Malnutrition screening in the elderly population

To assess the contributing factors of nutritional and health status amongst elderlies residing in the nursing homes of fars province, Iran: A cross sectional study

Background and Aims

In line with the global trend, the number of elderly is rising in Iran. It should be noted that the nutritional and health needs of these people, especially those living in nursing houses, are extremely significant. The present study aimed to identify the nutritional and health status and uncover their relationship with received care services by elderlies residing in nursing homes.

Methods

All 373 elderlies living in the nursing homes in Shiraz entered the study, and the requisite data were collected by references to elderlies' files, respective nurses, and elderlies themselves.

Results

The majority of the elderlies were at risk of malnutrition (62.5% of the total population, 55.4% of females, and approximately 44.6% of males). Elderlies with no insurance coverage mainly fell into the at-risk and malnutrition categories. There was a significant relationship between the needs assessment scores, reflecting the need for physical and psychological actions, and elderlies' malnutrition (odds ratio = 1.87, 95% confidence interval: 1.79-1.95). For each unit increase in the Physical and psychological need score, the odds of exposure to malnutrition (vs. nonmalnourished and at risk of malnutrition) was 1.87 times after adjustment for confounders.

Conclusion

The results of our study revealed that most of the elderlies living in the nursing homes of Shiraz had some levels of malnutrition such as at-risk for malnutrition (62.5%) and malnourished (18.9%). Based on these results, it is suggested that health policy-makers take practical steps toward promoting the nutritional care of old people and direct extra supervision to nursing homes and all healthcare provisions.

Role of Malnutrition in Atrial Fibrillation: A Prospective Study including Individuals ≥ 75 Years of Age

BACKGROUND

Atrial fibrillation (AF) is the most common rhythm disorder in the elderly. The AF can cause life-threatening thromboembolic complications. Therefore, there is a need to determine the risk factors of AF. In this study, we aimed to examine the association of markers of malnutrition with AF in individuals aged 75 years and older and to find the factors that may affect mortality.

METHODS

In this prospective study, 358 consecutive individuals aged 75 years and older presenting to the cardiology outpatient clinic were included. All participants were divided into AF and sinus rhythm (SR) groups. In addition, a questionnaire and scoring system were used to assess malnutrition status. Information was obtained from all patients through outpatient clinic visits or telephone interviews for one year. Death from any cause was considered as the endpoint.

RESULTS

AF was observed in 71 (19.8%) patients. Death was higher in patients with AF (p < 0.001), high CONUT score (p = 0.018), and GLIM malnutrition (p = 0.018). GLIM malnutrition caused a 2.8-fold increase in the development of AF.

CONCLUSIONS

Screening for malnutrition in the elderly is essential. According to GLIM criteria, malnutrition may play a role in the development of AF and increase one-year mortality in the elderly.

Prevalence of Malnutrition in People with Dementia in Long-Term Care: A Systematic Review and Meta-Analysis

Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5-90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0-32.26, p < 0.0001, I² = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39-65.28, p < 0.0001, I² = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.

Anaemia and Nutritional Status during HIV and Helminth Coinfection among Adults in South Africa

Sub-Saharan Africa is burdened with helminthiasis and HIV/AIDS, and there is a significant overlap between these infections. However, little is known about the extent of anaemia and malnutrition in HIV/AIDS and helminth coinfected adults. The study investigated the anaemia profiles and nutritional status of HIV and helminth coinfected adult South Africans. Stool samples were collected from participants (N = 414) for parasite detection using the Kato−Katz and Mini Parasep® SF techniques. Blood was collected to determine participants’ HIV status, micro- and macronutrients, haematological parameters, and Ascaris lumbricoides-specific IgE and IgG4 levels. Thereafter, participants were stratified into single infection (HIV or helminths), coinfection, and uninfected controls (no HIV and helminth) groups. The majority (74.9%) of participants had CD4 counts of >500 cells/μL, indicating no significant immunosupression. The coinfected group had an overall anaemia prevalence of 16.9%, which was lower than that of the HIV-infected group (44.6%) and higher than helminth infected group (15.4%). Overall helminth prevalence was 33%, with Ascaris lumbricoides being the most prevalent. The coinfected group also had lower vitamin A (p = 0.0107), calcium (p = 0.0002), and albumin (p < 0.0001) levels compared to HIV/helminth uninfected controls. Unexpectedly, the coinfected group had the highest serum iron levels, followed by the helminth-infected and control groups, both of which had similar iron levels, and finally, the HIV-infected group, which had the lowest iron levels (p = 0.04). Coinfected adults may be prone to micronutrient deficiency and anaemia. Further research and intervention programmes are required in this neglected field.

