1
|
Murakawa Y, Tamaki A, Matsuzawa R, Miyazaki S, Hori T, Naide M, Sakai K. Impact of the quantity and quality of erector spinae muscles on the short-term prognosis of elderly patients with aspiration pneumonia in Japan. Respir Med 2024; 232:107746. [PMID: 39102995 DOI: 10.1016/j.rmed.2024.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/05/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Whether muscle mass and muscle quality affect the prognosis of elderly patients with aspiration pneumonia is unclear. This study aimed to evaluate the relationship between erector spinae muscle mass and muscle quality on the 30-day prognosis of elderly patients with aspiration pneumonia. METHODS Two hundred fifty-eight patients who were diagnosed with aspiration pneumonia and admitted to Sanuki Municipal Hospital for pulmonary rehabilitation intervention were included. The cross-sectional area (ESMCSA/BSA) and CT values (ESMCT) of the erector spinae muscles at the 12th thoracic vertebra were measured on chest CT images to represent muscle mass and quality, respectively. The primary outcome was defined as 30-day survival. RESULTS Twenty-six patients died within 30 days after hospitalization. The ESMCSA/BSA ratio was significantly greater in the survival group than in the nonsurvival group (p = 0.001). The cutoff values for 30-day survival were calculated as follows: the ESMCSA/BSA was 11.046 cm2/m2 in male patients and 9.600 cm2/m2 in female patients; the ESMCT was 26.85 HU in male patients and 8.00 HU in female patients. A higher ESMCSA/BSA significantly improved 30-day survival, while ESMCT did not show a significant difference. Cox proportional hazards regression analysis revealed that the ESMCSA/BSA was independently associated with 30-day short-term prognosis (hazard ratio 0.34, p = 0.034). CONCLUSION The short-term prognosis of elderly patients with aspiration pneumonia may be more strongly influenced by muscle mass than by the muscle quality of the erector spinae muscles.
Collapse
Affiliation(s)
- Yuichi Murakawa
- Graduate School of Rehabilitation Science, Hyogo Medical University, 1-3-6 Minatojima, Chuo Ward, Kobe, Hyogo, 650-8530, Japan; Department of Rehabilitation Technology, Sanuki Municipal Hospital, 387-1 Ishida Higashi Kou, Sangawa-cho, Sanuki City, Kagawa, 769-2393, Japan
| | - Akira Tamaki
- Graduate School of Rehabilitation Science, Hyogo Medical University, 1-3-6 Minatojima, Chuo Ward, Kobe, Hyogo, 650-8530, Japan.
| | - Ryota Matsuzawa
- Graduate School of Rehabilitation Science, Hyogo Medical University, 1-3-6 Minatojima, Chuo Ward, Kobe, Hyogo, 650-8530, Japan
| | - Shinjiro Miyazaki
- Rehabilitation Center, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa, 760-0018, Japan
| | - Tatsuma Hori
- Department of Rehabilitation Technology, Sanuki Municipal Hospital, 387-1 Ishida Higashi Kou, Sangawa-cho, Sanuki City, Kagawa, 769-2393, Japan
| | - Miki Naide
- Department of Rehabilitation Technology, Sanuki Municipal Hospital, 387-1 Ishida Higashi Kou, Sangawa-cho, Sanuki City, Kagawa, 769-2393, Japan
| | - Kenichiro Sakai
- Department of Respiratory Medicine, Sanuki Municipal Hospital, 387-1 Ishida Higashi Kou, Sangawa-cho, Sanuki City, Kagawa, 769-2393, Japan
| |
Collapse
|
2
|
Karako K, Hata T, Inoue A, Oyama K, Ueda E, Sakatani K. Importance of serum albumin in machine learning-based prediction of cognitive function in the elderly using a basic blood test. Front Neurol 2024; 15:1362560. [PMID: 39114530 PMCID: PMC11303288 DOI: 10.3389/fneur.2024.1362560] [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: 12/28/2023] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction In this study, we investigated the correlation between serum albumin levels and cognitive function, and examined the impact of including serum albumin values in the input layer on the prediction accuracy when forecasting cognitive function using deep learning and other machine learning models. Methods We analyzed the electronic health record data from Osaka Medical and Pharmaceutical University Hospital between 2014 and 2021. The study included patients who underwent cognitive function tests during this period; however, patients from whom blood test data was not obtained up to 30 days before the cognitive function tests and those with values due to measurement error in blood test results were excluded. The Mini-Mental State Examination (MMSE) was used as the cognitive function test, and albumin levels were examined as the explanatory variable. Furthermore, we estimated MMSE scores from blood test data using deep learning models (DLM), linear regression models, support vector machines (SVM), decision trees, random forests, extreme gradient boosting (XGBoost), and light gradient boosting machines (LightGBM). Results Out of 5,017 patients who underwent cognitive function tests, 3,663 patients from whom blood test data had not been obtained recently and two patients with values due to measurement error were excluded. The final study population included 1,352 patients, with 114 patients (8.4%) aged below 65 and 1,238 patients (91.6%) aged 65 and above. In patients aged 65 and above, the age and male sex showed significant associations with MMSE scores of less than 24, while albumin and potassium levels showed negative associations with MMSE scores of less than 24. Comparing MMSE estimation performance, in those aged below 65, the mean squared error (MSE) of DLM was improved with the inclusion of albumin. Similarly, the MSE improved when using SVM, random forest and XGBoost. In those aged 65 and above, the MSE improved in all models. Discussion Our study results indicated a positive correlation between serum albumin levels and cognitive function, suggesting a positive correlation between nutritional status and cognitive function in the elderly. Serum albumin levels were shown to be an important explanatory variable in the estimation of cognitive function for individuals aged 65 and above.
Collapse
Affiliation(s)
- Kenji Karako
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Takeo Hata
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Atsushi Inoue
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| | - Katsunori Oyama
- Department of Computer Science, College of Engineering, Nihon University, Tokyo, Japan
| | - Eiichiro Ueda
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kaoru Sakatani
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Plotnikov G, Levy Y, Trotzky D, Nassar A, Bushkar Y, Derazne E, Kagansky D, Sharfman M, Kagansky N. Characteristics of older adults receiving enteral feeding at a geriatric medical center. BMC Geriatr 2024; 24:628. [PMID: 39044128 PMCID: PMC11265322 DOI: 10.1186/s12877-024-05202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent and hard-to-treat condition in older adults. enteral feeding is common in acute and long-term care. Data regarding the prognosis of patients receiving enteral feeding in geriatric medical settings is lacking. Such data is important for decision-making and preliminary instructions for patients, caregivers, and physicians. This study aimed to evaluate the prognosis and risk factors for mortality among older adults admitted to a geriatric medical center receiving or starting enteral nutrition (EN). METHODS A cohort retrospective study, conducted from 2019 to 2021. Patients admitted to our geriatric medical center who received EN were included. Data was collected from electronic medical records including demographic, clinical, and blood tests, duration of enteral feeding, Norton scale, and Short Nutritional Assessment Questionnaire score. Mortality was assessed during and after hospitalization. Data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality. RESULTS Of 9169 patients admitted, 124 (1.35%) received enteral feeding tubes. More than half of the patients (50.8%) had polypharmacy (over 8 medications), 62% suffered from more than 10 chronic illnesses and the majority of patients (122/124) had a Norton scale under 14. Most of the patients had a nasogastric tube (NGT) (95/124) and 29 had percutaneous endoscopic gastrostomies (PEGs). Ninety patients (72%) died during the trial period with a median follow-up of 12.7 months (0.1-62.9 months) and one-year mortality was 16% (20/124). Associations to mortality were found for marital status, oxygen use, and Red Cell Distribution Width (RDW). Age and poly-morbidity were not associated with mortality. CONCLUSION In patients receiving EN at a geriatric medical center mortality was lower than in a general hospital. The prognosis remained grim with high mortality rates and low quality of life. This data should aid decision-making and promote preliminary instructions.
Collapse
Affiliation(s)
- Galina Plotnikov
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Yochai Levy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | - Daniel Trotzky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Ahmad Nassar
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | - Yosef Bushkar
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Kagansky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Miya Sharfman
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel.
| | - Nadya Kagansky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| |
Collapse
|
4
|
Jiang M, Chen J, Wu M, Wu J, Xu X, Li J, Liu C, Zhao Y, Hua X, Meng Q. Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis. Chin Med J (Engl) 2024; 137:97-104. [PMID: 38073306 PMCID: PMC10766297 DOI: 10.1097/cm9.0000000000002937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients. METHODS This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes. RESULTS The optimal cut-off values of L3-SMI were 39.50 cm 2 /m 2 for male patients and 33.06 cm 2 /m 2 for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis ( Wald = 6.347, P = 0.012). CONCLUSIONS This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.
