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Cianferotti L, Bifolco G, Caffarelli C, Mazziotti G, Migliaccio S, Napoli N, Ruggiero C, Cipriani C. Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review. Nutrients 2024; 16:1773. [PMID: 38892706 PMCID: PMC11174536 DOI: 10.3390/nu16111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Hip fractures are a major health issue considerably impacting patients' quality of life and well-being. This is particularly evident in elderly subjects, in which the decline in bone and muscle mass coexists and predisposes individuals to fall and fracture. Among interventions to be implemented in hip fractured patients, the assessment and management of nutritional status is pivotal, particularly in subjects older than 65. Nutrition plays a central role in both primary and secondary preventions of fracture. An adequate protein intake improves muscle mass and strength and the intestinal absorption of calcium. Other nutrients with recognized beneficial effects on bone health are calcium, vitamins D, K, and C, potassium, magnesium, folate, and carotenoids. With reference to calcium, results from longitudinal studies showed that the consumption of dairy foods has a protective role against fractures. Moreover, the most recent systematic reviews and meta-analyses and one umbrella review demonstrated that the combination of calcium and vitamin D supplementation significantly reduces hip fracture risk, with presumed higher efficacy in older and institutionalized subjects. Owing to these reasons, the adequate intake of calcium, vitamin D, protein, and other macro and micronutrients has been successfully implemented in the Fracture Liaison Services (FLSs) that represent the most reliable model of management for hip fracture patients. In this narrative review, papers (randomized controlled trials, prospective and intervention studies, and systematic reviews) retrieved by records from three different databases (PubMed, Embase, and Medline) have been analyzed, and the available information on the screening, assessment, and management of nutritional and vitamin D status and calcium intake in patients with hip fractures is presented along with specific prevention and treatment measures.
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Affiliation(s)
- Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, 50134 Florence, Italy;
| | - Giuseppe Bifolco
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, 50134 Florence, Italy;
| | - Carla Caffarelli
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Silvia Migliaccio
- Department of Experimental Medicine, University Sapienza of Rome, 00185 Rome, Italy;
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Rome Biomedical Campus University Foundation, 00128 Rome, Italy;
| | - Carmelinda Ruggiero
- Geriatric and Orthogeriatric Units, Division Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy;
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
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Capurso C, Lo Buglio A, Bellanti F, Vendemiale G. Prognostic Nutritional Index and Instant Nutritional Assessement Are Associated with Clinical Outcomes in a Geriatric Cohort of Acutely Inpatients. Nutrients 2024; 16:1359. [PMID: 38732604 PMCID: PMC11085456 DOI: 10.3390/nu16091359] [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: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Among elderly inpatients, malnutrition is one of the most important predictive factors affecting length of stay (LOS), mortality, and risk of re-hospitalization. METHODS We conducted an observational, retrospective study on a cohort of 2206 acutely inpatients. Serum albumin and lymphocytes were evaluated. Instant Nutritional Assessment (INA) and the Prognostic Nutritional Index (PNI) were calculated to predict in-hospital mortality, LOS, and risk of rehospitalization. RESULTS An inverse relationship between LOS, serum albumin, and PNI were found. Deceased patients had lower albumin levels, lower PNI values, and third- and fourth-degree INA scores. An accurate predictor of mortality was PNI (AUC = 0.785) after ROC curve analysis; both lower PNI values (HR = 3.56) and third- and fourth-degree INA scores (HR = 3.12) could be independent risk factors for mortality during hospitalization after Cox regression analysis. Moreover, among 309 subjects with a lower PNI value or third- and fourth-class INA, hospitalization was re-hospitalization. CONCLUSIONS PNI and INA are two simple and quick-to-calculate tools that can help in classifying the condition of hospitalized elderly patients also based on their nutritional status, or in assessing their mortality risk. A poor nutritional status at the time of discharge may represent an important risk factor for rehospitalization in the following thirty days. This study confirms the importance of evaluating nutritional status at the time of hospitalization, especially in older patients. This study also confirms the importance for adequate training of doctors and nurses regarding the importance of maintaining a good nutritional status as an integral part of the therapeutic process of hospitalization in acute departments.
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Affiliation(s)
- Cristiano Capurso
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (A.L.B.); (F.B.); (G.V.)
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Hou TY, Lin YH, Liu YW, Liu YY, Li WF, Kuo MC, Huang SW, Yeh CH, Lin YC, Yin SM. The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients. BMC Surg 2024; 24:100. [PMID: 38580988 PMCID: PMC10996270 DOI: 10.1186/s12893-024-02397-0] [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: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Malnutrition is not uncommon among the elderly undergoing pancreatoduodenectomy (PD) and is related to increased complications. Previous studies have shown that the Geriatric Nutritional Risk Index (GNRI) predicts outcomes in various populations. Nevertheless, the research exploring the correlation between GNRI and postoperative outcomes in PD is scarce. This study aimed to investigate the preoperative malnutrition, as measured by GNRI, on outcomes in elderly patients undergoing PD. MATERIALS AND METHODS This retrospective analysis enrolled 144 elderly patients underwent PD for periampullary tumors from November 2016 to December 2021. Patients were stratified based on the GNRI value: high/moderate nutrition risk (GNRI ≤ 92, N = 54), low nutrition risk (92 < GNRI ≤ 98, N = 35), and no nutrition risk (GNRI > 98, N = 55). Perioperative outcomes and postoperative surgical complications were compared between these groups. Univariate and multivariate analyses were performed on major postoperative complications and prolonged postoperative length of stay (PLOS). RESULTS Patients in the high/moderate risk group were significantly older, with lower BMI (P = 0.012), higher mortality rate (11.1%, P = 0.024), longer PLOS (P < 0.001), and higher incidence of over grade IIIB complications (37.0%, P = 0.001), Univariate and multivariate analyses showed the high/moderate risk GNRI group (OR 3.61, P = 0.032), increased age (OR 1.11, P = 0.014) and operative time over 8 h (OR 3.04, P = 0.027) were significantly associated with increased major postoperative complications. The high/moderate risk GNRI group was also a significant predictor for prolonged PLOS (OR 3.91, P = 0.002). CONCLUSIONS Preoperative GNRI has the potential to be a predictive tool for identifying high-risk elderly patients and monitoring nutritional status preoperatively to improve postoperative surgical outcomes following PD.
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Affiliation(s)
- Teng-Yuan Hou
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Yu-Hung Lin
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Yueh-Wei Liu
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Yu-Yin Liu
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Wei-Feng Li
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Ming-Chun Kuo
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Szu-Wei Huang
- Department of Obstetrics and Gynecology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Cheng-Hsi Yeh
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Yu-Cheng Lin
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Shih-Min Yin
- Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
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Terp R, Kayser L, Lindhardt T. An educative nutritional intervention supporting older hospital patients to eat sufficiently using eHealth: a mixed methods feasibility and pilot study. BMC Geriatr 2024; 24:22. [PMID: 38177992 PMCID: PMC10768306 DOI: 10.1186/s12877-023-04582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/10/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Insufficient food intake is common in older hospital patients and increases the risk of readmission, mortality, and decline in functional status. To improve food intake in older patients, an eHealth solution (Food'n'Go) enabling them to participate in their own nutritional care was implemented in a hospital unit. We developed an educative nutritional intervention (ENI) to support hospitalized older adults (aged ≥ 65 years) to participate in their own nutritional care using Food'n'Go. In this study, we evaluate the feasibility of the ENI and its potential to improve nutritional intake. METHODS Feasibility was evaluated using process evaluation, and nutritional intake was examined by using a pre- and post-test design. Assessment of feasibility: Contextual factors (availability of Food'n'Go and prevalence of counseling by a dietitian); Intervention fidelity (whether patients were informed of nutrition and Food'n'Go, and whether their needs for support were assessed); and Mechanism of impact (patients' knowledge and skills related to nutrition and the use of Food'n'Go and their acceptance of the ENI). Assessment of nutritional intake: Patients' intake of protein and energy based on one-day observations before implementation of the ENI (pre-test; n = 65) and after a three-month intervention (post-test; n = 65). RESULTS Feasibility: Food'n'Go was available for more patients after the intervention (85 vs. 64%, p = .004). Most patients managed the use of Food'n'Go and were involved in ordering their food, but only a few monitored their food intake. Information on nutrition was not provided sufficiently to all patients. In general, the ENI had high acceptability among the patients. Nutritional intake: Compared to patients in the pre-test, patients in the post-test had a higher daily mean intake of energy (kJ) (6712 (SD: 2964) vs. 5660 (SD: 2432); difference 1052 (95% CI 111-1993)), and of protein (g) (60 (SD: 28) vs. 43 (SD: 19); difference 17 (95% CI 9-26)). Likewise, there was an increase in the mean attainment of protein requirements: 73% (SD: 34) vs. 59% (SD: 29) (p = .013). CONCLUSION The ENI is feasible for supporting hospitalized older adults to participate in their own nutrition using eHealth and preliminary results indicate that it may lead to an increasing energy and protein intake.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Hospitalsvej 1, 2900, Hellerup, Denmark
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Bower KL, Shilling DM, Bonnes SL, Shah A, Lawson CM, Collier BR, Whitehead PB. Ethical Implications of Nutrition Therapy at the End of Life. Curr Gastroenterol Rep 2023; 25:69-74. [PMID: 36862286 DOI: 10.1007/s11894-023-00862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW Provide an evidence-based resource to inform ethically sound recommendations regarding end of life nutrition therapy. RECENT FINDINGS • Some patients with a reasonable performance status can temporarily benefit from medically administered nutrition and hydration(MANH) at the end of life. • MANH is contraindicated in advanced dementia. • MANH eventually becomes nonbeneficial or harmful in terms of survival, function, and comfort for all patients at end of life. • Shared decision-making is a practice based on relational autonomy, and the ethical gold standard in end of life decisions. A treatment should be offered if there is expectation of benefit, but clinicians are not obligated to offer non-beneficial treatments. A decision to proceed or not should be based on the patient's values and preferences, a discussion of all potential outcomes, prognosis for given outcomes taking into consideration disease trajectory and functional status, and physician guidance provided in the form of a recommendation.