Social Determinants of the Non-Utilization of the Supplementary Feeding Program (PACAM) Aimed at Older Adults' Nutritional Support

Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving the program. First, the CASEN Survey 2017 was used (960,498 observations); the inclusion criterion was PACAM recipients (Yes/No). Next, a probit model was performed with a dichotomous response to determine the marginal effects of each independent variable (e.g., demographic, health, and social). The model shows a good fit (64.4%) with an explained variance between 10.5% to 14.1%. Those variables with more significant marginal effects are people aged 70-75, having tertiary and secondary education, urban living, not participating in social organizations, immigrants, and living in the austral zone. On the other hand, a higher likelihood of consumption was found among people of greater vulnerability (lowest income, lowest education, low health insurance, and aged over 80) and, therefore, in greater fragility. To conclude, the program achieves effective targeting, although improvement actions are required to expand coverage in some groups (indigenous people, immigrants, and people with disabilities). Moreover, authorities should evaluate and reinforce the program with tailored strategies for the older adults who actually withdraw food.

Association between serum albumin and mortality in Japan older people with dysphagia

To determine whether there is a link between serum albumin and mortality among participants in the elderly in Japan. This is a single-center,retrospective cohort study analysis of 253 old patients with dysphagia from Japan, conducted from January 2014 to January 2017. The primary outcome was mortality. We performed Cox regression analysis to compare the mortality between the two groups (divided by serum albumin = 3 g/dl). 253 patients were included in the analysis, of whom the number of serum albumin under 3 g/dl was 93. The log-rank test showed a significant longer mortality in the high group (serum albumin >  = 3 g/dl) compared with the low group (median, 382 vs. 176 days, P < 0.0001). Cox regression analysis showed that unadjusted HR for the high group relative to the low group was 0.40 (95% CI: 0.29-0.57; P < 0.001). After adjusting 3 models in multivariable analysis, serum albumin was significantly associated with mortality. The adjusted HRs (95% CI) for total mortality rates were 0.46 (0.33-0.65), 0.66 (0.44-0.99) and 0.64 (0.42-0.97), from model 2 to model 4. There is negative association between serum albumin and mortality in Japanese old people with dysphagia.

Cognitive impairment among older adults living in the community and in nursing home in Indonesia: a pilot study

The demographic phenomenon of population aging has brought some consequences, including a higher prevalence of cognitive impairment.

Objective

This study aimed to assess and compare cognitive impairment and its risk factors between older persons living in the community and in nursing home in Indonesia.

Methods

A cross-sectional study was employed among 99 older adults living in the community and 49 nursing home residents. Cognitive function was assessed using the Mini-Mental State Examination (MMSE).

Results

Older people living in the community showed a higher score on MMSE than those living in nursing home (p=0.044). Age, marital status, education level, and literacy status were significantly related to the cognitive function of older adults living in the community (p=0.003, p=0.007, p=0.005, p=0.001, respectively), while gender, education level, and literacy status were significantly related to that of nursing home residents (p=0.012, p=0.004, p=0.001, respectively).

Conclusions

Older adults living in the nursing home were more likely to experience cognitive decline than their counterparts in the community. Factors associated with cognitive decline differ between community-dwelling older adults and nursing home residents.

Development of a protein energy malnutrition screening tool for older Thais in public residential homes

OBJECTIVE

This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and to test its practicality.

DESIGN

This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-h recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analysed by χ2 test, Fisher's exact test, t-test, Mann-Whitney U test and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model.

SETTING

Four public residential homes in central region, Thailand.

PARTICIPANTS

249 older residents residing in public residential homes and eight intended users.