Collapse
Affiliation(s)
- Minjie Jiang
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
- Beijing Institute of Hepatology, Beijing 100069, China
| | - Juan Chen
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Muchen Wu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Jing Wu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Xiaotong Xu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Juan Li
- Department of Medical Oncology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Can Liu
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Yaping Zhao
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Xin Hua
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Qinghua Meng
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| |
Collapse
|
5
|
Geers J, Van den Bussche K, Vandeloo B, Kimenai DM, Van Loo I, Michiels V, Plein D, Beckers S, Muylle T, Lieten S, Cosyns B, Compté N, Argacha JF. Depression and Malnutrition for Prediction of Mortality after Transcatheter Aortic Valve Replacement: A Registry Study of a Tertiary Referral Hospital. Diagnostics (Basel) 2023; 13:2561. [PMID: 37568924 PMCID: PMC10416912 DOI: 10.3390/diagnostics13152561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Moderate to severe frailty is a predictor of a poor outcome after transcatheter aortic valve replacement (TAVR), but little is known about the prognostic importance of different geriatric frailty markers in an overall fit or pre-frail geriatric population undergoing TAVR. This retrospective study aimed to examine the incremental value of adding patient frailty markers to conventional surgical risk score to predict all-cause mortality in relatively fit elderly patients undergoing TAVR. Overall patient frailty was assessed using the comprehensive geriatric assessment frailty index (CGA-FI). Multivariable Cox regression models were used to evaluate relationships of different geriatric frailty markers with all-cause mortality and single and combined frailty models were compared to a baseline model that included EuroSCORE II factors. One hundred relatively fit geriatric patients (84 ± 4 years old, mean CGA-FI 0.14 ± 0.05) were included, and 28% died during a median follow-up of 24 months. After adjustment, risk of depression (geriatric depression scale 15 (GDS-15)) and malnutrition remained significantly associated with all-cause mortality (HR 4.381, 95% CI 1.787-10.743; p = 0.001 and HR 3.076, 95% CI 1.151-8.217; p = 0.025, respectively). A combined frailty marker model including both GDS-15 and malnutrition on top of EuroSCORE II improved the discriminative ability to predict all-cause mortality (change in c-index: + 0.044). Screening for those frailty markers on top of the traditionally used EuroSCORE II may improve risk stratification and prognosis in relatively fit geriatric patients undergoing TAVR.
Collapse
Affiliation(s)
- Jolien Geers
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Karen Van den Bussche
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Dorien M. Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH9 3FB, UK
| | - Ines Van Loo
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Vincent Michiels
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Daniele Plein
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Stefan Beckers
- Department of Anesthesiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Teun Muylle
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Siddhartha Lieten
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Nathalie Compté
- Department of Geriatrics, CHU Ambroise Paré, 7000 Mons, Belgium
| | - Jean-François Argacha
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| |
Collapse
|
6
|
Hiraike T, Momoki C, Habu D. Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study. BMC Geriatr 2023; 23:35. [PMID: 36670357 PMCID: PMC9854135 DOI: 10.1186/s12877-023-03740-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The global leadership initiative on malnutrition (GLIM) proposed the first international standards (GLIM criteria) for malnutrition diagnosis. Early screening using nutritional tools is recommended to improve the prognosis of older patients. The association between Mini Nutritional Assessment-Short Form (MNAⓇ-SF) and Geriatric Nutritional Risk Index (GNRI) and prognosis has been reported, but there is insufficient evidence to develop the GLIM criteria for older inpatients. We aimed to evaluate the MNAⓇ-SF, GNRI, and GLIM criteria to determine their contribution to the prognosis prediction of hospitalized older patients at 1 year after discharge. METHODS This study included 386 patients hospitalized between September 2014 and October 2015, and May and December 2019. After excluding 17 patients who died at the time of initial hospitalization, 23 who were lost to follow-up after 1 year, and 28 who had missing data on admission, only 318 were included in the final analysis. The primary outcome was death within 1 year after discharge, assessed using the MNA®-SF, GNRI, and GLIM criteria, and survival analysis was conducted. Multivariate Cox proportional hazards analysis was performed to identify the nutritional assessment tools that contributed to the prognosis prediction. RESULTS A total of 43 patients died within 1 year. Of them, 58.1% had malnutrition and 37.2% were at risk of malnutrition, assessed using the MNAⓇ-SF; 27.9% had severely malnourished assessed using the GNRI; and 58.1% had severely malnourished assessed using the GLIM criteria. The proportions of malnourished and severely malnourished patients were significantly higher in the mortality group than in the survival group. Multivariate Cox proportional hazards analysis showed hazard ratios of 1.06 (95% confidence interval [CI]: 0.24-4.71) for at risk and 2.17 (95% CI: 0.48-9.84) for malnutrition (MNAⓇ-SF); 5.68 (95% CI: 2.74-11.80) for moderately malnourished and 7.69 (95% CI: 3.13-18.91) for severely malnourished (GNRI); and 1.47 (95% CI: 0.48-4.50) for moderately malnourished and 2.45 (95% CI: 1.22-4.93) for severely malnourished (GLIM criteria); GNRI had the most significant contribution to prognosis prediction. CONCLUSIONS GNRI significantly contributed to the prognosis prediction 1 year after hospital discharge of older patients.
Collapse
Affiliation(s)
- Taeko Hiraike
- grid.261445.00000 0001 1009 6411Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
| | - Chika Momoki
- Department of Food Science and Human Nutrition, Faculty of Agriculture, Setsunan University, 45-1, Nagaotoge-Cho, Hirakata-Shi, Osaka, 573-0101, Japan.
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
| |
Collapse
|
7
|
Reeves D, Holland F, Morbey H, Hann M, Ahmed F, Davies L, Keady J, Leroi I, Reilly S. Retrospective study of more than 5 million emergency admissions to hospitals in England: Epidemiology and outcomes for people with dementia. PLoS One 2023; 18:e0281158. [PMID: 36888666 PMCID: PMC9994676 DOI: 10.1371/journal.pone.0281158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/13/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION People living with dementia (PwD) admitted in emergency to an acute hospital may be at higher risk of inappropriate care and poorer outcomes including longer hospitalisations and higher risk of emergency re-admission or death. Since 2009 numerous national and local initiatives in England have sought to improve hospital care for PwD. We compared outcomes of emergency admissions for cohorts of patients aged 65+ with and without dementia at three points in time. METHODS We analysed emergency admissions (EAs) from the Hospital Episodes Statistics datasets for England 2010/11, 2012/13 and 2016/17. Dementia upon admission was based on a diagnosis in the patient's hospital records within the last five years. Outcomes were length of hospital stays (LoS), long stays (> = 15 days), emergency re-admissions (ERAs) and death in hospital or within 30 days post-discharge. A wide range of covariates were taken into account, including patient demographics, pre-existing health and reasons for admission. Hierarchical multivariable regression analysis, applied separately for males and females, estimated group differences adjusted for covariates. RESULTS We included 178 acute hospitals and 5,580,106 EAs, of which 356,992 (13.9%) were male PwD and 561,349 (18.6%) female PwD. Uncontrolled differences in outcomes between the patient groups were substantial but were considerably reduced after control for covariates. Covariate-adjusted differences in LoS were similar at all time-points and in 2016/17 were 17% (95%CI 15%-18%) and 12% (10%-14%) longer for male and female PwD respectively compared to patients without dementia. Adjusted excess risk of an ERA for PwD reduced over time to 17% (15%-18%) for males and 17% (16%-19%) for females, but principally due to increased ERA rates amongst patients without dementia. Adjusted overall mortality was 30% to 40% higher for PwD of both sexes throughout the time-period; however, adjusted in-hospital rates of mortality differed only slightly between the patient groups, whereas PwD had around double the risk of dying within 30 days of being discharged. CONCLUSION Over the six-year period, covariate-adjusted hospital LoS, ERA rates and in-hospital mortality rates for PwD were only slightly elevated compared to similar patients without dementia and remaining differences potentially reflect uncontrolled confounding. PwD however, were around twice as likely to die shortly after discharge, the reasons for which require further investigation. Despite being widely used for service evaluation, LoS, ERA and mortality may lack sensitivity to changes in hospital care and support to PwD.