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Affiliation(s)
- Katie L Bower
- Carilion Clinic, Department of Surgery, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave., Roanoke, VA, 24014, USA. .,Carilion Clinic Palliative Medicine, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave, Roanoke, VA, 24014, USA.
| | - Danielle M Shilling
- Mayo Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sara L Bonnes
- Mayo Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Apeksha Shah
- Cooper University Health Care, Cooper Medical School of Rowan University Digestive Health Institute, Camden, NJ, USA
| | - Christy M Lawson
- Division of Trauma and Critical Care Surgery, Univeristy of Tennessee, Knoxville, TN, USA
| | - Bryan R Collier
- Carilion Clinic, Department of Surgery, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave., Roanoke, VA, 24014, USA
| | - Phyllis B Whitehead
- Carilion Clinic Palliative Medicine, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave, Roanoke, VA, 24014, USA
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Terp R, Lindhardt T, Kayser L. Theory-driven development of an educative nutritional intervention (ENI) supporting older hospital patients to eat sufficiently, assisted by an eHealth solution: an intervention mapping approach. BMC Health Serv Res 2022; 22:1435. [DOI: 10.1186/s12913-022-08679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background:
Insufficient protein and energy intake is a prevalent and serious problem in older hospital patients. Here, we describe the development of a program consisting of 1) an educative nutritional intervention (ENI) to support older hospital patients to participate in their own nutritional care using the eHealth solution Food’n’Go, and 2) a plan for education and support of healthcare professionals, enabling them to conduct the ENI. Further, we describe the evaluation of the acceptability of the program as perceived by nursing staff and dieticians.
Methods:
The Intervention Mapping (IM) framework was used to design and develop the ENI through six steps: 1) a logic model of the problem was developed; 2) performance objectives and related change objectives were defined for patients, relatives, and healthcare professionals; 3) the intervention was designed using relevant theory-based change methods; 4) program materials were produced; and finally, 5) implementation and maintenance were planned and 6) evaluation of the program was planned. End users (patients, relatives, and healthcare professionals) were involved in the design and development of the ENI.
Results:
Based on the logic model, the personal determinants (knowledge, skills, self-efficacy, outcome expectation, social support, attitude, and awareness) related to the patients and their relatives were addressed in the ENI, and those related to the healthcare professionals were addressed in the plan for their education and support. Theories of behavioral change, technology acceptance, and nutritional management for older persons were applied. A plan for evaluation of the effectiveness (intake of energy and protein) and feasibility of the ENI was conducted. The feasibility measurements were the behaviors and determinants related to the intervention outcome that were identified in the logic model of change. The ENI was perceived as acceptable by the nursing staff and dieticians.
Conclusion:
We developed a theory- and evidence-based intervention guided by the IM framework and a sociotechnical approach, which was perceived as acceptable and ready for use to support older hospital patients to eat sufficiently assisted by eHealth.
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Terp R, Kayser L, Lindhardt T. Older Patients' Competence, Preferences, and Attitudes Toward Digital Technology Use: Explorative Study. JMIR Hum Factors 2021; 8:e27005. [PMID: 33988512 PMCID: PMC8164121 DOI: 10.2196/27005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/28/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Malnutrition is prevalent in older patients, which is associated with severe consequences such as a decline in functional status, increased risk of readmission, and increased mortality. A tablet-based eHealth solution (Food'n'Go) was recently developed and introduced at our clinic to support older patients' involvement in nutritional interventions during their hospitalization, thereby enhancing their awareness and motivation for choosing the right food to obtain sufficient calorie and protein intake. To reap the full benefits from the eHealth solution, the technology should be introduced and accompanied by support that targets the end users' competence level and needs. OBJECTIVE In this study, we aimed to explore older patients' readiness (ie, competence, preferences, and attitudes) toward the use of information and communication technology (ICT), and to identify the factors that may act as barriers or facilitators for their engagement with health technology. METHODS A descriptive and explorative study was performed using triangulation of data derived from semistructured interviews and questionnaires (based on the Readiness and Enablement Index for Health Technology [READHY] instrument). Older hospitalized patients (age ≥65 years; N=25) were included from two hospitals in Denmark. RESULTS The majority (16/25, 64%) of the older patients (median age 81 years) were users of ICT. The qualitative findings revealed that their experiences of benefits related to the use of ICT facilitated usage. Barriers for use of ICT were health-related challenges, limited digital literacy, and low self-efficacy related to ICT use due to age-related prejudices by their relatives and themselves. The qualitative findings were also reflected in the low median scores on the eHealth Literacy Questionnaire (eHLQ) READHY scales within dimensions addressing the user's knowledge and skills (eHLQ1:1.8; eHLQ3: 2.0), and the user experience (eHLQ6: 2.0; eHLQ7: 1.5). CONCLUSIONS Older patients are potential users of ICT, but experience a variety of barriers for using eHealth. When introducing older patients to eHealth, it is important to emphasize the possible benefits, and to offer support targeting their knowledge, skills, and motivation.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tove Lindhardt
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
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Han CY, Miller M, Yaxley A, Baldwin C, Woodman R, Sharma Y. Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis. BMJ Open 2020; 10:e040146. [PMID: 33318114 PMCID: PMC7737105 DOI: 10.1136/bmjopen-2020-040146] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness. DESIGN Randomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults ≥65 years were collated from MEDLINE, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated. RESULTS Twenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2-5 times/week, of 20-90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n=3, SMD 0.25; 95% CI 0.03 to 0.46; p=0.02) and improvement in short physical performance battery (SPPB) scores (n=3, MD 0.48; 95% CI 0.12 to 0.84; p=0.008) compared with standard care. Only the chair-stand test (n=3) out of the three SPPB components was significantly improved (MD 0.26; 95% CI 0.09 to 0.43; p=0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I2=96%, p<0.001). The pooled effect for handgrip (n=3)±knee extension muscle strength (n=4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data. CONCLUSIONS There is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Yogesh Sharma
- Department of General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. GeroScience 2020; 42:1547-1578. [PMID: 33001410 PMCID: PMC7528158 DOI: 10.1007/s11357-020-00272-3] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.
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Affiliation(s)
- Richard Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Deaglan McCullough
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Tom Butler
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK.
| | - Fatima Perez de Heredia
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Claire Stewart
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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Lau S, Pek K, Chew J, Lim JP, Ismail NH, Ding YY, Cesari M, Lim WS. The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients 2020; 12:nu12092885. [PMID: 32967354 PMCID: PMC7551805 DOI: 10.3390/nu12092885] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research.
