. A nosocomial infection was diagnosed for 17.0% of the patients. In univariate analysis, the number of medicines, pressure sore, pneumonia diagnosis, illness severity, indwelling bladder catheter, IADL at baseline, and all disability parameters (ADL at baseline, ADL at admission, recent functional decline) were significantly associated with nosocomial infection (p<0.05). In multivariate analysis considering functional status at admission, indwelling bladder catheter (OR=4.43), severe disability at admission (OR=4.42) and illness severity (OR=2.68) were independently associated with nosocomial infection (p<0.05). In a second analysis considering functional status at baseline, only disability at baseline was independently associated with the onset of a nosocomial infection (OR=2.21). CONCLUSION Our results suggest a significant impact of functional impairment on the incidence of nosocomial infections in hospitalized elderly population. Disability is a higher risk factor for nosocomial infections than the usual and well-known other parameters. Larger prospective studies are needed to examine the power of this relationship.
Collapse
Affiliation(s)
- S Mazière
- Sylvie Mazière, Clinique de médecine gériatrique CHU A. Michallon, 38043 Grenoble cedex 09. Tel : (+33)4 76 76 54 21,
| | | | | |
Collapse
|
38
|
Laurent M, Bories PN, Le Thuaut A, Liuu E, Ledudal K, Bastuji-Garin S, Paillaud E. Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients. J Am Med Dir Assoc 2012; 13:760.e7-12. [DOI: 10.1016/j.jamda.2012.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022]
|
39
|
Cairns S, Reilly J, Stewart S, Tolson D, Godwin J, Knight P. The prevalence of health care-associated infection in older people in acute care hospitals. Infect Control Hosp Epidemiol 2012; 32:763-7. [PMID: 21768759 DOI: 10.1086/660871] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the prevalence of health care-associated infection (HAI) in older people in acute care hospitals, detailing the specific types of HAI and specialties in which these are most prevalent. DESIGN Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data set. PATIENTS AND SETTING All inpatients in acute care (n = 11,090) in all acute care hospitals in Scotland (n = 45). RESULTS The study found a linear relationship between prevalence of HAI and increasing age (P<.0001) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the largest burden of HAI in the 75-84- and over-85-year age groups, and surgical-site infections represented the largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in each of the over-65 age groups (P<.0001). Importantly, this study reveals that a high prevalence of HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties. CONCLUSIONS HAI is an important outcome indicator of acute inpatient hospital care, and our analysis demonstrates that HAI prevalence increases linearly with increasing age (P<.0001). Focusing interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be overemphasized to those working in all areas of acute care.
Collapse
|
40
|
Gamaletsou M, Poulia KA, Karageorgou D, Yannakoulia M, Ziakas P, Zampelas A, Sipsas N. Nutritional risk as predictor for healthcare-associated infection among hospitalized elderly patients in the acute care setting. J Hosp Infect 2012; 80:168-72. [DOI: 10.1016/j.jhin.2011.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 08/07/2011] [Indexed: 10/14/2022]
|
41
|
Loveday H, Smales C, Tsiami A, Browne J. The effectiveness of nutritional interventions to reduce the risk of healthcare-associated infection in the undernourished elderly: a systematic review. ACTA ACUST UNITED AC 2012; 10:1-18. [PMID: 27820446 DOI: 10.11124/jbisrir-2012-276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Heather Loveday
- 1. JBI Collaborating Centre, College of Nursing, Midwifery and Healthcare, University of West London London, UK 2. JBI Collaborating Centre, School of Psychology, Social Care and Human Sciences, University of West London, London, UK. 3. JBI Collaborating Centre, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | | | | | | |
Collapse
|
42
|
Avci M, Ozgenc O, Coskuner SA, Olut AI. Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients. Arch Gerontol Geriatr 2012; 54:247-50. [DOI: 10.1016/j.archger.2011.03.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
|
43
|
Bouillanne O, Hay P, Liabaud B, Duché C, Cynober L, Aussel C. Evidence that albumin is not a suitable marker of body composition-related nutritional status in elderly patients. Nutrition 2011; 27:165-9. [DOI: 10.1016/j.nut.2009.12.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 12/23/2009] [Accepted: 12/23/2009] [Indexed: 11/26/2022]
|
44
|
Nutrition périopératoire chez la personne âgée. Cas particulier de la fracture de l’extrémité supérieure du col du fémur. NUTR CLIN METAB 2010. [DOI: 10.1016/j.nupar.2010.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
45
|
Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized Nutritional Intervention During and After Hospitalization: The Nutrition Intervention Study Clinical Trial. J Am Geriatr Soc 2010; 59:10-7. [DOI: 10.1111/j.1532-5415.2010.03174.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Hall DP, Scott DHT. The risks of acquiring hospital-acquired infections from wet breathing systems. Expert Rev Anti Infect Ther 2010; 8:1071-3. [PMID: 20954870 DOI: 10.1586/eri.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