Collapse
Affiliation(s)
- David Reeves
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Fiona Holland
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Hazel Morbey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Mark Hann
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Linda Davies
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - John Keady
- National Institute for Health Research School for Social Care Research, Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Iracema Leroi
- Department of Psychiatry St James’ Hospital, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| |
Collapse
|
8
|
Bhagwasia M, Rao AR, Banerjee J, Bajpai S, Raman AV, Talukdar A, Jain A, Rajguru C, Sankhe L, Goswami D, Shanthi GS, Kumar G, Varghese M, Dhar M, Gupta M, A-Koul P, Mohanty RR, Chakrabarti SS, Yadati SR, Dey S, Dey AB. Association Between Cognitive Performance and Nutritional Status: Analysis From LASI-DAD. Gerontol Geriatr Med 2023; 9:23337214231194965. [PMID: 37743872 PMCID: PMC10515514 DOI: 10.1177/23337214231194965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
Malnutrition in low- and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data from the LASI DAD. We conducted descriptive statistics on nutritional parameters (body-mass index, waist-hip ratio, and Mini-Nutritional Assessment), cognitive functions, and socio-demographic variables in 2,892 adults aged ≥60 years. Cognitive domains assessed included delayed recall, orientation, language, executive function, abstract reasoning, and attention. Cognitive impairment was defined as impaired performance in two or more domains. Mean age was 69.3 ± 7.1 years, 52.9% were female, and 57.5% were illiterate. Low body-mass index (adjusted OR: 1.88, p < .001), at risk of malnutrition (adjusted OR: 1.89, p < .001) and malnourished (adjusted OR: 2.86, p < .001) on Mini-Nutritional Assessment were associated with the presence of cognitive impairment. Better cognitive performance was associated with increased body mass index (adjusted OR: 0.74, p-.03), hemoglobin (adjusted OR: 0.91, p-.006), and serum albumin (adjusted OR: 0.38, p < .001). This study shows that nutritional status assessed by anthropometric measures and blood markers is strongly linked to cognitive performance in older adults.
Collapse
Affiliation(s)
| | | | | | - Swati Bajpai
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Arvind Jain
- Dr S. N. Medical College, Jodhpur, Rajasthan, India
| | - Chhaya Rajguru
- Grant Medical College and J.J. Hospital, Mumbai, Maharashtra, India
| | - Lalit Sankhe
- Grant Medical College and J.J. Hospital, Mumbai, Maharashtra, India
| | | | | | - Govind Kumar
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Mathew Varghese
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Minakshi Dhar
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monica Gupta
- Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Parvaiz A-Koul
- Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | | | | | - Sharmistha Dey
- All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit Ballav Dey
- All India Institute of Medical Sciences, New Delhi, India
- Venu Geriatric Institute, New Delhi, India
| |
Collapse
|
9
|
Urgessa M. The Mini Nutritional Assessment tool's applicability for the elderly in Ethiopia: validation study. PeerJ 2022; 10:e14396. [PMID: 36411835 PMCID: PMC9675339 DOI: 10.7717/peerj.14396] [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: 04/05/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Mini Nutrition Assessment (MNA) is a widely used and valid tool for screening and assessment of malnutrition among the elderly population worldwide. However, MNA has not been validated among the Ethiopian elderly population and this study assessed the validity of the tool for the target population. Methods Cross-sectional validation study design employed to validate MNA in Meki town, East Ethiopia. This study included 176 randomly selected elders living in the community, whereas amputated, bedridden, visible deformity, known liver and/or renal disorders were excluded. The original MNA questionnaires were translated to local language and administered to each participant after doing the pretest. The anthropometric, self-perception of nutritional status and serum albumin concentrations were measured. Reliability, validity, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated. Receiver-operating characteristic (ROC) curve analysis was plotted to identify the area under the curve (AUC) and optimal cut-off value for the prediction of malnutrition. Result A total of one hundred and seventy-six elders participated in this study. Of the total participants, 78(44.3%) were males. The mean (SD) age of the participants was 67.6 (±5.8) years and ranged from 60 to 84 years. The prevalence of malnutrition based on the MNA criteria (MNA < 17 points) was 18.2%, and 13.1% based on serum albumin concentration (<3 g/dl).The MNA had an overall Internal consistency of Cronbach's alpha 0.61. The tool also demonstrated significant criterion-related validity (0.75, p < 0.001) and concurrent validity (0.51, p < 0.001) with serum albumin concentration and self-perception of nutritional status respectively. Using the original cut-off point, the sensitivity, specificity, PPV and NPV of the tool were 93.5%, 44.6%, 65.4% and 86.0%, respectively. By modifying, the cut-off point to a value of <20.5, the sensitivity and specificity of the tool increases to 97.6% and 82.8% respectively. The AUC (95%CI) showed an overall accuracy of 92.7% (88.5, 96.9). Conclusion The MNA tool can be used as a valid malnutrition screening tool for the Ethiopian elderly population by modifying the original cut-off point.
Collapse
Affiliation(s)
- Megersso Urgessa
- Department of Public Health, School of Health Sciences, Madda Walabu University, Shashemene, Oromia, Ethiopia
| |
Collapse
|
10
|
Amasene M, Medrano M, Echeverria I, Urquiza M, Rodriguez-Larrad A, Diez A, Labayen I, Ariadna BB. Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults. Front Nutr 2022; 9:920485. [PMID: 35811947 PMCID: PMC9263978 DOI: 10.3389/fnut.2022.920485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background The Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. Methods A total of 597 hospitalized older adults (84.3 ± 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). Results Better nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408–3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326–6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). Conclusions The current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.
Collapse
Affiliation(s)
- Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Medrano
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Iñaki Echeverria
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Department of Physical Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Diez
- Nurse Supervisor, Bioaraba Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Idoia Labayen
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Besga-Basterra Ariadna
- Ageing and Frailty Research Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- Internal Medicine Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- *Correspondence: Besga-Basterra Ariadna
| |
Collapse
|
11
|
Borghi-Silva A, Back GD, Garcia de Araújo AS, Oliveira MR, da Luz Goulart C, Silva RN, Bassi D, Mendes RG, Arena R. COVID-19 seen from a syndemic perspective: Impact of unhealthy habits and future perspectives to combat these negative interactions in Latin America. Prog Cardiovasc Dis 2022; 71:72-78. [PMID: 35490872 PMCID: PMC9047636 DOI: 10.1016/j.pcad.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 02/08/2023]
Abstract
COVID-19 has to this point led to more than 5 million deaths and has imposed numerous measures restricting populations worldwide, including Latin America (LA). However, analyzing COVID-19 from the perspective of a syndemic, it demonstrates the relationship between the interaction of multiple comorbidities and the increase of contagion in people who are socially vulnerable. The number of deaths by COVID-19 in LA is strongly associated with multi-morbidities (diabetes, obesity, sedentary, smoking, among others) and disproportionately attacks communities located in poorer, low-income regions and ethnic minorities. This review aims to revisit the relationship between COVID-19 and both unhealthy living habits (i.e., sedentary lifestyle, poor nutritional habits, overweight and obesity, smoking) and cardiovascular disease in Latin American countries. In addition, this review aims to introduce strategies and policies that combat social inequalities and enable healthy living behaviors in LA countries. If LA countries do not work on public policies that decrease multi-morbidities and social inequalities, we will be unable to eliminate COVID-19, as well as possible other outbreaks that may arise in the future.
Collapse
Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Guilherme Dionir Back
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Adriana S Garcia de Araújo
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Murilo Rezende Oliveira
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Daniela Bassi
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Postgraduate Program in Management and Health Services, Ceuma, University, São Luís, MA, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, LACAP, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL., USA
| |
Collapse
|
12
|
Ong RHS, Chow WL, Cheong M, Lim GH, Xie W, Baggs G, Huynh DTT, Oh HC, How CH, Tan NC, Tey SL, Chew STH. Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:52. [PMID: 34895351 PMCID: PMC8665498 DOI: 10.1186/s41043-021-00277-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
Background Nutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore. Methods A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging. Results Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores. Conclusions Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups. Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).
Collapse
Affiliation(s)
| | - Wai Leng Chow
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Magdalin Cheong
- Department of Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Gladys Huiyun Lim
- Department of Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Weiyi Xie
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Geraldine Baggs
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore, Singapore
| | | | - Siew Ling Tey
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | | |
Collapse
|
13
|
Hall A, Boulton E, Kunonga P, Spiers G, Beyer F, Bower P, Craig D, Todd C, Hanratty B. Identifying older adults with frailty approaching end-of-life: A systematic review. Palliat Med 2021; 35:1832-1843. [PMID: 34519246 PMCID: PMC8637378 DOI: 10.1177/02692163211045917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention. AIM To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outcomes. DESIGN Systematic review (PROSPERO: CRD42020462624). DATA SOURCES Six databases were searched, with no date restrictions, for articles reporting prognostic or intervention studies. Key inclusion criteria were adults aged 65 and over, identified as frail via an established measure. End-of-life was defined as the final 12 months. Key exclusion criteria were proxy definitions of frailty, or studies involving people with cancer, even if also frail. RESULTS Three articles met the inclusion criteria. Strongest evidence came from one study in English primary care, which showed distinct trajectories in electronic Frailty Index scores in the last 12 months of life, associated with increased risk of death. We found no studies evaluating established clinical tools (e.g. Gold Standards Framework) with existing frail populations. We found no intervention studies; the literature on advance care planning with people with frailty has relied on proxy definitions of frailty. CONCLUSION Clear implications for policy and practice are hindered by the lack of studies using an established approach to assessing frailty. Future end-of-life research needs to use explicit approaches to the measurement and reporting of frailty, and address the evidence gap on interventions. A focus on models of care that incorporate a palliative approach is essential.