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Affiliation(s)
- Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Correspondence: ; Tel.: +65-6359-6474
| | - Kalene Pek
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Noor Hafizah Ismail
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20122 Milan, Italy
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
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Terp R, Kayser L, Lindhardt T. "It is not rocket science.." - Older peoples' understanding of nutrition - A qualitative study. Appetite 2020; 156:104854. [PMID: 32871203 DOI: 10.1016/j.appet.2020.104854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to: 1) explore older patients' knowledge, skills and behavior in relation to nutrition and 2) achieve an understanding of older patients' experiences, understanding and attitudes towards management of nutritional needs. DESIGN Semi-structured interviews were conducted and analyzed using content analysis. The Readiness and Enablement Index for Health Technology (READHY) instrument was used as a framework. SETTING Two hospital units specialized in internal medicine located at two university hospitals in Copenhagen. PARTICIPANTS Patients (N = 25) age 65 ≥ years and admitted to hospital for medical treatment. FINDINGS The informants' knowledge, behavior and attitude towards nutrition was influenced by their experience of food as an everyday phenomenon but less so by the experience of nutrition as important for their well-being and health. Three themes were identified: 1) Food - an everyday phenomenon; 2) Habits and preferences and 3) When food becomes nutrition. CONCLUSION Older, ill patients have limited knowledge about specific needs for energy and protein and the importance of nutrition for their physical functioning. They have potential resources and competencies which can positively impact and be utilized in nutritional interventions. Social interaction, the pleasurable experience of eating well-prepared food, and daily routines facilitate their nutritional intake.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, København K, Denmark.
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hospitalsvej 1, 2900, Hellerup, Denmark.
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12
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Zhou T, Liu L, Dai HS, Zhang CC, He Y, Zhang LD, Li DJ, Bie P, Ding J, Chen ZY. Impact of body mass index on postoperative outcomes in patients undergoing radical resection for hilar cholangiocarcinoma. J Surg Oncol 2020; 122:1418-1425. [PMID: 32794267 DOI: 10.1002/jso.26172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/02/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Body mass index (BMI) has been widely used as a prognostic indicator. The association between preoperative BMI and postoperative morbidity in patients with hilar cholangiocarcinoma (HCCA) has not been proved. This study aimed to identify the association between preoperative BMI and postoperative morbidity following radical resection of HCCA. METHODS Patients were divided into three groups according to preoperative BMI: low BMI (≤18.4 kg/m2 ), normal BMI (18.4-24.9 kg/m2 ), and high BMI (≥24.9 kg/m2 ). Baseline characteristics, operative variables, postoperative 30-day mortality, and morbidity were compared. Risk factors associated with postoperative morbidity were assessed using univariable and multivariable logistic analyses. RESULTS Among 260 patients, 183 (70.4%) had normal BMI, 32 (12.3%) had low BMI, and 45 (17.3%) had high BMI. Compared to the patients with normal-BMI, both low and high BMI patients exhibited a significantly higher postoperative morbidity (87.5% and 82.2% vs 63.9%, P = .019 and P = .025, respectively). Additionally, the multivariable analysis revealed that both low and high BMI patients remained independently associated with an increased risk of postoperative morbidity. (OR: 3.707, 95% CI: 1.080-12.725, P = .037; and OR: 2.858, 95% CI: 1.167-7.002, P = .022, respectively). CONCLUSION BMI is an independent risk factor for higher postoperative morbidity in patients who undergo surgical treatment of hilar cholangiocarcinoma.
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Affiliation(s)
- Tian Zhou
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Cheng-Cheng Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yu He
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lei-Da Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Da-Jiang Li
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Bie
- Department of Hepatobiliary Surgery, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Ding
- Department of Hepatobiliary Surgery, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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13
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Developing the Expanded Food Security Screener and Pilot Testing It for Prioritization of Applicants to the Home-Delivered Meal Program. TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Which laboratory malnutrition markers best predict 1-year mortality in hospitalized older adults? Eur Geriatr Med 2019; 10:619-624. [PMID: 34652737 DOI: 10.1007/s41999-019-00204-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/08/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE To study which laboratory malnutrition markers best predict 1-year mortality in the general population of hospitalized older adults as well as among patients at risk for malnutrition. METHODS A historical prospective study. All older adults (age ≥ 65 years) hospitalized in one geriatric department during 9 months were included. Malnutrition Universal Screening Tool (MUST) was used to determine malnutrition risk. Laboratory malnutrition markers included albumin serum levels, transferrin serum levels, total cholesterol serum levels, vitamin D serum levels, and lymphocyte count. A receiver operating characteristic (ROC) curve analysis was used to study which markers best predict 1-year mortality. RESULTS Overall, 437 patients (63.2% women; mean age 84.7 years) were included. Overall, 126 (28.8%) patients died in the year following admission. ROC curve analysis showed that low albumin serum levels best predict 1-year mortality (AUC 0.721, p < 0.001), followed by low transferrin serum levels (AUC 0.661, p < 0.001) and low lymphocyte count (AUC 0.575, p = 0.016). Among 178 (40.7%) patients at risk for malnutrition, 63 (35.4%) patients died in the year following admission. ROC curve analysis showed that albumin serum levels best predict 1-year mortality in patients at risk for malnutrition (AUC 0.720, p < 0.001), followed by transferrin serum levels (AUC 0.659, p = 0.001). Regression analysis showed that low albumin serum levels were also independently associated with 1-year mortality among the whole cohort and among patients at risk for malnutrition (OR 0.2, 95% CI 0.1-0.4, p < 0.001, for both). CONCLUSIONS Low albumin serum levels best predict 1-year mortality in hospitalized older adults, followed by low transferrin serum levels.
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15
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Zhu X, Zheng J, Liu K, You L. Rationing of Nursing Care and Its Relationship with Nurse Staffing and Patient Outcomes: The Mediation Effect Tested by Structural Equation Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101672. [PMID: 31091660 PMCID: PMC6572194 DOI: 10.3390/ijerph16101672] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/31/2022]
Abstract
Purpose: The purpose of this study is to test the mediation effect of rationing of nursing care (RONC) and the relationship this has between nurse staffing and patient outcomes. Methods: The analytic sample included 7802 nurse surveys and 5430 patient surveys. Three patient outcome indicators, nurse staffing, RONC, and confounding factors were considered in the model pathways. Results: The hypothesized model was shown to be statistically significant. In the model, nurses who were in the units with lower nurse-to-patient ratios reported higher scores on RONC, which meant that an increased level of withheld nursing care or a failure to carry out nursing duties was apparent. Nurses who reported a higher score on RONC, scored poorly on the quality assessment and were more frequently involved in patient adverse events. Nurse staffing influenced quality assessments and patient adverse events through RONC. In units with poorer nurse-reported quality assessments or more frequently patient adverse events, patient-reported dissatisfaction scores were higher. Conclusions: The results suggest that a lack of nurse staffing leads to RONC, which leads to poorer patient outcomes. These results are seen when considering the evaluations completed by both nurses and patients. The relationship between staffing numbers and patient outcomes explains the mediating role of RONC.
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Affiliation(s)
- Xiaowen Zhu
- School of Nursing, Jinan University, Guangzhou 510632, China.
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China.
| | - Ke Liu
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, China.
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16
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Gur-Yaish N, Tonkikh O, Shadmi E, Zisberg A. Informal support for older adults is negatively associated with walking and eating during hospitalization. Geriatr Nurs 2019; 40:264-268. [DOI: 10.1016/j.gerinurse.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 12/27/2022]
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Dent E, Hoogendijk EO, Visvanathan R, Wright ORL. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging 2019; 23:431-441. [PMID: 31021360 DOI: 10.1007/s12603-019-1176-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
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Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
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18
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Ní Chróinín D, Basic D, Conforti D, Shanley C. Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study. Eur Geriatr Med 2018; 9:321-327. [PMID: 34654235 DOI: 10.1007/s41999-018-0041-7] [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: 12/18/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes. MATERIALS AND METHODS Consecutive patients admitted under geriatric medicine over 5 years were prospectively included. Pre-hospital decline was defined as decrease in Modified Barthel Index (MBI) between pre-morbid status (1 month prior) and admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise). Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death. RESULTS Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline. On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83, p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional decline (OR 15.22, CI 10.89-21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong association was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14). No association was observed with in-hospital death. CONCLUSION Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early interventions to optimise function in such patients is needed.