RESULTS

26·9 % had PEM (serum albumin <3·5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥ 9 types of medicine daily. These predictors were included in PEM screening tool. Regarding the tool performance test, area under the ROC curve was 0·8 (P < 0·001) with sensitivity and specificity of 83·9 and 45·5 %, respectively. For its practicality, eight intended users reported that it was useful and easy to use.

CONCLUSIONS

New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.

The dietary practices and beliefs of people living with older-onset inflammatory bowel disease

BACKGROUND AND OBJECTIVES

The role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Studies have previously examined dietary practices in IBD, but none have specifically focused on older-onset disease. IBD may put vulnerable groups at risk of nutritional deficiency and associated complications, potentially heightened by comorbidities, frailty and polypharmacy. Our objective was to describe dietary practices and beliefs in older-onset IBD.

METHODS

A questionnaire exploring dietary practices and beliefs was prospectively administered to 137 people with older-onset IBD attending gastroenterology clinics.

RESULTS

Thirty-two percent believed diet was the initiating factor for their IBD. This was significantly more likely in people with Crohn's disease than ulcerative colitis (P = 0.05) and in those who felt limited in their dietary choices due to cost (P = 0.008). Forty-three percent believed diet could trigger IBD relapse and 68% avoided dietary components to avoid relapse. Most frequently avoided were spicy and fatty foods, carbonated drinks, red meat, alcohol and raw fruit and vegetables. Twenty-two percent of participants had tried a whole food exclusion diet, most frequently gluten- or lactose-free. Almost a third avoided eating out (29%) or eating the same meal as their family (32%) to prevent relapse. Respondents rarely relied upon healthcare professionals or patient support organisations for their dietary information.

CONCLUSION

Individuals with older-onset IBD report dietary practices with a high degree of consistency. Dietary avoidance may impact upon both nutritional and psychosocial wellbeing in this more vulnerable group and, as such, early dietetic assessment could help improve outcomes.

Nutrition assessment and geriatric associated conditions among free living elderly people in Birjand, East of Iran: a cross-sectional study

BACKGROUND

Few data are available on the nutritional status of Iranian geriatric population. The present study aimed to determine the nutritional status of older adults' population in Birjand, East of Iran.

METHODS

The community-based cohort study was performed on older adults population (60 years and older) living in urban and rural areas of Birjand. The mini nutritional assessment (MNA) questionnaire was used to assess nutritional status. Anthropometric and biochemical evaluation were also performed for all of the participants.

RESULTS

A total of 1417 geriatric person were enrolled in this study, which, most of them were female (51.9 %). According to MNA tool, most of the participants (73.3 %) had normal nutrition (MNA score ≥ 24). Malnourished (MNA score < 17) and at high risk of malnutrition (MNA score: 17- 23.5) were constituted 0.9 % and 25.8 % of the participants, respectively. Marital status, occupation, period of education and family member were associated with nutritional status. Multiple logistic regression showed that with increase of body mass index (BMI) (OR = 0.96), education years (OR = 0.95), hemoglobin (OR = 0.86) and lymphocyte (OR = 0.98), the odds of malnutrition decreased, but with increase of age the odds (1.03) of malnutrition is also elevated.

CONCLUSIONS

MNA could successfully forecast the risk of malnutrition and malnourished people. Sociodemographic factors are associated with the nutritional status.

Lockdown Effect on Elderly Nutritional Health

Pandemics and lockdowns may be associated with unpremeditated consequences, such as bodyweight changes, isolation, as well as sedentarity. Reports have been published on malnutrition among patients suffering from COVID-19. This study aimed to highlight the short-term effects of the lockdown on the nutritional health of elderly people living at home and benefiting from home care services, yet without any COVID-19 pathology. In 50 subjects displaying weight, body mass index, and MNA score stability two months earlier, we observed significant alterations in these parameters following the lockdown. Thus, malnutrition rose from 28–34% to 58%. Furthermore, trigger factors for malnutrition changed, with social isolation accounting for 64% of the confinement’s deleterious effects among the elderly. In conclusion, despite the elderly being not directly affected by SARS-CoV2, the nutritional status of elderly subjects living at home with no or only mild autonomy loss was greatly and rapidly affected by the lockdown. Moreover, the main trigger factors for malnutrition were essentially related to social isolation and depressive syndromes. Knowing the impact of confinement on the elderly’s health, these results may help further modulate ongoing public health interventions in case of future lockdowns.