Collapse
Affiliation(s)
- Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gemma Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|
14
|
How Do Geriatric Scores Predict 1-Year Mortality in Elderly Patients with Suspected Pneumonia? Geriatrics (Basel) 2021; 6:geriatrics6040112. [PMID: 34842708 PMCID: PMC8628683 DOI: 10.3390/geriatrics6040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients’ comorbidities (cumulative illness rating scale—geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia. Methods: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p < 0.01), CIRS-G (p < 0.001) and MNA (p < 0.001) were strongly associated with poorer long-term outcomes in univariate analysis. CIRS-G (p < 0.05) and MNA (p < 0.05) were significant predictors of 1-year mortality in multivariate analysis. Conclusion: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care.
Collapse
|
15
|
Alia S, Aquilanti L, Pugnaloni S, Di Paolo A, Rappelli G, Vignini A. The Influence of Age and Oral Health on Taste Perception in Older Adults: A Case-Control Study. Nutrients 2021; 13:nu13114166. [PMID: 34836421 PMCID: PMC8618294 DOI: 10.3390/nu13114166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/13/2023] Open
Abstract
Declining gustatory function, nutrition, and oral health are important elements of health in older adults that can affect the aging process. The aim of the present work was to investigate the effect of age and oral status on taste discrimination in two different groups of elderly subjects living either in an Italian residential institution (TG) or in the community (CG). A total of 90 subjects were enrolled in the study (58 CG vs. 32 TG). Masticatory performance (MP) was assessed using the two-color mixing ability test. Taste function was evaluated using cotton pads soaked with six taste stimuli (salty, acid, sweet, bitter, fat and water). A positive correlation between age and missing teeth (r = 0.51, C.I. [0.33; 0.65], p < 0.0001), and a negative correlation between age and MP (r = −0.39, C.I. [−0.56; −0.20], p < 0.001) were found. Moreover, significant differences for salty taste, between TG and CG were detected (p < 0.05). Significant differences in bitter taste sensitivity between subjects wearing removable and non-removable prosthesis were also determined (p < 0.05). In addition, significant gender differences and between males in TG and CG were identified (p < 0.05). The best understanding of the relationship between MP, taste sensitivity, and nutritional factors is a necessary criterion for the development of new therapeutic strategies to address more effectively the problems associated with malnutrition in elderly subjects.
Collapse
Affiliation(s)
- Sonila Alia
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
| | - Luca Aquilanti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
| | - Sofia Pugnaloni
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
| | - Alice Di Paolo
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
| | - Giorgio Rappelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10, 60126 Ancona, Italy
| | - Arianna Vignini
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy; (S.A.); (L.A.); (S.P.); (A.D.P.); (G.R.)
- Correspondence: ; Tel.: +39-071-2206058
| |
Collapse
|
16
|
Suzuki J, Ikeda R, Kato K, Kakuta R, Kobayashi Y, Ohkoshi A, Ishii R, Hirano-Kawamoto A, Ohta J, Kawata R, Kanbayashi T, Hatano M, Shishido T, Miyakura Y, Ishigaki K, Yamauchi Y, Nakazumi M, Endo T, Tozuka H, Kitaya S, Numano Y, Koizumi S, Saito Y, Unuma M, Hashimoto K, Ishida E, Kikuchi T, Kudo T, Watanabe K, Ogura M, Tateda M, Sasaki T, Ohta N, Okazaki T, Katori Y. Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan. PLoS One 2021; 16:e0254261. [PMID: 34329339 PMCID: PMC8323917 DOI: 10.1371/journal.pone.0254261] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan. METHODS A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals. RESULTS Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group. CONCLUSION AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.
Collapse
Affiliation(s)
- Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Kengo Kato
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ohta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Kawata
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Tomonori Kanbayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Hatano
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadahisa Shishido
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuya Miyakura
- Department of Otolaryngology, South Miyagi Medical Center, Ogawara, Japan
| | - Kento Ishigaki
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | | | - Miho Nakazumi
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Takuya Endo
- Department of Otolaryngology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Hiroki Tozuka
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Shiori Kitaya
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Yuki Numano
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Shotaro Koizumi
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Yutaro Saito
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Mutsuki Unuma
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Ken Hashimoto
- Department of Otolaryngology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Eiichi Ishida
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Toshiaki Kikuchi
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Takayuki Kudo
- Department of Otolaryngology, South Miyagi Medical Center, Ogawara, Japan
| | - Kenichi Watanabe
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Masaki Ogura
- Department of Otolaryngology, Sendai City Hospital, Sendai, Japan
| | - Masaru Tateda
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Takatsuna Sasaki
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Nobuo Ohta
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Tatsuma Okazaki
- Department of Physical Medicine and Rehabilitation, Tohoku University graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
17
|
Covid-19 and the next outbreak: decreasing frailty by using mild stress? Biogerontology 2021; 22:565-569. [PMID: 34273015 PMCID: PMC8286035 DOI: 10.1007/s10522-021-09930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (Covid-19) has resulted in many deaths, particularly of very old or obese people. These people are at risk to die in the event of an outbreak, like under one-year old babies were at risk to die one century ago from various diseases. It is argued that mild stress could help people to resist new outbreaks. The people who are obese because of bad feeding habits (snacking, junk food, overfeeding) and inactivity should adopt more healthy behaviours. Because an inactive way of life at old age can increase frailty, physical and mental activities should be kept at the highest possible level in elderly people, particularly if they live in retirement homes. In the event of an outbreak, management staff of these homes should not confine residents in their room for weeks or months, as it can increase inactivity, under-nutrition, sarcopenia, and depressive symptoms. People with or without co-morbidities should be active and one could wonder whether other mild stresses such as sauna bathing could help to better resist infection.
Collapse
|
18
|
Abate SM, Chekole YA, Estifanos MB, Abate KH, Kabthymer RH. Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis. Clin Nutr ESPEN 2021; 43:174-183. [PMID: 34024511 PMCID: PMC7968150 DOI: 10.1016/j.clnesp.2021.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malnutrition is inevitable in patients with Coronavirus Disease 2019 (COVID-19) due to its effect on the gastrointestinal system, immune system, and high metabolic activity. However, the prevalence of malnutrition and its outcomes is uncertain. This study aimed to investigate the prevalence and outcome of malnutrition among patients with COVID-19. METHOD A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019 to September, 2020 without language restriction. All observational studies reporting the prevalence of malnutrition were included while case reports and reviews were excluded. The data were extracted with two independent authors with a customized format and the disagreements were resolved by the other authors. The methodological quality of included studies was evaluated using a standardized critical appraisal tool. RESULTS A total of 511 articles were identified from different databases and 27 articles were selected for evaluation after the successive screening. Fourteen articles with 4187 participants were included. The pooled prevalence of malnutrition among hospitalized patients with COVID-19 was 49.11% (95% CI: 31.67 to 66.54). The odd of mortality among patients COVID-19 with malnutrition was 10 times more likely as compared to those who were well-nourished. CONCLUSION The prevalence of malnutrition and mortality associated with malnutrition among COVID-19 hospitalized patients was very high which entails a mitigating strategy by different stakeholders to prevent and manage malnutrition and its outcomes. REGISTRATION This systematic review was registered in Prospero's international prospective register of systematic reviews (CRD42020215396).
Collapse
Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia.
| | - Yigrem Ali Chekole
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Mahlet Birhane Estifanos
- Department of Nutrition, School of Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, College of Public Health and Medical Sciences, Jimma University, Ethiopia
| | - Robel Hussen Kabthymer
- Department of Nutrition, School of Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
| |
Collapse
|
19
|
Mjid M, Snene H, Basly J, Cheikhrouhou S, Hedhli A, Kacem M, Ouahchi Y, Louzir B, Toujani S, Merai S. [Assessment of body composition during pulmonary tuberculosis]. Rev Mal Respir 2021; 38:34-40. [PMID: 33423857 DOI: 10.1016/j.rmr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although the body mass index (BMI) is the most commonly used tool to assess the nutritional status of patients with active tuberculosis (TB), it does not assess changes in body composition. This study aims to assess the contribution of bioelectrical impedancemetry (BIA) for the assessment of body composition during the course of TB compared to BMI and to examine the associated factors. METHODS Cross-sectional study carried out in patients with active TB at the pulmonology department of CHU la Rabta in Tunis, Tunisia. The nutritional assessment was based on the measurement of BMI and the analysis of body composition by BIA. Malnutrition was accepted when the lean mass index (LMI) was ≤16kg/m2 in men and 15kg/m2 in women. RESULTS Ninety-five patients were included. According to their LMI, 38 patients were undernourished. The decline in LMI was associated with the severity of TB. Although BMI and LMI were correlated, the use of BMI alone failed to recognize lean mass loss in one in ten patients. CONCLUSION Undernutrition is frequent in patients with active TB. It is correlated with the severity of the disease. In addition to anti-tuberculosis drugs, nutritional management of these patients is essential.