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Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia. .,UNSW South Western Sydney Clinical School, UNSW, Liverpool, Australia.
| | - David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia.
| | - David Conforti
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia
| | - Chris Shanley
- Centre for Applied Nursing Research, Western Sydney University, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
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Terp R, Jacobsen KO, Kannegaard P, Larsen AM, Madsen OR, Noiesen E. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk—a randomized controlled trial. Clin Rehabil 2018; 32:930-941. [DOI: 10.1177/0269215518765912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To investigate the effect of a nutrition intervention program for geriatric nutritional at-risk patients. Design: A randomized controlled trial. Setting: Department of geriatric medicine in a university hospital and in the primary healthcare sector, Copenhagen. Subjects: Geriatric patients ( N = 144) at nutritional risk. Intervention: The intervention consisted of an individual dietary plan for home, including pre-discharge advice on nutritional intake, combined with three follow-up visits after discharge (one, four, and eight weeks). Main measures: Change in body weight, Barthel Index, hand-grip strength and self-rated health from baseline (discharge) to three months after discharge, readmission, and mortality (90 and 120 days). Results: The mean (SD) age in total sample was 87.2 (6.2) years. Sample size in the intervention group (IG) was N = 72, and in the control group (CG), N = 72. IG had a mean (SD) weight gain of 0.9 (4.2) kg compared to a weight loss of 0.8 (3.6) kg in the CG ( P = 0.032). In addition, an improvement in self-rated health was seen in the IG compared to CG (IG: 23 (47%) vs. CG: 12 (24%); P = 0.021). No significant difference between groups was found in functional status, mortality, or readmission rates. Conclusion: An individual dietary plan based on everyday food, combined with three follow-up visits (one, four, and eight weeks) after discharge, led to an improvement in nutritional status and self-rated health in geriatric patients.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Kim Otto Jacobsen
- Department of Geriatric Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Pia Kannegaard
- Department of Geriatric Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne-Mette Larsen
- Nutritional Unit, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Eline Noiesen
- Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Isshiki M, Hirayama S, Ueno T, Ito M, Furuta A, Yano K, Yamatani K, Sugihara M, Idei M, Miida T. Apolipoproteins C-II and C-III as nutritional markers unaffected by inflammation. Clin Chim Acta 2018. [PMID: 29540295 DOI: 10.1016/j.cca.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Rapid turnover proteins (RTPs), such as transthyretin (TTR), retinol binding protein (RBP), and transferrin (Tf), provide an accurate assessment of nutritional status but are susceptible to inflammation. Lipid-related markers, which have short half-lives in serum, may be better suited for nutritional assessment. We sought to identify sensitive nutritional markers unaffected by inflammation. METHODS Fasting serum samples were collected from 30 malnourished inpatients and 25 healthy volunteers. Malnourished inpatients were divided into 2 groups: a low-C-reactive protein (CRP) group (CRP < 20 mg/l, n = 15) and a high-CRP group (CRP ≥ 20 mg/l, n = 15). Lipid-related markers, traditional nutritional markers, RTPs, micronutrients, and ketone bodies were measured and compared among the groups. RESULTS Apolipoprotein (Apo)C-II and ApoC-III concentrations were lower in malnourished inpatients than in the control group. There was no significant difference in ApoC-II and ApoC-III between the low- and high-CRP groups. Carnitine transporters and ketone bodies did not show a significant difference among the three groups. Albumin, TTR, RBP, and Tf concentrations were lowest in the high-CRP group, intermediate in the low-CRP group, and highest in the control group. CONCLUSIONS These results indicate that ApoC-II and ApoC-III are appropriate nutritional biomarkers unaffected by inflammation.
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Affiliation(s)
- Miwa Isshiki
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Satoshi Hirayama
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Tsuyoshi Ueno
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masayuki Ito
- Department of Medical Technology, Niigata College of Medical Technology, 5-13-3 Kamishinei-cho, Nishi-ku, Niigata-shi, Niigata 950-2076, Japan
| | - Ayaka Furuta
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kouji Yano
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Center for Genomic and Regenerative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kotoko Yamatani
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masami Sugihara
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mayumi Idei
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Strasser B, Volaklis K, Fuchs D, Burtscher M. Role of Dietary Protein and Muscular Fitness on Longevity and Aging. Aging Dis 2018; 9:119-132. [PMID: 29392087 PMCID: PMC5772850 DOI: 10.14336/ad.2017.0202] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/02/2017] [Indexed: 12/21/2022] Open
Abstract
Muscle atrophy is an unfortunate effect of aging and many diseases and can compromise physical function and impair vital metabolic processes. Low levels of muscular fitness together with insufficient dietary intake are major risk factors for illness and mortality from all causes. Ultimately, muscle wasting contributes significantly to weakness, disability, increased hospitalization, immobility, and loss of independence. However, the extent of muscle wasting differs greatly between individuals due to differences in the aging process per se as well as physical activity levels. Interventions for sarcopenia include exercise and nutrition because both have a positive impact on protein anabolism but also enhance other aspects that contribute to well-being in sarcopenic older adults, such as physical function, quality of life, and anti-inflammatory state. The process of aging is accompanied by chronic immune activation, and sarcopenia may represent a consequence of a counter-regulatory strategy of the immune system. Thereby, the kynurenine pathway is induced, and elevation in the ratio of kynurenine to tryptophan concentrations, which estimates the tryptophan breakdown rate, is often linked with inflammatory conditions and neuropsychiatric symptoms. A combined exercise program consisting of both resistance-type and endurance-type exercise may best help to ameliorate the loss of skeletal muscle mass and function, to prevent muscle aging comorbidities, and to improve physical performance and quality of life. In addition, the use of dietary protein supplementation can further augment protein anabolism but can also contribute to a more active lifestyle, thereby supporting well-being and active aging in the older population.
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Affiliation(s)
- Barbara Strasser
- Division of Medical Biochemistry, Biocenter, Medical University Innsbruck, Austria
| | | | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, Medical Section, University Innsbruck, Austria
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Vaudin A, Song HJ, Mehta M, Sahyoun N. Measuring Nutrition-Related Unmet Needs in Recently Hospital-Discharged Homebound Older Adults. J Nutr Gerontol Geriatr 2018; 37:30-48. [PMID: 29505394 DOI: 10.1080/21551197.2018.1431587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Functional limitations in homebound older adults may cause difficulties with obtaining and preparing adequate healthy food. Services exist to help with these difficulties, however, not all individuals who could benefit receive them. This secondary analysis of observational data, obtained via questionnaires from homebound, recently hospital discharged older adults (n = 566), aimed to identify the prevalence and correlates of unmet need for such services, and to examine the disagreement between self-reported need for a service and functional limitation that could be addressed by that service. One-fifth of respondents reported unmet need for vision services and oral health services, and one-tenth reported unmet need for transportation services and physical therapy. There was a significant association between reported need and functional limitation (p < 0.001) for all services, except mental health and grocery delivery. However, for each service there were participants who under-reported need, compared with functional ability indicators. More research is required to determine the best methods for measuring these needs to ensure that nutritional vulnerability is detected and addressed in those returning from hospital.
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Affiliation(s)
- Anna Vaudin
- a Department of Nutrition and Food Science , University of Maryland, College Park , College Park , Maryland , USA
| | - Hee-Jung Song
- a Department of Nutrition and Food Science , University of Maryland, College Park , College Park , Maryland , USA
| | - Mira Mehta
- a Department of Nutrition and Food Science , University of Maryland, College Park , College Park , Maryland , USA
| | - Nadine Sahyoun
- a Department of Nutrition and Food Science , University of Maryland, College Park , College Park , Maryland , USA
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Gagliardi C, Corsonello A, Di Rosa M, Fabbietti P, Cherubini A, Mercante O, Mazzei B, Postacchini D, Deales A, Bustacchini S, Lattanzio F. Preadmission Functional Decline Predicts Functional Improvement Among Older Patients Admitted to Acute Care Hospital. J Gerontol A Biol Sci Med Sci 2017; 73:1363-1369. [DOI: 10.1093/gerona/glx211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cristina Gagliardi
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Andrea Corsonello
- Italian National Research Center on Aging (INRCA), Research Hospital of Cosenza, Italy
| | - Mirko Di Rosa
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Paolo Fabbietti
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Antonio Cherubini
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Oriano Mercante
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Bruno Mazzei
- Italian National Research Center on Aging (INRCA), Research Hospital of Cosenza, Italy
| | - Demetrio Postacchini
- Italian National Research Center on Aging (INRCA), Research Hospital of Fermo, Italy
| | - Alberto Deales
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Silvia Bustacchini
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Fabrizia Lattanzio
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
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Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. BMC Geriatr 2017; 17:136. [PMID: 28673255 PMCID: PMC5496255 DOI: 10.1186/s12877-017-0527-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/27/2017] [Indexed: 01/22/2023] Open
Abstract
Background Malnutrition is a nutritional disorder that adversely affects the body from a functional or clinical perspective. It is very often observed in the elderly population. This study aimed to estimate the prevalence of malnutrition among hospitalized elderly patients and its associated factors and outcomes in terms of length of stay and mortality in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Methods In a cross-sectional study, we evaluated the nutritional status of hospitalized elderly patients using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF). Results A total of 248 hospitalized patients were included (70.0 ± 7.7 years; 60% female). According to the MNA-SF, a total of 76.6% patients were either malnourished or at risk of malnutrition. Malnourished patients had significantly lower levels of serum albumin (28.2 ± 7.7), hemoglobin (10.5 ± 1.8), and lymphocyte (1.7 ± 0.91). They had increased tendency to stay in the hospital for longer durations (IQR, 5-11 days; median = 7 days) and had a mortality rate of 6.9%. Conclusion Malnutrition was highly prevalent among hospitalized elderly and was associated with increased length of stay and mortality.