Association between the dental occlusion and perceived ability to eat foods of Taiwanese older adults

Tooth loss is a common problem among older adults that affects masticatory function (MF) and food selection. Financial burden is a reason that some older adults in Taiwan with this condition forgo dental restoration. To identify the number of posterior occlusal support areas (POSAs) associated with MF. Large-scale cross-sectional study included 1100 community-dwelling participants of Taiwan aged ≥65 years. Participants completed dental examination and questionnaires through personal interviews. Masticatory performance was evaluated using a colour-changeable chewing gum. Masticatory ability was evaluated on the basis of how many of 14 common foods the participants were able to eat. Participants were grouped into 10 categories (A1-A3, B1-B4 and C1-C3) according to the Eichner index (EI) of posterior occlusal contacts. Multivariable regression models were used to analyse the association between the EI groups and MF. More than 80% of the participants with two or more POSAs (those in groups A1-B2) could easily eat various foods. Compared with those in groups A1-B2, those in groups in B3, B4, C1, C2 and C3 exhibited a significantly different masticatory performance (all P < .001) and significantly higher difficulty in eating fruits and vegetables. A dose-response effect between POSAs and perceived masticatory ability to eat fruits and vegetables was observed (P < .05 for both trends). Preservation of at least two POSAs is essential for MF. Older adults with tooth loss can undergo the restoration of two POSAs to improve MF and increase food intake.

Low skeletal muscle mass predicts poor clinical outcomes in patients with abdominal trauma

OBJECTIVE

The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma.

METHODS

Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed.

RESULTS

Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm²/m² for men and 37.35 cm²/m² for women). Low skeletal muscle mass was significantly associated with longer hospital length of stay, longer intensive care length of stay, higher cost, higher frequency of mechanical ventilation, longer duration of vasopressor use, and higher incidence of massive transfusion and overall complications (P < 0.05). Subgroup analysis showed that pneumonia, acute gastrointestinal dysfunction, cholecystitis, digestive tract fistula, gastric fistula, and intestinal fistula were significantly associated with low skeletal muscle mass (P < 0.05). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for overall complications (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.33-4.49; P = 0.004), hospital length of stay (OR, 3.49; 95% CI, 1.96-6.20; P < 0.001), and hospital cost (OR, 2.67; 95% CI, 1.48-4.80; P = 0.001).

CONCLUSIONS

Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.

Detection of nutritional risk and hospital stay in the hospitalized elderly adult

Introduction

Background and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogotá, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p < 0.001), older age (p < 0.001), and a diagnosis of delirium (OR = 5.98, 95 % CI: 2.78 to 12.86), diarrhea and gastroenteritis (OR = 5.01, 95 % CI: 2.44 to 10.32), gastrointestinal hemorrhage (OR = 4.44, 95 % CI: 2.38 to 8.28), specified pneumonia (OR = 4.43, 95% CI: 2.11 to 9.30), and high blood pressure (3.94, 95 % CI: 2.07 to 7.50). Other diagnoses included abdominal pain (other) (OR = 3.80, 95 % CI: 1.81 to 7.99), urinary tract infections (OR = 3.64, 95 % CI: 2.07 to 6.24), acute bronchitis (OR = 3.22, 95 % CI: 1.56 to 6.65), and bacterial pneumonia (OR = 3.02, 95 % CI: 1.65 to 5.55). Conclusion: the prevalence of the risk of malnutrition in our institution is approximately one in two patients, with a significant association to increased hospital stay ≥ 8 days, patient age ≥ 80 years, and mainly diagnoses of delirium, diarrhea, and gastroenteritis of suspected infectious etiology.

Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants

Objectives. A general body of evidence suggests that low serum albumin might be associated with increased risk of adverse cardiometabolic outcomes, but findings are divergent. We aimed to quantify associations of serum albumin with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), all-cause mortality, and other adverse outcomes using a systematic review and meta-analyses of published observational cohort studies. Design. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched to January 2020. Relative risks (RRs) with 95% confidence intervals (CIs) comparing top versus bottom thirds of serum albumin levels were pooled. Results. Fifty-four articles based on 48 unique observational cohort studies comprising of 1,492,237 participants were eligible. Multivariable adjusted RRs (95% CIs) comparing the top vs bottom third of serum albumin levels were: 1.03 (0.86-1.22) for T2D; 0.60 (0.53-0.67) for CVD; 0.74 (0.66-0.84) for coronary heart disease (CHD); 0.57 (0.36-0.91) for CHD death; 0.76 (0.65-0.87) for myocardial infarction; 0.66 (0.55-0.77) for all-cause mortality; 0.71 (0.61-0.83) for venous thromboembolism; 0.65 (0.48-0.88) for cancer mortality; and 0.62 (0.46-0.84) for fracture. Heterogeneity between contributing studies of T2D was partly explained by sample sizes of studies (p for meta-regression = .035). Conclusions. Elevated levels of serum albumin are associated with reduced risk of vascular outcomes, all-cause mortality, certain cancers, and fracture. Inconsistent findings for T2D may be attributed to selective reporting by studies. Further research is needed to assess any potential causal relevance to these findings and the role of serum albumin concentrations in disease prevention.Systematic review registration: PROSPERO 2019: CRD42019125869.

Nutritional considerations for the management of the older person with hepato-pancreatico-biliary malignancy

Malnutrition and cancer cachexia are prevalent in older people with hepato-pancreatico-biliary (HPB) malignancy, with the resultant loss of muscle mass and function accelerating normal age-associated losses. Unintentional weight loss may be missed in patients with pre-illness obesity, delaying diagnosis and limiting treatment potential and access. Sarcopenia and/or sarcopenic obesity increase the risk of dose-limiting chemotherapy toxicity, post-operative mortality and overall survival. The aetiology of malnutrition and weight loss is multi-factorial in patients with HPB malignancy, necessitating systematic evaluation of endocrine and exocrine function, and multi-modal therapeutic strategies. Prehabilitation aims to reduce the complications and side effects associated with treatment, aid recovery and improve quality of life, with the greatest benefits potentially being seen in high risk groups, such as people who are older and frail. Post-operatively, individualised nutritional support therapies targeting the preservation of weight and muscle indices are required to improve post-operative morbidity, and avoid delay or early cessation of any necessary adjuvant therapy.

Association between malnutrition, clinical parameters and health-related quality of life in elderly hospitalized patients with Parkinson's disease: A cross-sectional study

Objective

This study aimed to explore the association between malnutrition, clinical parameters, and health-related quality of life in elderly hospitalized patients with Parkinson’s disease (PD).

Methods

Cross-sectional study of 92 hospitalized elderly patients with PD (mean age 73.6 ± 6.7 years) without dementia. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Motor impairment and non-motor symptoms burden (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Non-Motor Symptoms Questionnaire, and Hoehn & Yahr staging), depression (Becks Depression Inventory-II), and health-related quality of life (PD quality of life Questionnaire-39) were assessed.

Results

Every second patient was malnourished or at risk of malnutrition. In the multivariable analysis, male gender, longer disease duration, higher Hoehn & Yahr and depression were associated with total MNA score. Besides non-motor symptoms and motor impairment, malnutrition was an independent predictor of poor health-related quality of life. In the multivariate analysis, malnutrition had a statistically significant effect on emotional well-being, mobility, social support, stigmatization, and cognition. The strongest association was found between malnutrition and emotional well-being.

Conclusion

Elderly male persons with longer PD duration and higher disease stages are more likely to be malnourished or at risk for malnutrition. Malnutrition was mainly associated with poor emotional well-being, suggesting that treatment of depression and anxiety beside diet and physical activity can help improving nutrition status in these subjects. The MNA should not be used independent of other measures of cognition and depression in people with advanced PD.