Collapse
Affiliation(s)
- M Mjid
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - H Snene
- Service de pneumologie allergologie, faculté de Médecine de Tunis, université de Tunis El Manar, CHU Mongi Slim La Marsa, 2046, Sidi Daoued, Tunis, Tunisie.
| | - J Basly
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - S Cheikhrouhou
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - A Hedhli
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - M Kacem
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - Y Ouahchi
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - B Louzir
- Service de pneumologie allergologie, faculté de Médecine de Tunis, université de Tunis El Manar, CHU Mongi Slim La Marsa, 2046, Sidi Daoued, Tunis, Tunisie
| | - S Toujani
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| | - S Merai
- Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie
| |
Collapse
|
20
|
Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
Collapse
Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
| | | |
Collapse
|
21
|
Yu W, Yu W, Liu X, Wan T, Chen C, Xiong L, Zhang W, Lü Y. Associations between malnutrition and cognitive impairment in an elderly Chinese population: an analysis based on a 7-year database. Psychogeriatrics 2021; 21:80-88. [PMID: 33207393 DOI: 10.1111/psyg.12631] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to elucidate whether malnutrition is associated with cognitive impairment in an older Chinese population. METHODS A cross-sectional study was conducted in 2365 participants aged 60 years or older from January 2013 to September 2019. Nutritional status was measured by using the Mini Nutritional Assessment Short Form (MNA-SF). Cognitive function was assessed with the Mini-Mental State Examination (MMSE). The relationship between malnutrition or each Mini Nutritional Assessment Short Form domain and cognitive impairment was examined with univariate and multivariate logistic regression analysis. RESULTS The prevalence of malnutrition, risk of malnutrition, and cognitive impairment was 5.54%, 33.45%, and 36.74%, respectively. The prevalence was higher in those 80 years and older: 7.88%, 40.75%, and 53.65%, respectively. The Mini-Mental State Examination score was positively correlated with the Mini Nutritional Assessment Short Form score (r = 0.364, P < 0.001). After adjustment for age, gender, education, marital status, and living alone, malnutrition (odds ratio (OR) = 3.927, 95% confidence interval (CI): 2.650-5.819), anorexia (OR = 1.454, 95%CI: 1.192-1.774), weight loss (OR = 1.697, 95%CI: 1.406-2.047), impaired mobility (OR = 4.156, 95%CI: 3.311-5.218), and psychological stress (OR = 1.414, 95%CI: 1.070-1.869) were significantly associated with an increased risk of cognitive impairment. CONCLUSIONS Our results suggest that the prevalence of malnutrition and cognitive impairment is relatively high and increases with age. Malnutrition, anorexia, weight loss, impaired mobility, and psychological stress are significantly associated with an increased risk of cognitive impairment. Therefore, clinicians should assess the nutritional and cognitive status of the elderly regularly to improve early detection and timely intervention.
Collapse
Affiliation(s)
- Wuhan Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihua Yu
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Xintong Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianchi Wan
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenxi Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Xiong
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenbo Zhang
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
22
|
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
|
23
|
Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Ueshima J, Mori N. Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan. Geriatr Gerontol Int 2020; 20:811-816. [PMID: 33058420 DOI: 10.1111/ggi.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
AIM The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut-off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. METHODS This retrospective cross-sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut-off value of GNRI, and the results were compared against the Mini Nutritional Assessment - Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut-off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. RESULTS The mean age of the patients was 76.0 ± 7.0 years. The optimal cut-off value of GNRI for Mini Nutritional Assessment - Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817-0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776-0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut-off in the European Society of Clinical Nutrition and Metabolism-defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment - Short Form-based and MUST-based diagnosis, respectively. CONCLUSIONS The study showed GNRI <96 points as the optimal cut-off value for nutritional screening. GNRI might be one of the easy-to-use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811-816.
Collapse
Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Ryoko Kato
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
24
|
Maurer E, Wallmeier V, Reumann MK, Ehnert S, Ihle C, Schreiner AJ, Flesch I, Issack PS, Stollhof LE, Nüssler AK. Risk of malnutrition in orthopedic trauma patients with surgical site infections is associated with increased morbidity and mortality - a 3-year follow-up study. Injury 2020; 51:2219-2229. [PMID: 32620329 DOI: 10.1016/j.injury.2020.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Malnutrition is a worldwide problem which can result in prolonged hospitalization from complications such as poor wound healing and increased morbidity. There is increasing evidence of the effect of risk of malnutrition (ROM) on outcomes in orthopedic surgical patients. However, there is little data on the effect of nutritional status on clinical outcomes in orthopedic trauma patients with surgical site infections (SSI). Therefore, our aim was to investigate how malnutrition risk affects clinical outcomes in a prospective cohort of orthopedic trauma patients with SSI. METHODS The study included 345 patients who underwent surgery due to SSI at a level 1 trauma center. All patients were evaluated on their nutritional status as assessed by the Nutritional Risk Screening in 2014/15 and 2017/18. 238 (69.0%) datasets were available for the follow-up analysis. Twenty patients (8.4%) had died, resulting in 218 patients. Outcomes investigated included comorbidities, medication intake, destination of discharge, degree of mobility, support for procuring food, mortality risk and quality of life. RESULTS 32.8% were at risk of malnutrition (ROM) at EXAM1. Female patients had a higher ROM than males (p < 0.05). Patients with ROM had more comorbidities (p < 0.001), an increased need for medication intake (p < 0.001), a decreased level of mobility (p < 0.001) and increased need of support in procuring food (p < 0.001). The destination of discharge was independent of the nutritional status (p = 0.641). Twenty (8.4%) of the available 238 patients had died during follow-up time period, resulting in a 6.2-times higher risk of mortality in patients with ROM. EQ-5D revealed that mobility, self-supply and usual activities of daily living were increased in well-nourished patients (p < 0.001). CONCLUSION ROM in orthopedic trauma patients with SSI is associated with an increased number of comorbidities and need for medication intake, a decrease in mobility and a higher dependency for food acquisition. Patients at ROM exhibited a 6.2-times higher mortality rate than well-nourished patients. EQ-5D evaluation showed better mobility, self-supply, and activity of daily living in well-nourished patients. We therefore strongly recommend supplementing patients with ROM with a specific diet during and after discharge from the hospital in order to reduce postoperative complications and long-term mortality.
Collapse
Affiliation(s)
- Elke Maurer
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - Vera Wallmeier
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Marie K Reumann
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Christoph Ihle
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Anna J Schreiner
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Ingo Flesch
- Department of Septic Trauma Surgery, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Paul S Issack
- Department of Orthopaedic Surgery, New York - Presbyterian Hospital, 170 William St, New York, NY 10038, United States
| | - Laura E Stollhof
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Andreas K Nüssler
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| |
Collapse
|
25
|
Hasan TF, Kelley RE, Cornett EM, Urman RD, Kaye AD. Cognitive impairment assessment and interventions to optimize surgical patient outcomes. Best Pract Res Clin Anaesthesiol 2020; 34:225-253. [PMID: 32711831 DOI: 10.1016/j.bpa.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
For elderly patients undergoing elective surgical procedures, preoperative evaluation of cognition is often overlooked. Patients may experience postoperative delirium (POD) and postoperative cognitive decline (POCD), especially those with certain risk factors, including advanced age. Preoperative cognitive impairment is a leading risk factor for both POD and POCD, and studies have noted that identifying these deficiencies is critical during the preoperative period so that appropriate preventive strategies can be implemented. Comprehensive geriatric assessment is a useful approach which evaluates a patient's medical, psycho-social, and functional domains objectively. Various screening tools are available for preoperatively identifying patients with cognitive impairment. The Enhanced Recovery After Surgery (ERAS) protocols have been discussed in the context of prehabilitation as an effort to optimize a patient's physical status prior to surgery and decrease the risk of POD and POCD. Evidence-based protocols are warranted to standardize care in efforts to effectively meet the needs of these patients.