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Humphreys K, Vadher D, Allen Y, Patel N, Shah S. Examining the links between hydration, nutrition and mouth health. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:566-570. [PMID: 28541101 DOI: 10.12968/bjon.2017.26.10.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hydration, nutrition and mouth health have historically been overlooked and considered in isolation when, in reality, they are interlinked and interdependent. Not only do these health factors greatly influence each other, but also they have a significant effect on general health and wellbeing. By viewing each of these areas in isolation, health professionals risk missing opportunities to maximise patients' health and quality of life. Collaboration between health professions will also maximise benefits to patients. This article aims to explain the health effects of hydration, nutrition and mouth health and the links between them so practitioners consider how they can make positive changes in these areas for their patients and how they can promote collaboration with other health professionals.
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Affiliation(s)
- Katie Humphreys
- Dental Core Trainee in Dental Public Health, Health Education England
| | - Devika Vadher
- Clinical Fellow in Dental Public Health, Health Education England
| | - Yasmin Allen
- Clinical Fellow in Leadership and Management, Health Education England
| | - Nikki Patel
- Clinical Fellow in Leadership and Management, Health Education England
| | - Sam Shah
- Training Programme Director and Honorary Consultant, Dental Public Health, Health Education England
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Dewake N, Hamasaki T, Sakai R, Yamada S, Nima Y, Tomoe M, Kakuta S, Iwasaki M, Soh I, Shimazaki Y, Ansai T. Relationships among sense of coherence, oral health status, nutritional status and care need level of older adults according to path analysis. Geriatr Gerontol Int 2017; 17:2083-2088. [PMID: 28345311 DOI: 10.1111/ggi.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/26/2016] [Accepted: 01/17/2017] [Indexed: 11/29/2022]
Abstract
AIM Sense of coherence (SOC) is a measurement of ability of an individual to cope with psychological stress and remain in good health. The aim of the present study was to examine the relationships among SOC score, oral health status, nutritional status and care need level of older adults using path analysis. METHODS We enrolled 53 older adults (17 men and 36 women) who were attending a day care service (mean age 80.4 ± 6.5 years). SOC was assessed using a 13-item, seven-scale instrument. Oral health status (number of present teeth, denture use) and nutritional status (assessed with Mini-Nutritional Assessment Short-Form) were also evaluated. Path analysis was used to examine the relationship of SOC with other related factors, including care need level. RESULTS The mean SOC score was 57.0 ± 13.9. Mini-Nutritional Assessment Short-Form results showed that one participant (1.8%) was malnourished, 26 (49.1%) were at risk of malnutrition and 26 (49.1%) had normal nutritional status. Participants with high SOC scores showed a strong positive attitude, had a relatively large number of teeth, were in good nutritional condition and showed low care need levels. CONCLUSIONS The present results showed that maintaining a high SOC level and good oral health help to reduce care need levels in older adults, and also prevent a worsening of their nutritional condition. Geriatr Gerontol Int 2017; 17: 2083-2088.
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Affiliation(s)
- Nanae Dewake
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.,Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Tomoko Hamasaki
- Department of Nutrition, Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Japan
| | - Rie Sakai
- Department of Health and Nutrition Care, Faculty of Allied Health Sciences, University of East Asia, Shimonoseki, Japan
| | - Shima Yamada
- Department of Nutritional Sciences, Faculty of Health and Welfare, Seinan Jo Gakuin University, Kitakyushu, Japan
| | - Yuko Nima
- Department of Nutrition, Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Japan
| | - Miki Tomoe
- Department of Nutrition, Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Japan
| | - Satoko Kakuta
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Masanori Iwasaki
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Inho Soh
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
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Rondanelli M, Talluri J, Peroni G, Donelli C, Guerriero F, Ferrini K, Riggi E, Sauta E, Perna S, Guido D. Beyond Body Mass Index. Is the Body Cell Mass Index (BCMI) a useful prognostic factor to describe nutritional, inflammation and muscle mass status in hospitalized elderly?: Body Cell Mass Index links in elderly. Clin Nutr 2017; 37:934-939. [PMID: 28408051 DOI: 10.1016/j.clnu.2017.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/25/2016] [Accepted: 03/20/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND & AIM The aim of this study was to establish the effectiveness of Body Cell Mass Index (BCMI) as a prognostic index of (mal)nutrition, inflammation and muscle mass status in the elderly. METHODS A cross-sectional observational study has been conducted on 114 elderly patients (80 women and 34 men), with mean age equal to 81.07 ± 6.18 years. We performed a multivariate regression model by Structural Equation Modelling (SEM) framework. We detected the effects over a Mini Nutritional Assessment (MNA) stratification, by performing a multi-group multivariate regression model (via SEM) in two MNA nutritional strata, less and bigger (or equal) than 17. RESULTS BCMI had a significant effect on albumin (β = +0.062, P = 0.001), adjusting for the other predictors of the model as Body Mass Index (BMI), age, sex, fat mass and cognitive condition. An analogous result is maintained in MNA<17 stratum. BMI has confirmed to be a solid prognostic factor for both free fat mass (FFM) (β = +0.480, P < 0.001) and Skeletal Muscle Index (SMI) (β = +0.265, P < 0.001), assessed by DXA. BCMI also returned suggestive evidences (0.05 < P < 0.10) for both the effect on FFM and on SMI in overall sample. CONCLUSIONS The main result of this study is that the BCMI, compared to BMI, proved to be significantly related to an important marker as albumin in geriatric population. Then, assessing the BCMI could be a valuable, inexpensive, easy to perform tool to investigate the inflammation status of elderly patients.
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Affiliation(s)
- Mariangela Rondanelli
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, Pavia, Italy
| | - Jacopo Talluri
- Research and Clinical Investigation Department, Akern, Pontassieve, Italy
| | - Gabriella Peroni
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, Pavia, Italy.
| | - Chiara Donelli
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, Pavia, Italy
| | | | - Krizia Ferrini
- Istituto Europeo di Oncologia, Department of Experimental Oncology, Milan, Italy; University of Pavia, Department of Brain and Behavioral Sciences, Medical and Genomic Statistics Unit, Pavia, Italy
| | - Emilia Riggi
- University of Pavia, Department of Brain and Behavioral Sciences, Medical and Genomic Statistics Unit, Pavia, Italy
| | - Elisabetta Sauta
- University of Pavia, Department of Brain and Behavioral Sciences, Medical and Genomic Statistics Unit, Pavia, Italy
| | - Simone Perna
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, Pavia, Italy
| | - Davide Guido
- University of Pavia, Department of Brain and Behavioral Sciences, Medical and Genomic Statistics Unit, Pavia, Italy; University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Biostatistics and Clinical Epidemiology Unit, Pavia, Italy
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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.
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Admission handgrip strength predicts functional decline in hospitalized patients. Clin Nutr ESPEN 2017; 17:28-32. [DOI: 10.1016/j.clnesp.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 12/24/2022]
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Hudgens J, Langkamp-Henken B. The Mini Nutritional Assessment as an Assessment Tool in Elders in Long-Term Care. Nutr Clin Pract 2017; 19:463-70. [PMID: 16215140 DOI: 10.1177/0115426504019005463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The prevalence of malnutrition increases with age and is most common in the institutionalized individual. Malnutrition is a condition associated with greater susceptibility to infection, longer hospital stay, and increased mortality. Detection of risk of malnutrition in elders and early intervention may lessen these negative consequences. A tool that has been used for assessing nutritional status of elders is the Mini Nutritional Assessment, or MNA. The MNA tool was originally validated in relatively healthy elders in France and New Mexico, but assessment scores seem to correlate with immune function, morbidity, and mortality of elders in long-term care. One of the advantages of using the MNA for assessing nutritional status of elders in long-term care is that it does not need any biochemical tests, such as serum albumin or prealbumin. A weakness of the MNA is that a number of questions target independent-living elders but not elders in long-term care or elders receiving nutrition support. The benefits, limitations, and interpretations in the use of this tool in a long-term care setting are discussed.