de Oliveira MRM, Leandro-Merhi VA. Food intake and nutritional status of hospitalised older people. Int J Older People Nurs 2010; 6:196-200. [DOI: 10.1111/j.1748-3743.2010.00227.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Dayer R, Brennan TC, Rizzoli R, Ammann P. PTH improves titanium implant fixation more than pamidronate or renutrition in osteopenic rats chronically fed a low protein diet. Osteoporos Int 2010; 21:957-67. [PMID: 19859647 DOI: 10.1007/s00198-009-1031-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 07/27/2009] [Indexed: 11/24/2022]
Abstract
SUMMARY We evaluated the effects of parathyroid hormone (PTH), pamidronate, or renutrition on osseointegration of titanium implants in the proximal tibia of rats subject to prolonged low-protein diets. PTH improved mechanical fixation, microarchitecture, and increased pull-out strength. Pamidronate or renutrition had lesser effects. PTH can thus improve implant osseointegration in protein-malnourished rats. INTRODUCTION Protein malnutrition impairs implant osseointegration in rats. PTH and pamidronate prevent deleterious effects of protein restriction introduced just prior to implantation. Whether these treatments improve osseointegration after chronic protein deprivation, i.e., in osteopenic bone at time of implantation, is unknown. We evaluated effects of PTH, pamidronate, or renutrition on resistance to pull-out of titanium rods implanted into the rat tibiae following isocaloric low-protein intake. METHODS Forty-one adult female rats received normal or isocaloric low-protein diets. Six weeks later, implants were surgically inserted into proximal tibiae. Following implantation, rats on low-protein diets were treated with PTH (1-34), pamidronate, saline vehicle, or normal protein diets, for another 8 weeks. Tibiae were removed for micro-computerised tomographic morphometry and evaluation of pull-out strength. RESULTS Pull-out strength decreased in rats on isocaloric low-protein diets compared with normal protein group (-33.4%). PTH increased pull-out strength in low-protein group, even compared to controls from the normal protein group. PTH and pamidronate increased bone volume/tissue volume, bone-to-implant contact, and trabecular thickness, whilst trabecular separation was reduced, with a shift to more plate-like bone surrounding the implants. CONCLUSIONS PTH reversed the deleterious effects of long-term protein undernutrition on mechanical fixation and bone microarchitecture and improved implant osseointegration more than pamidronate or renutrition, likely through changes to structure model index.
Collapse
Affiliation(s)
- R Dayer
- Division of Bone Diseases, Department of Rehabilitation and Geriatrics, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center for Osteoporosis Prevention, 1211 Geneva 14, Switzerland.
| | | | | | | |
Collapse
|
49
|
Scott DHT, Fraser S, Willson P, Drummond GB, Baillie JK. Passage of pathogenic microorganisms through breathing system filters used in anaesthesia and intensive care. Anaesthesia 2010; 65:670-3. [PMID: 20374232 DOI: 10.1111/j.1365-2044.2010.06327.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY Invasive ventilation poses a risk of respiratory infection that can be drug-resistant. One means of reducing transmission of infection is the use of a breathing system filter. Filters are intended to be used with dry gas. Current international standards do not require that filters prevent bacterial transfer when wet. It is not known whether microorganisms pass through wet filters, but theory predicts that this might occur. We tested six filters from three different manufacturers. We passed a suspension of microorganisms through the filters using the least pressure necessary, and incubated a sample of the filtrate on blood agar. All the filters tested allowed free passage of both Candida albicans and coagulase-negative staphylococci. The median (IQR [range]) pressure required for fluid to flow across the filter varied greatly between different filter types (20 (0-48 [0-138]) cmH(2)O). We conclude that even large microorganisms pass across moist breathing system filters in conditions that are found in clinical practice.
Collapse
Affiliation(s)
- D H T Scott
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | | | | | | | | |
Collapse
|
50
|
Abstract
The objective was to examine the effect of BMI on the incidence of various infectious diseases in institutionalised, geriatric subjects. In a retrospective cohort study we analysed medical records of 619 patients aged 75 years and older (mean age 87.6 (sd 6.4) years) who were treated in a geriatric hospital in Vienna, Austria. The total incidence rate of infection in this population was 0.80 per person-year. The most frequent infections were urinary tract infections (0.30 per person-year), followed by infections of the lower respiratory tract (0.19 per person-year), diarrhoea (0.12 per person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27-28 kg/m2. Compared with the reference group with a BMI of 24-27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of < 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20-23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients.
Collapse
|