Collapse
Affiliation(s)
- Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Roger E Kelley
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, Massachussetts, 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| |
Collapse
|
26
|
de Almeida Mello J, Fávaro-Moreira NC, Krausch-Hofmann S, Vanneste D, Matthys C, Declercq A, Duyck J. Can the interRAI home care instrument be applied to the definition criteria of the Global Leadership Initiative on Malnutrition (GLIM)? A longitudinal study. Clin Nutr 2020; 39:3477-3482. [PMID: 32280009 DOI: 10.1016/j.clnu.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND & AIMS As malnutrition is an important modifiable risk factor for poor clinical outcomes, it is important to target malnourished older people and older people at risk of malnourishment. The Global Leadership Initiative on Malnutrition (GLIM) recently reached a consensus for a global definition of malnutrition. The primary aim of this study was to apply the interRAI Home Care (interRAI HC) instrument to fit the GLIM definition criteria of malnutrition to the closest. A second goal was to identify potential risk factors associated with malnutrition using this comprehensive assessment and to quantify their association. METHODS This is a case control study, which retrospectively determines the exposure to the risk of malnutrition and estimates its potential risk factors. The longitudinal data came from a larger study called Protocol 3. Eligibility criteria were a minimum age of 65 years old, a minimum score of 6 on the Edmonton Frail Scale or at least a moderate level of functional impairment measured by a Belgian version of the Katz scale. Older people with an official dementia diagnosis were also eligible. Bivariate analysis was performed and logistic regression models were developed in order to identify significant determinants of malnutrition. RESULTS The data consisted of 6334 frail older people (mean age: 80.6 ± 6.9, 70.6% female). About 2.4% became malnourished within a follow-up period of one year after baseline. The adjusted logistic regression yielded significant odds ratios for dysphagia (OR 2.2), loss of appetite (OR 1.8), bladder incontinence (OR 1.5) and low fluid intake (OR 1.5). Diabetes (OR 0.5) and visits to the physician (OR 0.5) had both a significant reverse effect. CONCLUSIONS This study was the first large longitudinal research to explore the risk factors of malnutrition with a comprehensive assessment instrument as the interRAI HC, applying it to the recent GLIM definition criteria. The worldwide use of the interRAI instruments makes these findings relevant for global clinical practice and research. Adapting the interRAI instruments to the GLIM definition improves accurate detection, prevention and early treatment of malnourishment, avoiding further health deterioration in older people.
Collapse
Affiliation(s)
- Johanna de Almeida Mello
- KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8, 3000, Leuven, Belgium.
| | - Nádia Cristina Fávaro-Moreira
- KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7 Blok a - Bus 7001, 3000, Leuven, Belgium.
| | - Stefanie Krausch-Hofmann
- KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7 Blok a - Bus 7001, 3000, Leuven, Belgium.
| | - Dirk Vanneste
- KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8, 3000, Leuven, Belgium.
| | - Christophe Matthys
- KU Leuven - Department of Clinical and Experimental Medicine, UZ Herestraat 49, 3000, Leuven, Belgium; Clinical Nutrition Unit, Department of Endocrinology, University Hospitals Leuven, Herestraat 49 - Box 7003-44, 3000, Leuven, Belgium.
| | - Anja Declercq
- KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8, 3000, Leuven, Belgium; Centre for Sociological Research Onderzoek (CeSO), Parkstraat 45 - Bus 3601, 3000 Leuven, Belgium.
| | - Joke Duyck
- KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7 Blok a - Bus 7001, 3000, Leuven, Belgium; KU Leuven BIOMAT Research Cluster - Department of Oral Health Sciences, Kapucijnenvoer 7 Blok a - Bus 7001, 3000, Leuven, Belgium.
| |
Collapse
|
27
|
Brucato A, Ferrari A, Tiraboschi M, Zucchi A, Cogliati C, Torzillo D, Dentali F, Tavecchia L, Gessi V, Squizzato A, Moretti S, Permunian ET, Carobbio A, Pasina L, De Stefano F, Tombetti E, Cumetti D, Tognoni G, Barbui T. Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study). Eur J Intern Med 2020; 72:60-66. [PMID: 31757579 DOI: 10.1016/j.ejim.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
Collapse
Affiliation(s)
- Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alberto Ferrari
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Mara Tiraboschi
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Health Protection Agency, Bergamo, Italy
| | - Chiara Cogliati
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Daniela Torzillo
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Tavecchia
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vera Gessi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Sara Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio De Stefano
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | | | - Davide Cumetti
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Gianni Tognoni
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| |
Collapse
|
28
|
Motokawa K, Yasuda J, Mikami Y, Edahiro A, Morishita S, Shirobe M, Ohara Y, Nohara K, Hirano H, Watanabe Y. The Mini Nutritional Assessment-Short Form as a predictor of nursing home mortality in Japan: A 30-month longitudinal study. Arch Gerontol Geriatr 2020; 86:103954. [DOI: 10.1016/j.archger.2019.103954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022]
|
29
|
Potentially modifiable determinants of malnutrition in older adults: A systematic review. Clin Nutr 2019; 38:2477-2498. [DOI: 10.1016/j.clnu.2018.12.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 01/09/2023]
|
30
|
Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Impact of edema on length of calf circumference in older adults. Geriatr Gerontol Int 2019; 19:993-998. [DOI: 10.1111/ggi.13756] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Yuria Ishida
- Department of NutritionAichi Medical University Hospital Nagakute Aichi Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
| | - Tomoyuki Nonogaki
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Akio Shimizu
- Department of NutritionHamamatsu City Rehabilitation Hospital Hamamatsu Shizuoka Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Ryoko Kato
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Naoharu Mori
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
| |
Collapse
|
31
|
Ultrasound Muscle Assessment and Nutritional Status in Institutionalized Older Adults: A Pilot Study. Nutrients 2019; 11:nu11061247. [PMID: 31159255 PMCID: PMC6627854 DOI: 10.3390/nu11061247] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 01/10/2023] Open
Abstract
Muscle thickness, measured by ultrasonography, has been investigated for nutritional assessment in older adults, however the associations between muscle ultrasound parameters in the lower limb and nutritional status have not been studied. The aim of this study was to investigate the relationship between muscle thickness echo intensity (EI), and nutritional status in home care residents. A cross sectional study was conducted involving 19 older adults from a home care in Malaga (Spain). We evaluated lower leg muscles by ultrasound, anthropometric data, physical function (measured by gait speed and the Short Physical Performance Battery), strength (handgrip and knee extensors strength) and nutritional status across the Mini-Nutritional Assessment Short-Form (MNA-SF). We found that muscle thickness assessed by ultrasonography independently predicts nutritional status by MNA-SF and after adjusting for handgrip strength or age and sex. As secondary findings, we found relations between strength, functional capacity and the MNA-SF test. These results suggest that lower leg muscle ultrasound parameters could be used as a low-cost objective method for muscle evaluation in nutritional assessment in older adults.
Collapse
|
32
|
Gingrich A, Volkert D, Kiesswetter E, Thomanek M, Bach S, Sieber CC, Zopf Y. Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients. BMC Geriatr 2019; 19:120. [PMID: 31029082 PMCID: PMC6487020 DOI: 10.1186/s12877-019-1115-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/24/2019] [Indexed: 12/26/2022] Open
Abstract
Background Sarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study was to assess the prevalence of these syndromes and their overlap in older medical inpatients. Methods Patients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated. Results One hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m2 were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes. Conclusions Nearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.
Collapse
Affiliation(s)
- Anne Gingrich
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Marta Thomanek
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Svenja Bach
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Yurdagül Zopf
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| |
Collapse
|
33
|
Maeda K, Ishida Y, Nonogaki T, Mori N. Reference body mass index values and the prevalence of malnutrition according to the Global Leadership Initiative on Malnutrition criteria. Clin Nutr 2019; 39:180-184. [PMID: 30712782 DOI: 10.1016/j.clnu.2019.01.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition. This study aimed to investigate the optimal reference values of body mass index (BMI) for discriminating severe malnutrition according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition in the clinical setting. METHODS This study included 6783 patients aged ≥40 years, who were admitted to an academic hospital. Of the 1987 patients who presented with low BMI in period 1, optimal BMI cut-off values were determined using receiver operating characteristic analyses against in-hospital mortality in younger (aged <70 years) and older age groups. Next, 4796 patients from period 2 were screened using a validated nutritional screening tool. Patients had their nutritional condition assessed after screenings were analyzed using the GLIM criteria, which included body weight changes, BMI, reduced muscle mass, nutritional intake, and disease burden. Additionally, patients diagnosed with malnutrition were classified as having moderate or severe malnutrition, according to the obtained BMI values from the period 1 data. RESULTS The optimal cut-off BMI values were 17.0 kg/m2 for younger patients and 17.8 kg/m2 for older patients. Patients at risk of malnutrition included 14.5% and 42.0% of admitted younger and older patients in period 2, respectively. GLIM-defined malnutrition was diagnosed in 18.0% of all patients (10.6% and 25.7% in younger and older patients, respectively). After adapting the BMI cut-off values according to the period 1 results, 9.0% and 9.0% of all patients were diagnosed as having moderate and severe malnutrition, respectively. Patients with GLIM-defined malnutrition showed significantly higher in-hospital mortality compared to those without malnutrition. CONCLUSIONS The Asian reference values of BMI to grade malnutrition severity according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition were determined. These reference values will contribute to implementing the GLIM criteria in Asian populations.