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Kim JH, Min SK, Lee H, Hong G, Lee HK. The safety and risk factors of major hepatobiliary pancreatic surgery in patients older than 80 years. Ann Surg Treat Res 2016; 91:288-294. [PMID: 27904850 PMCID: PMC5128374 DOI: 10.4174/astr.2016.91.6.288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/19/2016] [Accepted: 08/03/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose Recently, the number of elderly patients has increased due to a longer life expectancy. Among these elderly patients, more octogenarians will be diagnosed with major hepatobiliary pancreatic (HBP) diseases. Therefore, we need to evaluate the safety and risk factors of major HBP surgery in patients older than 80 years. Methods From January 2000 to April 2015, patients who underwent major HBP surgery were identified. The patients were divided into 2 groups according to their age at the time of surgery: Group O (≥80 years) and group Y (<80 years). The patient characteristics and intra- and postoperative outcomes were retrospectively investigated in the 2 groups. Results The median age was 84 years (range, 80–95 years) in group O and 61 years (range, 27–79 years) in group Y. group O had worse American Society of Anesthesiologists (ASA) physical status (ASA ≥ III: 23% vs. 7%, P = 0.002) and was associated with a higher rate of hypertension and heart problems as comorbidities. There were significant differences in albumin and BUN, favoring group Y. The length of intensive care unit stay was longer in group O, whereas the overall complication and mortality rates did not show statistical difference. But, there was a significant difference in systemic complication of both Clavien-Dindo classification grade ≥II and ≥III as complications were divided into surgical site complication and systemic complication. Conclusion Major HBP surgery can be performed safely in patients older than 80 years if postoperative management is appropriately provided.
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Affiliation(s)
- Jong Hun Kim
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seog Ki Min
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
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Relationship of serum vitamin D level on geriatric syndromes and physical performance impairment in elderly hypertensive patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:537-45. [PMID: 27582772 PMCID: PMC4987426 DOI: 10.11909/j.issn.1671-5411.2016.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To investigate the relationship among serum vitamin D levels, physical performance impairment, and geriatric syndromes in elders with hypertension. Methods According to the concentration of vitamin D levels, a total of 143 elderly patients with hypertension were classified into vitamin D deficient group (vitamin D ≤ 20 ng/mL, n = 94) and vitamin D appropriate group (vitamin D > 20 ng/mL, n = 49). Geriatric syndromes and physical performance were assessed by using comprehensive geriatric assessment (CGA). Correlation among vitamin D levels, geriatric syndromes and physical performance was analyzed. Results No statistical differences were found in various aspects of geriatric syndromes between the two groups (P > 0.05). While correlation analysis indicated that vitamin D levels had a positive association with ADL score (r = 0.235, P < 0.01) and a negative association with Morse fall scale score (r = –0.238, P < 0.01). Patients with deficient vitamin D level had longer time both in the Five Time Sit to Stand Test (5tSTS), (15.765 ± 5.593) and the four-meter walk test [7.440 (5.620, 9.200)], a weaker hand-grip in the grip strength test (28.049 ± 9.522), and a lower Tinetti performance-oriented mobility assessment (Tinetti POMA) [26 (22, 27)] and Balance subscale of the Tinetti performance-oriented mobility assessment (B-POMA) score [14 (12, 16)], compared with appropriate vitamin D level [(13.275 ± 3.692); 5.810 (4.728, 7.325)]; (31.989 ± 10.217); [26.5 (25, 28)]; [15 (14, 16), respectively, all P < 0.05]. Furthermore, results of logistic regression indicated that vitamin D was significantly associated with 5tSTS (OR = 1.2, 95% CI = 1.050–1.331, P < 0.01), Tinetti POMA (OR = 3.7, 95% CI:1.284–10.830, P < 0.05) and B-POMA (OR = 0.8, 95% CI:0.643–0.973, P < 0.05). Conclusions In elderly hypertensive patients, serum vitamin D deficient level is associated with physical performance impairment. However, no statistical significance was found between vitamin D and geriatric syndromes. Further study is required to investigate possible mechanisms for the association between vitamin D and physical performance.
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Mosquera C, Koutlas NJ, Edwards KC, Strickland A, Vohra NA, Zervos EE, Fitzgerald TL. Impact of malnutrition on gastrointestinal surgical patients. J Surg Res 2016; 205:95-101. [DOI: 10.1016/j.jss.2016.05.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/28/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
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Shiraki T, Iida O, Takahara M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Fujita M, Uematsu M. The Geriatric Nutritional Risk Index is Independently Associated with Prognosis in Patients with Critical Limb Ischemia Following Endovascular Therapy. Eur J Vasc Endovasc Surg 2016; 52:218-24. [DOI: 10.1016/j.ejvs.2016.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/19/2016] [Indexed: 12/22/2022]
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Singler K, Goisser S, Volkert D. Ernährungsmanagement in der Alterstraumatologie. Z Gerontol Geriatr 2016; 49:535-46. [DOI: 10.1007/s00391-016-1091-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/21/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
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Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial. Contemp Clin Trials 2016; 49:6-14. [PMID: 27178766 DOI: 10.1016/j.cct.2016.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/25/2016] [Accepted: 05/09/2016] [Indexed: 01/08/2023]
Abstract
Hospitalization induces functional decline in older adults. Many geriatric patients fail to fully recover physical function after hospitalization, which increases the risk of frailty, disability, dependence, re-hospitalization, and mortality. There is a lack of evidence-based therapies that can be implemented following hospitalization to accelerate functional improvements. The aims of this Phase I clinical trial are to determine 1) the effect size and variability of targeted interventions in accelerating functional recovery from hospitalization and 2) the feasibility of implementing such interventions in community-dwelling older adults. Older patients (≥65years, n=100) will be recruited from a single site during hospitalization for an acute medical condition. Subjects will be randomized to one of five interventions initiated immediately upon discharge: 1. protein supplementation, 2. in-home rehabilitation plus placebo supplementation, 3. in-home rehabilitation plus protein supplementation, 4. single testosterone injection, or 5. isocaloric placebo supplementation. Testing will occur during hospitalization (baseline) and at 1 and 4weeks post-discharge. Each testing session will include measures of muscle strength, physical function/performance, body composition, and psychological function. Physical activity levels will be continuously monitored throughout study participation. Feasibility will be determined through collection of the number of eligible, contacted, and enrolled patients; intervention adherence and compliance; and reasons for declining enrollment and study withdrawal. This research will determine the feasibility of post-hospitalization strategies to improve physical function in older adults. These results will also provide a foundation for performing larger, multi-site clinical trials to improve physical function and reduce readmissions in geriatric patents.
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McLeod M, Breen L, Hamilton DL, Philp A. Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology 2016; 17:497-510. [PMID: 26791164 PMCID: PMC4889643 DOI: 10.1007/s10522-015-9631-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/22/2015] [Indexed: 12/19/2022]
Abstract
Due to improved health care, diet and infrastructure in developed countries, since 1840 life expectancy has increased by approximately 2 years per decade. Accordingly, by 2050, a quarter of Europe’s population will be over 65 years, representing a 10 % rise in half a century. With this rapid rise comes an increased prevalence of diseases of ageing and associated healthcare expenditure. To address the health consequences of global ageing, research in model systems (worms, flies and mice) has indicated that reducing the rate of organ growth, via reductions in protein synthetic rates, has multi-organ health benefits that collectively lead to improvements in lifespan. In contrast, human pre-clinical, clinical and large cohort prospective studies demonstrate that ageing leads to anabolic (i.e. growth) impairments in skeletal muscle, which in turn leads to reductions in muscle mass and strength, factors directly associated with mortality rates in the elderly. As such, increasing muscle protein synthesis via exercise or protein-based nutrition maintains a strong, healthy muscle mass, which in turn leads to improved health, independence and functionality. The aim of this review is to critique current literature relating to the maintenance of muscle mass across lifespan and discuss whether maintaining or reducing protein synthesis is the most logical approach to support musculoskeletal function and by extension healthy human ageing.
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Affiliation(s)
- Michael McLeod
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Leigh Breen
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Andrew Philp
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK. .,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Suárez N, Alonso-Renedo J, Contín KC, de Asteasu MLS, Echeverria NF, Lázaro MG, Izquierdo M. Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: study protocol for a randomized controlled trial. BMC Geriatr 2015; 15:112. [PMID: 26374430 PMCID: PMC4571136 DOI: 10.1186/s12877-015-0109-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of hospitalization, which frequently results in failure to recover from the pre-hospitalization functional loss, new disability or even continued functional decline. Alternative care models with an emphasis on multidisciplinary and continuing care units are currently being developed. Their main objective, other than the recovery of the condition that caused admission, is the prevention of functional decline. Many studies on functional decline have discussed the available evidence regarding the effectiveness of acute geriatric units. Despite the theoretical support for the idea that mobility improvement in the hospitalized patient carries multiple benefits, this idea has not been fully translated into clinical practice. METHODS/DESIGN This study is a randomized clinical trial conducted in the Department of Geriatrics of a tertiary public hospital with 35 beds allocated. Hospitalized patients who meet the inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent exercise training programme, which will be composed of supervised progressive resistance exercise training, balance-training, and walking for 5-7 consecutive days. During the training period, patients will be trained in 20 min sessions twice a day (morning and evening). DISCUSSION Functional and cognitive impairment after and during acute hospitalization in older adults is a major determinant of the later need for health resources. If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving the functional capacity of acute elderly patients hospitalized for medical pathology versus conventional care, a change of the current system of hospitalization of elderly patients with medical conditions may be justified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02300896 (Date of registration 19 November 2014).