Expression Patterns of Muscle-Specific miR-133b and miR-206 Correlate with Nutritional Status and Sarcopenia

Sarcopenia and malnutrition are commonly occurring conditions in the elderly that frequently coexist, leading to substantial effects on morbidity/mortality. Evidence established muscle-specific microRNAs (miRNAs) or myomiRs as essential regulators of skeletal muscle processes, from myogenesis to muscle homeostasis. This study aimed to evaluate the association between myomiRs and sarcopenia and explore the potential of nutrition in mediating this association. qPCR was employed to characterize the myomiR-1, -133a/b, -206, -208b, and -499 expression profiles of 109 non-sarcopenic and 109 sarcopenic subjects. In our sample, the proportion malnourished or at-risk subjects was higher in sarcopenia (p < 0.001). Among the detected myomiRs (miR-133a/b and miR-206), lower levels of miR-133b was significantly associated with the presence of sarcopenia (p = 0.006); however, this relationship was not independent from nutritional status in multivariate analysis, suggesting a mediating effect of nutrition on the relationship between miR-133b and sarcopenia. Correlation analyses showed that lower miR-133b levels were associated with poor nutritional status (Mini Nutritional Assessment Long Form (MNA-LF) score, p = 0.005); furthermore, correlations with albumin, ferritin, and iron were found. Similar results were obtained for miR-206. Statistically more significant correlations were observed in subjects with sarcopenia. In conclusion, our findings highlight a nutrient-miR-133b/miR-206 pathway having a potential role in the age-related muscle decline.

Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China

OBJECTIVES

To assess the association between malnutrition and physical frailty among nursing home older adults in China.

DESIGN AND SETTING

A cross-sectional study in 15 nursing homes in Changsha, China.

PARTICIPANTS

A total of 705 nursing home residents who were aged 60 and older.

MEASUREMENTS

Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty.

RESULTS

The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60-106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty.

CONCLUSION

Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.

Impact of Nutritional Status on Muscle Architecture in Elerly Patients Hospitalized in Internal Medicine Wards

Nutritional alterations are highly prevalent in older rather than adult hospitalized patients. In these subjects, a loss of physical performance is dependent on the impairment of muscle architecture. This study aimed to investigate the association between the nutritional status and muscle architecture in elderly patients hospitalized in internal medicine wards. 68 aged patients admitted in internal medicine wards were consecutively enrolled and stratified in three groups based on the Mini Nutritional Assessment (MNA) score: well-fed (WF), at risk of malnutrition (RM), and malnourished (M). Biochemical indices and anthropometric parameters were sampled at hospital admission. Furthermore, all patients were assessed at admission and after 7 days of hospitalization for muscle strength (hand-grip test), mass (bioimpedentiometry), and architecture (ultrasonography of vastus lateralis). At hospital admission, M patients showed lower percentage of fat free mass and muscle mass with respect to WF and RM. Furthermore, M group presented with lower muscle thickness and pennation angle, as compared to WF and RM. At admission, the MNA score was positively related to the pennation angle and muscle strength. Multivariate linear regression analysis showed that the nutritional status at admission was the only significant factor influencing pennation angle. Finally, during the first 7 days of hospitalization, a decrease of pennation angle occurred in all the groups studied. We conclude that malnutrition at admission is associated with impaired muscle architecture in elderly patients hospitalized in internal medicine wards. Moreover, muscle architecture is impacted by early hospitalization, irrespective of nutritional status.

Relationship between oral environment and development of pneumonia and acute viral respiratory infection in dependent older individuals

AIM

The importance of oral care has been recognized for the prevention of airway infections in older individuals who require long-term care. The present prospective cohort study was carried out a decade ago to identify risk factors with numerous intraoral conditions as possible predictors involved in the onset of pneumonia and acute viral respiratory infection (AVRI) in older people requiring long-term care during a 6-month follow-up period (including winter).

METHODS

This study included 1785 older individuals residing in 31 long-term care facilities in which dental hygienists were involved in instruction on daily oral care. Primary end-points were development of pneumonia and AVRI during the 6-month follow-up period. Several factors related to each participant's general condition, oral environment, swallowing function and vaccinations (or lack thereof) were evaluated by calibrated dentists and dental hygienists before the study onset.

RESULTS

During the 6-month follow-up period, 74 participants (4.1%) developed pneumonia, and 28 participants (1.6%) developed AVRI. Cox proportional hazard analysis showed that poor nutritional status and the presence of dysphagia were significant risk factors for pneumonia onset. The presence of dry mouth and halitosis were significant risk factors for AVRI.