Collapse
Affiliation(s)
- Keisuke Maeda
- Palliative Care Center, Aichi Medical University, Japan; Nutritional Therapy Support Center, Aichi Medical University Hospital, Japan.
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Japan
| | | | - Naoharu Mori
- Palliative Care Center, Aichi Medical University, Japan; Nutritional Therapy Support Center, Aichi Medical University Hospital, Japan
| |
Collapse
|
34
|
Maeda K, Ishida Y, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Burden of Premorbid Consumption of Texture Modified Diets in Daily Life on Nutritional Status and Outcomes of Hospitalization. J Nutr Health Aging 2019; 23:973-978. [PMID: 31781727 DOI: 10.1007/s12603-019-1237-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Due to the water-rich cooking process required to soften texture modified diets (TMDs), TMDs may have poorer nutrition. The aim of this study was to investigate the associations between daily premorbid TMD consumption and nutritional status at the time of hospitalization, and its burden on hospitalization outcomes. DESIGN Retrospective observational study. SETTING An academic hospital. PARTICIPANTS The cohort comprised 3,594 older adult patients aged ≥65 years admitted to the hospital. MEASUREMENTS Patients were interviewed on admission using a premorbid daily consumption meal form to determine whether the patient ate a TMD. Nutritional status was examined using nutritional screening tools (Mini-Nutritional Assessment Short Form [MNA-SF], Malnutrition Universal Screening Tool [MUST], Geriatric Nutritional Risk Index [GNRI]) and the European Society of Clinical Nutrition and Metabolism (ESPEN)-defined criteria of malnutrition at admission. Length of hospital stay (LOS) and in-hospital mortality were considered outcomes of hospitalization. Multivariate analyses were performed to detect associations between premorbid TMD consumption and nutritional status and outcomes. RESULTS The mean age of the subjects was 75.9±7.0 years, including 58% males. Overall, 110 (3.1%) patients consuming a premorbid TMD were identified. They were older (p<0.001), had poor nutritional status (lower MNA-SF score [p<0.001] and GNRI value [p<0.001], higher MUST score [p<0.001], and more prevalent ESPEN-defined malnutrition [61.8% vs. 14.0%, p<0.001] than did patients without a TMD. The mortality rate and LOS of patients with TMD was higher (7.3% vs. 2.9%, p=0.017) and longer (19 days vs. 8 days, p<0.001) than those without TMD. Multivariate analyses showed that TMD consumption was independently associated with poor nutritional status and prolonged LOS after adjusting confounders. CONCLUSION Daily consumption of a TMD during the premorbid period affects nutritional status at the time of hospitalization and outcomes. Further studies are necessary to investigate whether nutritional intervention can improve outcomes for people on a TMD.
Collapse
Affiliation(s)
- K Maeda
- Keisuke Maeda, M.D., Ph.D., Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan, Phone: +81-561-62-3311; Fax: +81-561-78-6364, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Fogg C, Griffiths P, Meredith P, Bridges J. Hospital outcomes of older people with cognitive impairment: An integrative review. Int J Geriatr Psychiatry 2018; 33:1177-1197. [PMID: 29947150 PMCID: PMC6099229 DOI: 10.1002/gps.4919] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. METHODS Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. RESULTS One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. CONCLUSIONS Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
Collapse
Affiliation(s)
- Carole Fogg
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- School of Health Sciences and Social Work, Faculty of ScienceUniversity of PortsmouthPortsmouthUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter Griffiths
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Paul Meredith
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
| | - Jackie Bridges
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| |
Collapse
|
36
|
Le Bourg E, Redman LM. Do-It-Yourself Calorie Restriction: The Risks of Simplistically Translating Findings in Animal Models to Humans. Bioessays 2018; 40:e1800087. [DOI: 10.1002/bies.201800087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 05/22/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Eric Le Bourg
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Integrative; Université de Toulouse; CNRS, UPS 31062 Toulouse Cedex France
| | - Leanne M. Redman
- Division of Clinical Sciences Pennington; Biomedical Research Center; 6400 Perkins Road Baton Rouge LA 70808 USA
| |
Collapse
|
37
|
Pasina L, Cortesi L, Tiraboschi M, Nobili A, Lanzo G, Tettamanti M, Franchi C, Mannucci PM, Ghidoni S, Assolari A, Brucato A. Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study. Arch Gerontol Geriatr 2018; 74:169-173. [PMID: 29121542 DOI: 10.1016/j.archger.2017.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 10/09/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. METHODS This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR≤29mL/min/1.73m2; severe dementia; albuminemia ≪2.5g/dL; hospital admissions in the six months before the index admission. RESULTS Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p≪0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. CONCLUSIONS Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.
Collapse
Affiliation(s)
- Luca Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Laura Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Giovanna Lanzo
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Italy
| | | | | | | |
Collapse
|
38
|
Uchmanowicz I, Jankowska-Polańska B, Wleklik M, Lisiak M, Gobbens R. Frailty Syndrome: Nursing Interventions. SAGE Open Nurs 2018; 4:2377960818759449. [PMID: 33415192 PMCID: PMC7774369 DOI: 10.1177/2377960818759449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/30/2017] [Accepted: 01/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background Frailty syndrome is now becoming a challenge for multidisciplinary teams. Frailty assessment in elderly patients is recommended due to the associated cascade of irreversible alterations that ultimately result in disability. Aims The purpose of this article is to identify interventions, which can be implemented and performed by nurses as part of a multidisciplinary plan. Nursing strategies related to nutrition, polypharmacy, adherence to treatment, falls, exercise, and mood and cognitive intervention are described. Design Discussion paper. Data sources Relevant and up-to-date literature from PubMed, MEDLINE, and Scopus databases regarding the selected issues, such as nutritional status, polypharmacy, falls, physical activity, and cognitive functions. Conclusion Frailty is considered preventable or even reversible with the appropriate interventions, which can help maintain or even restore physical abilities, cognitive function, or nutritional status in frail elderly patients. Hence, the nursing interventions are significant in clinical practice and should be implemented for frail patients. Implications for nursing Health-care providers, especially nurses, in their clinical practice should recognize not only elderly patients but also elderly patients with concurrent frailty, requiring intensified therapeutic interventions tailored to their individual needs. Frailty syndrome is undoubtedly a challenge for multidisciplinary teams providing health care for geriatric patients.
Collapse
Affiliation(s)
- Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Wleklik
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Lisiak
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| |
Collapse
|
39
|
Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study. Healthcare (Basel) 2018; 6:healthcare6010009. [PMID: 29361696 PMCID: PMC5872216 DOI: 10.3390/healthcare6010009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 12/21/2022] Open
Abstract
Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge.
Collapse
|
40
|
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
|
41
|
Wleklik M, Uchmanowicz I, Jankowska-Polańska B, Andreae C, Regulska-Ilow B. The Role of Nutritional Status in Elderly Patients with Heart Failure. J Nutr Health Aging 2018; 22:581-588. [PMID: 29717757 DOI: 10.1007/s12603-017-0985-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.
Collapse
Affiliation(s)
- M Wleklik
- Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland,
| | | | | | | | | |
Collapse
|
42
|
Kimura D, Murata M, Kimura Y, Nunotani M, Hayashi Y, Abe K. Nutritional status and management of risks due to physical therapy in patients hospitalized for long periods. J Phys Ther Sci 2017; 29:1910-1913. [PMID: 29200622 PMCID: PMC5702812 DOI: 10.1589/jpts.29.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to understand the nutritional status of patients hospitalized
for long periods and the risk of physical therapy (PT) for such patients. [Subjects and
Methods] Participants were selected from patients who were hospitalized at a designated
medical long-term care sanatorium. The participants were divided into 5 groups (A–E)
depending on their mode of energy intake and ambulatory ability during PT. The serum
albumin level, energy intake, total daily energy expenditure, and total daily energy
expenditure per session of PT (EEPT) were evaluated for each group. [Results]
Protein-energy malnutrition was observed in 69.6% of the participants. No significant
association was identified between the serum albumin level and body mass index. Energy
intake was significantly higher in Groups D and E, whose energy intake was via ingestion,
than in Groups A and B, whose intake was via tube feeding. EEPT was highest in patients of
Group E who had gait independence different from the ability of those in groups A–D.
[Conclusion] The actual energy intake is lower with tube feeding than with ingestion. Risk
management and energy intake should be revisited in elderly patients who have been
hospitalized for long periods and subsequently obtain gait independence.