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Affiliation(s)
- Nicolás Martínez-Velilla
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Alvaro Casas-Herrero
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | - Nacho Suárez
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
| | - Javier Alonso-Renedo
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Koldo Cambra Contín
- Navarrabiomed-Fundación Miguel Servet, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | | | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
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Rémond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron MA, Dos Santos CN, Walther B, Bordoni A, Dupont D, Tomás-Cobos L, Vergères G. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget 2015; 6:13858-98. [PMID: 26091351 PMCID: PMC4546438 DOI: 10.18632/oncotarget.4030] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/11/2022] Open
Abstract
Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.
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Affiliation(s)
- Didier Rémond
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Danit R. Shahar
- Department of Public Health, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Doreen Gille
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Paula Pinto
- Escola Superior Agrária, Insituto Politécnico de Santarém, 2001-904 Santarem, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
| | | | - Marie-Agnès Peyron
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Claudia Nunes Dos Santos
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
- Instituto de Biologia Experimental e Tecnológica, 2780-157 Oeiras, Portugal
| | - Barbara Walther
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Alessandra Bordoni
- Department of Agri-Food Sciences and Technologies, University of Bologna, 47521 Cesena, Italy
| | - Didier Dupont
- UMR 1253, Science et Technologie du Lait & de l'Œuf, INRA, 35000 Rennes, France
| | | | - Guy Vergères
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
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Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J 2015; 6:e0017. [PMID: 25973269 PMCID: PMC4422456 DOI: 10.5041/rmmj.10201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.
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Affiliation(s)
- Hanna Admi
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - Hagar Baruch
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
| | - Anna Zisberg
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
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Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg 2015; 261:345-52. [PMID: 24651133 DOI: 10.1097/sla.0000000000000628] [Citation(s) in RCA: 354] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery. BACKGROUND Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery. Therefore, the predictive value of preoperative functional compromise assessment was investigated. Sarcopenia is a hallmark of functional compromise. METHODS A total of 310 consecutive patients who underwent oncologic colorectal surgery were included in a prospective digital database. Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography. Groningen Frailty Indicator and Short Nutritional Assessment Questionnaire scores were used to assess frailty and nutritional compromise. Predictors for anastomotic leakage, sepsis, and mortality were analyzed by logistic regression analysis. RESULTS Age was an independent predictor of mortality [P = 0.04; odds ratio, 1.17; 95% confidence interval (CI), 1.01-1.37]. Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in nonsarcopenic patients (P = 0.001; odds ratio, 15.5; 95% CI, 2.00-120). Sarcopenia was not predictive for anastomotic leakage or sepsis. Combination of high Short Nutritional Assessment Questionnaire score, high Groningen Frailty Indicator score, and sarcopenia strongly predicted sepsis (P = 0.001; odds ratio, 25.1; 95% CI, 5.11-123), sensitivity, 46%; specificity, 97%; positive likelihood ratio, 13 (95% CI, 4.4-38); negative likelihood ratio, 0.57 (95% CI, 0.33-0.97). CONCLUSIONS Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome. Assessment of functional compromise by means of a nutritional questionnaire (Short Nutritional Assessment Questionnaire), a frailty questionnaire (Groningen Frailty Indicator), and sarcopenia measurement (L3 muscle index) can accurately predict postoperative sepsis.
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Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient. J Orthop Trauma 2015; 29:e103-8. [PMID: 25210832 DOI: 10.1097/bot.0000000000000233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine patient and hip fracture characteristics, early postoperative complication rate, and need for institutionalization at the time of discharge from the hospital in patients treated for a second contralateral hip fracture. METHODS During a 6-year period (2003-2009), 71 patients (60 women and 11 men; age range, 54-94 years) underwent first hip fracture surgery and subsequent contralateral hip fracture surgery at our hospital. Variables, including age, gender, American Society of Anesthesiologists classification (ASA), AO fracture classification, time between both hip fractures, rate and severity of early postoperative complications, and destination of discharge were obtained from the electronic medical records. Data from both hospitalization periods were compared. RESULTS Forty-six percent of second hip fractures occurred within 2 years after the first hip fracture. After the first hip fracture surgery, 13 patients had 1 or multiple complications compared with 23 patients after a second hip fracture surgery (P = 0.02). The mean time (±SD) between the first and second hip fractures in patients without complications after the second injury was 4.3 (±4.2) years, compared with 2.6 (±2.1) years in patients with complications after the second injury (P = 0.03). The mean ASA classification of patients without complications after the second hip fracture surgery was 2.6 (±0.6) versus 3.0 (±0.6) in patients with complications (P = 0.04). After the first hip fracture surgery, 27 patients (38%) were discharged to an institutional care facility, whereas 72% of patients resided at an institutional care facility after a second hip fracture. CONCLUSIONS Early complication rate in patients sustaining a second contralateral hip fracture was almost twice that documented after the first hip fracture. After the second hip fracture surgery, most patients resided in an institutional care facility. LEVEL OF EVIDENCE Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
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Shpata V, Ohri I, Nurka T, Prendushi X. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients. Clin Interv Aging 2015; 10:481-6. [PMID: 25733824 PMCID: PMC4337415 DOI: 10.2147/cia.s77042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18-64 years), and to examine the negative consequences associated with risk of malnutrition in older adults. MATERIALS AND METHODS A prospective cohort study in the ICU of the University Hospital Center of Tirana, Albania, was conducted. Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay, the duration of being on the ventilator, the total complications, the infectious complications, and the mortality. RESULTS In this study, 963 patients participated, of whom 459 patients (47.7%) were aged ≥65 years. The prevalence of malnutrition risk at the time of ICU admission of the patients aged ≥65 years old was 71.24%. Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients, for 1) infections (odds ratio [OR] =4.37; 95% confidence interval [CI]: 2.61-7.31); 2) complications (OR =6.73; 95% CI: 4.26-10.62); 3) mortality (OR =2.68; 95% CI: 1.72-4.18); and 4) ICU length of stay >14 days (OR =5.18, 95% CI: 2.43-11.06). CONCLUSION Malnutrition risk is highly prevalent among elderly ICU patients, especially among severely ill patients with malignancy admitted to the emergency ward. ICU elderly patients at malnutrition risk will have higher complication and infection rates, longer duration of ICU stay, and increased mortality. Efforts should be made to implement a variety of nutritional care strategies, to change the nutritional practices not only at ward level, but nationally, according to the best clinical practice and recent guidelines.
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Affiliation(s)
- Vjollca Shpata
- Faculty of Medical Technical Sciences, University of Medicine in Tirana, Tirana, Albania
| | - Ilir Ohri
- University Hospital Center of Tirana "Mother Theresa", Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania
| | - Tatjana Nurka
- Faculty of Medical Technical Sciences, University of Medicine in Tirana, Tirana, Albania
| | - Xhensila Prendushi
- Faculty of Medical Technical Sciences, University of Medicine in Tirana, Tirana, Albania
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Zisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G. Hospital-Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors. J Am Geriatr Soc 2015; 63:55-62. [DOI: 10.1111/jgs.13193] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Zisberg
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Nurit Gur-Yaish
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Orly Tonkikh
- Cheryl Spencer Department of Nursing; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
| | - Gary Sinoff
- Department of Gerontology; Faculty of Social Welfare and Health Sciences; University of Haifa; Mount Carmel Israel
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Guerra RS, Amaral TF, Sousa AS, Pichel F, Restivo MT, Ferreira S, Fonseca I. Handgrip strength measurement as a predictor of hospitalization costs. Eur J Clin Nutr 2014; 69:187-92. [PMID: 25369830 DOI: 10.1038/ejcn.2014.242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/16/2014] [Accepted: 09/27/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied. OBJECTIVE To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs. SUBJECTS/METHODS A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status. RESULTS Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724). CONCLUSIONS Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.