Collapse
Affiliation(s)
- Daisuke Kimura
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki City 701-0193, Okayama, Japan
| | | | - Yuko Kimura
- Department of Rehabilitation, Kousyokai Aino Hospital, Japan
| | | | - Yoshitaka Hayashi
- Graduate School of Health Sports Sciences, Mukogawa Women's University, Japan
| | - Kazuo Abe
- Department of Community Health Care Medicine, Hyogo College of Medicine, Japan
| |
Collapse
|
43
|
Kańtoch A, Wielek J, Gryglewska B, Grodzicki T. Nutritional and Functional Status in Newly Hospitalized Older Patients Who are Not Underweight. J Nutr Gerontol Geriatr 2017; 36:111-120. [PMID: 29095131 DOI: 10.1080/21551197.2017.1377138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although malnutrition is commonly associated with being underweight, it occurs whenever nutrient intakes are inadequate, regardless of current body weight. The aim of the study was to determine nutritional status as a predictor of functional status among older patients without underweight according to body mass index (BMI) at hospital admission. This cross-sectional study enrolled 90 patients aged ≥65 years (mean age 78.1 ± 6.4). Assessments included basic and Instrumental Activities of Daily Living (bADL, IADL), Mini Nutritional Assessment (MNA), and BMI. Most of respondents were at risk of malnutrition (46%) or malnutrition (17%) according to MNA. Patients with/at risk of malnutrition had lower scores in bADL (p = 0.020), IADL (p = 0.010) and MNA (p < 0.001). Scores for bADL and IADL positively correlated with MNA (r = 0.34, r = 0.42, respectively) and negatively with age (r = -0.33, r = -0.21). MNA scores were also significant predictors of staying independence in bADL (β = 0.53, p < 0.001) and IADL (β = 0.45, p < 0.001) in regression analysis. Our findings indicated that most older patients with normal/elevated BMI were malnourished or at risk of malnutrition and experienced functional limitations in ADL at admission to hospital. In this population, nutritional status estimated by MNA appears to be one of the most important factors in predicting functional status of older adults who are not underweight.
Collapse
Affiliation(s)
- Anna Kańtoch
- a Department of Internal Medicine and Gerontology , Jagiellonian University Medical College , Kraków , Poland
| | - Jolanta Wielek
- a Department of Internal Medicine and Gerontology , Jagiellonian University Medical College , Kraków , Poland
| | - Barbara Gryglewska
- a Department of Internal Medicine and Gerontology , Jagiellonian University Medical College , Kraków , Poland
| | - Tomasz Grodzicki
- a Department of Internal Medicine and Gerontology , Jagiellonian University Medical College , Kraków , Poland
| |
Collapse
|
44
|
Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital. Proc Nutr Soc 2017; 77:95-99. [PMID: 29081312 DOI: 10.1017/s0029665117002804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.
Collapse
|
45
|
Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E829. [PMID: 28771192 PMCID: PMC5579622 DOI: 10.3390/nu9080829] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
Collapse
Affiliation(s)
- Zhiying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
- Abbott Nutrition Research and Development Asia-Pacific Center, 138668 Singapore, Singapore.
| | | | - Menghua Luo
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29412, USA.
| |
Collapse
|
46
|
Liu GX, Chen Y, Yang YX, Yang K, Liang J, Wang S, Gan HT. Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes. Geriatr Gerontol Int 2017; 17:2485-2492. [PMID: 28657169 DOI: 10.1111/ggi.13110] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Gong-Xiang Liu
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Yan Chen
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Ying-Xue Yang
- Department of Gastroenterology, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Kun Yang
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Jin Liang
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Shuang Wang
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Hua-Tian Gan
- The Center of Gerontology and Geriatrics, West China Hospital; Sichuan University; Chengdu Sichuan China
| |
Collapse
|
47
|
Zhu M, Wei J, Chen W, Yang X, Cui H, Zhu S. Nutritional Risk and Nutritional Status at Admission and Discharge among Chinese Hospitalized Patients: A Prospective, Nationwide, Multicenter Study. J Am Coll Nutr 2017; 36:357-363. [PMID: 28548607 DOI: 10.1080/07315724.2017.1304293] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mingwei Zhu
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Wei Chen
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Xin Yang
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Hongyuan Cui
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Sainan Zhu
- Department of Statistics, Peking University First Hospital, Beijing, China
| | | |
Collapse
|
48
|
Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr 2017; 117:532-540. [DOI: 10.1017/s0007114517000435] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
Collapse
|
49
|
Rosa CB, Garces SBB, Hansen D, Brunelli ÂV, Bianchi PD, Coser J, Krug MDR, Schwanke CHA. Malnutrition risk and hospitalization in elderly assisted in Primary Care. CIENCIA & SAUDE COLETIVA 2017. [DOI: 10.1590/1413-81232017222.15732016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract The aim of this study was to investigate the association of malnutrition risk and single items of the Mini Nutritional Assessment (MNA®) with hospitalization in the last 12 months in the elderly assisted in primary care. A cross-sectional study was conducted with the evaluation of 1229 elderly persons assisted in Family Health Strategies in seven cities of South Brazil. Malnutrition risk was evaluated using the MNA®, and hospitalization was determined by one question of the Probability of Repeated Admission (PRA) instrument. Most of the elderly were women (61.7%), with a mean age of 71.7 ± 7.7 years. The malnutrition risk rate was 23.3% and hospitalization was 32.9%. The frequency of malnutrition and risk of malnutrition was two times greater among the elderly who were hospitalized (36.8 versus 18.6% - P < 0.001). There was a significant association between hospitalization and 11 (64.7%) of the 17 items on the MNA® evaluated (P < 0.05). Of these, seven items were independently associated with hospitalization by multivariate analysis. We observed an association of malnutrition risk and most of the single MNA® items as well, with hospitalization in the elderly assisted in primary care.
Collapse
|
50
|
Natella PA, Le Corvoisier P, Paillaud E, Renaud B, Mahé I, Bergmann JF, Perchet H, Mottier D, Montagne O, Bastuji-Garin S. Long-term mortality in older patients discharged after acute decompensated heart failure: a prospective cohort study. BMC Geriatr 2017; 17:34. [PMID: 28125958 PMCID: PMC5270303 DOI: 10.1186/s12877-017-0419-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). However, few studies specifically addressed ADHF outcomes in patients aged 75 years or over, who contribute more than half of all ADHF admissions. Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality. METHODS This prospective cohort study in five French hospitals included consecutive patients aged 75 years or older and discharged after emergency-department admission for ADHF meeting Framingham criteria (N = 478; median age, 85 years; 68% female). Kaplan-Meier 1-year and 2-year survival curves were plotted. Admission characteristics independently associated with overall 2-year mortality were identified using multivariable Cox proportional-hazards regression. RESULTS Mortality was 41.7% (95% confidence interval [95% CI], 37.2%-53.5%) after 1 year and 56.0% (95% CI, 51.5%-60.7%) after 2 years. By multivariable analysis, independent predictors of 2-year mortality were male sex (hazard ratio [HR], 1.36; 95% CI, 1.00-1.82), age >85 years (HR, 1.57; 95% CI, 1.19-2.07), higher number of impaired activities of daily living (HR, 1.11 per impaired item; 95% CI, 1.05-1.17), recent weight loss (HR, 1.61; 95% CI, 1.14-2.28), and lower systolic blood pressure (HR, 0.86 per standard deviation increase; 95% CI, 0.74-0.99). Creatinine clearance ≤30 mL/min showed a trend toward an association with 2-year mortality (HR, 1.36; 95% CI, 0.97-2.00). CONCLUSION Functional impairment before admission is associated with higher long-term mortality in patients ≥75 years admitted for ADHF. This study focused on geriatric markers not traditionally collected in heart-failure patients but did not analyse all cardiologic parameters associated with outcomes in other studies. Nevertheless, our findings may contribute to identify those patients admitted for ADHF who have the worst prognosis.
Collapse
Affiliation(s)
- Pierre-André Natella
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Philippe Le Corvoisier
- Inserm, Centre d’Investigation Clinique, 1430 Créteil, France
- AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010 Créteil, France
| | - Elena Paillaud
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France
| | - Bertrand Renaud
- AP-HP, Hôpital Henri Mondor, Structure des Urgences, Créteil, France
| | - Isabelle Mahé
- AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France
- Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-François Bergmann
- AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France
- Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Hervé Perchet
- Centre hospitalier de Meaux, Service de Cardiologie, Meaux, France
| | - Dominique Mottier
- CHU Brest, Hôpital Cavale Blanche, Département de Médecine Interne et de Pneumologie, Brest, France
- Université de Bretagne Occidentale, EA 3878 (GETBO), Brest, France
| | - Olivier Montagne
- Inserm, Centre d’Investigation Clinique, 1430 Créteil, France
- AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010 Créteil, France
| | - Sylvie Bastuji-Garin
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique, Créteil, France
| |
Collapse
|