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Affiliation(s)
- R S Guerra
- 1] Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal [2] UISPA-IDMEC, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal [3] Unidade de Nutrição, Centro Hospitalar do Porto, Porto, Portugal
| | - T F Amaral
- 1] UISPA-IDMEC, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal [2] Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - A S Sousa
- 1] Unidade de Nutrição, Centro Hospitalar do Porto, Porto, Portugal [2] Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - F Pichel
- Unidade de Nutrição, Centro Hospitalar do Porto, Porto, Portugal
| | - M T Restivo
- UISPA-IDMEC, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - S Ferreira
- Serviço de Informação de Gestão, Centro Hospitalar do Porto, Porto, Portugal
| | - I Fonseca
- Unidade de Nutrição, Centro Hospitalar do Porto, Porto, Portugal
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Validity of the Braden Nutrition Subscale in Predicting Pressure Ulcer Development. J Wound Ostomy Continence Nurs 2014; 41:436-43. [DOI: 10.1097/won.0000000000000059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pancreatoduodenectomy with portal vein resection is feasible and potentially beneficial for elderly patients with pancreatic cancer. Pancreas 2014; 43:951-8. [PMID: 24717827 DOI: 10.1097/mpa.0000000000000136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to evaluate the feasibility and clinical benefit of pancreatoduodenectomy (PD) with portal vein resection (PVR) in elderly patients. METHODS This retrospective study enrolled 272 consecutive patients with pancreatic ductal adenocarcinoma who underwent PD between 2000 and 2012. The patients were categorized into 4 groups: elderly (≥70 years) and younger (<70 years) PD-PVR groups as well as elderly and younger PD groups. Preoperative patient background, postoperative course, and overall survival were compared. RESULTS Among the patients who underwent PD-PVR, the elderly group had significantly higher prevalence of comorbidity compared with the younger group (77% and 52%, respectively; P = 0.003), whereas there were no differences in the intraoperative and pathological characteristics. Postoperatively, morbidity and length of hospital stay were similar between the elderly and younger groups. Despite the fact that the proportion of patients who underwent adjuvant chemotherapy was lower in the elderly group (62% vs 83%; P = 0.005), the overall survival of the elderly group was comparable with that of the younger group, and both groups had a significantly more favorable prognosis than that of 36 patients with unresected tumors (P = 0.006 and P < 0.001, respectively). CONCLUSIONS Pancreatoduodenectomy with portal vein resection is safe and potentially beneficial for elderly patients with pancreatic cancer.
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Martínez-Reig M, Gómez-Arnedo L, Alfonso-Silguero SA, Juncos-Martínez G, Romero L, Abizanda P. Nutritional risk, nutritional status and incident disability in older adults. The FRADEA study. J Nutr Health Aging 2014; 18:270-6. [PMID: 24626754 DOI: 10.1007/s12603-013-0388-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze if body mass index (BMI) and waist circumference (WC) as measures of nutritional status, and the Mini Nutritional Assessment Short Form (MNA-SF) as a nutritional risk measure are associated with increased risk of incident disability in basic activities of daily living (BADL) in a population based cohort of Spanish older adults. DESIGN Concurrent cohort study. SETTING Albacete City, Spain. PARTICIPANTS 678 subjects over age 70 from the FRADEA Study (Frailty and Dependence in Albacete). MEASUREMENTS BMI, WC and MNA-SF were recorded at the basal visit of the FRADEA Study. Incident disability in BADL was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding from basal to follow-up visit, using the Barthel index. The association between nutritional status and nutritional risk with incident BADL disability was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, basal function, comorbidity, cognitive decline, depression risk and frailty status. RESULTS Each point less of MNA-SF (OR 1.17, 95%CI 1.04-1.31) and MNA-SF<14 (OR 2.33, 95%CI 1.39-3.89), but not MNA-SF<12 (OR 1.47, 95%CI 0.89-2.42) had a greater adjusted risk of incident disability in BADL. Neither BMI (OR 1.02, 95%CI 0.97-1.06) nor WC (OR 1.01, 95%CI 0.99-1.03) were associated. Weight loss (OR 1.75, 95%CI 1.08-2.83) and mobility impairment (OR 3.35, 95%CI 1.67-6.73) remained as adjusted predictors of incident BADL disability, while anorexia almost reached the significance (OR 1.65, 95%CI 0.94-2.87). CONCLUSION Nutritional risk measured with the MNA-SF is associated with incident disability in BADL in older adults, while nutritional status measured with BMI or WC is not.
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Affiliation(s)
- M Martínez-Reig
- Pedro Abizanda Soler, Hospital Perpetuo Socorro, C/ Seminario 4, 02006 Albacete, Spain, Tel.: +34967597651, Fax: +34967597635,
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Schrader E, Baumgärtel C, Gueldenzoph H, Stehle P, Uter W, Sieber CC, Volkert D. Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients--independent of health status. J Nutr Health Aging 2014; 18:257-63. [PMID: 24626752 DOI: 10.1007/s12603-013-0394-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between nutritional and functional status in acute geriatric patients including mobility and considering health status. DESIGN Cross-sectional study. SETTING Hospital. PARTICIPANTS 205 geriatric patients (median age 82.0 (IQR: 80-86) years, 69.3% women). MEASUREMENTS Nutritional status was determined by Mini Nutritional Assessment (MNA) and patients were categorized as well-nourished (≥ 24 points), at risk of malnutrition (17-23.5 points) or as malnourished (< 17 points). Functional status was determined by Barthel Index (BI) and Timed 'Up and Go' Test (TUG) and related to MNA categories. Using binary multiple logistic regression the impact of nutritional status on functional status was examined, adjusted for health status. RESULTS 60.3% of the patients were at risk of malnutrition and 29.8% were malnourished. Ability to perform basic activities of daily living (ADL) decreased with declining nutritional status. The proportion of patients unable to perform the TUG increased with worsening of nutritional status (45.0% vs. 50.4% vs. 77.0%, p<0.01). After adjusting for age, gender, number of diagnoses, disease severity and cognitive function, a higher MNA score significantly lowered the risk of being dependent in ADL (OR 0.85, 95 % CI 0.77-0.94) and inability to perform the TUG (OR 0.90, 95 % CI 0.82-0.99). CONCLUSION Nutritional status according to MNA was related to ADL as well as to mobility in acute geriatric patients. This association remained after adjusting for health status.
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Affiliation(s)
- E Schrader
- Eva Schrader, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Donini LM, Ricciardi LM, Neri B, Lenzi A, Marchesini G. Risk of malnutrition (over and under-nutrition): validation of the JaNuS screening tool. Clin Nutr 2013; 33:1087-94. [PMID: 24373664 DOI: 10.1016/j.clnu.2013.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Malnutrition (over and under-nutrition) is highly prevalent in patients admitted to hospital and it is a well-known risk factor for increased morbidity and mortality. Nutritional problems are often misdiagnosed, and especially the coexistence of over and undernutrition is not usually recognized. We aimed to develop and validate a screening tool for the easy detection and reporting of both undernutrition and overnutrition, specifically identifying the clinical conditions where the two types of malnutrition coexist. METHODS The study consisted of three phases: 1) selection of an appropriate study population (estimation sample) and of the hospital admission parameters to identify overnutrition and undernutrition; 2) combination of selected variables to create a screening tool to assess the nutritional risk in case of undernutrition, overnutrition, or the copresence of both the conditions, to be used by non-specialist health care professionals; 3) validation of the screening tool in a different patient sample (validation sample). RESULTS Two groups of variables (12 for undernutrition, 7 for overnutrition) were identified in separate logistic models for their correlation with the outcome variables. Both models showed high efficacy, sensitivity and specificity (overnutrition, 97.7%, 99.6%, 66.6%, respectively; undernutrition, 84.4%, 83.6%, 84.8%). The logistic models were used to construct a two-faced test (named JaNuS - Just A Nutritional Screening) fitting into a two-dimension Cartesian coordinate graphic system. In the validation sample the JaNuS test confirmed its predictive value. Internal consistency and test-retest analysis provide evidence for the reliability of the test. CONCLUSION The study provides a screening tool for the assessment of the nutritional risk, based on parameters easy-to-use by health care personnel lacking nutritional competence and characterized by excellent predictive validity. The test might be confidently applied in the clinical setting to determine the importance of malnutrition (including the copresence of over and undernutrition) as a risk factor for morbidity and mortality.
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Affiliation(s)
- Lorenzo M Donini
- Department Experimental Medicine, Medical Physiopathology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, 00185 Roma, Italy.
| | - Laura Maria Ricciardi
- Department of Medicine and Surgery, Unit of Metabolic Diseases & Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Italy
| | - Barbara Neri
- Department Experimental Medicine, Medical Physiopathology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, 00185 Roma, Italy
| | - Andrea Lenzi
- Department Experimental Medicine, Medical Physiopathology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, 00185 Roma, Italy
| | - Giulio Marchesini
- Department of Medicine and Surgery, Unit of Metabolic Diseases & Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Italy
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