CONCLUSIONS

This prospective multicenter cohort study identified poor nutritional status and dysphagia as independent risk factors for the development of pneumonia, and dry mouth and halitosis as independent risk factors for the development of AVRI in older people who require long-term care and who routinely receive professional oral care. Geriatr Gerontol Int 2019; 19: 1136-1140.

Nutrition in wound healing: investigation of the molecular mechanisms, a narrative review

Nutrition can be outlined in terms of epigenetic signals influencing each of the wound healing steps (haemostasis, inflammatory, proliferative and remodelling phase). Specific nutrients, such as amino acids, minerals, vitamins, natural compounds and herbal extracts, target DNA-regulating transcription factors, cytokines, extracellular matrix proteins and glycosaminoglycan, and are specifically involved in the wound healing process. This review focuses on experimental in vivo and clinical evidence of dietary supplements administration in pressure ulcers. A good nutritional status is, for example, fundamental to the haemostasis phase of skin wounds. In the inflammatory phase, vitamin A enhances cytokine release, bromelain and amino acids prevent prolonged inflammatory events, while vitamin C enhances neutrophil migration and lymphocyte activation. In the proliferative phase, vitamin C and Centella asiatica are required for collagen synthesis. Glucosamine enhances hyaluronic acid production, vitamin A promotes epithelial cell differentiation, zinc is required for DNA and protein synthesis and cell division, and Aloe vera supports granulation tissue generation. Finally, in the remodelling phase, amino acids and proteins play a key role in wound scar stabilisation.

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy

The oral health state plays an important role in the concept of 'elderly frailty', since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set-Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.

Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis

BACKGROUND/AIMS

The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP.

METHODS

In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching.

RESULTS

The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality.

CONCLUSION

Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Exploring the Views and Dietary Practices of Older People at Risk of Malnutrition and Their Carers: A Qualitative Study

BACKGROUND

While malnutrition is an important cause of morbidity and mortality in older people, it is commonly under-recognised. We know little on the views of community-dwelling older people and their carers regarding the management of malnutrition. The aim of the study was: (a) to explore views and dietary practices of older people at risk of malnutrition and their carers; (b) to identify gaps in knowledge, barriers and facilitators to healthy eating in later life; (c) to explore potential interventions for malnutrition in primary care.

METHODS

A qualitative study was performed using semi-structured interviews with participants recruited from four general practices and a carers' focus group in London. Community-dwelling people aged ≥75, identified as malnourished or at risk of malnutrition (n = 24), and informal carers of older people (n = 9) were interviewed. Data were analysed using thematic analysis.

RESULTS

Older people at risk of malnutrition rarely recognise appetite or weight loss as a problem. Commonly held perceptions include that being thin is healthy and 'snacking' is unhealthy. Changes in household composition, physical or mental health conditions and cognitive impairment can lead to inadequate food intake. Most carers demonstrate an awareness of malnutrition, but also a lack of knowledge of what constitutes a nutritious diet. Although older people rarely seek any help, most would value advice from their GP/practice nurse, a dietitian or another trained professional.

CONCLUSION

Older people at risk of malnutrition and their carers lack knowledge on nutritional requirements in later life but are receptive to intervention. Training for health professionals in delivering tailored dietary advice should be considered.

Nutritional assessment and factors associated with malnutrition among the elderly population of Nepal: a cross-sectional study

Objectives

This study aimed at assessing the nutritional status among the elderly population and factors associated with malnutrition in the community setting in rural Nepal.

Results

Out of 339 participants, 24.8% (95% CI 20.21–29.30) fell into the normal nutritional status range; 49.6% (95% CI 44.29–54.91) were at risk for malnutrition while 24.8% (95% CI 20.21–29.30) were in the malnourished range, based on Mini Nutritional Assessment scores. Our findings revealed that belonging to a Dalit community, being unemployed, having experience of any form of mistreatment, lack of physical exercise, experiencing problems with concentration in past 30 days and taking medication for more than one co-morbidity was significantly associated with the malnutrition status of the elderly.

Association between locomotive syndrome and blood parameters in Japanese middle-aged and elderly individuals: a cross-sectional study

Background

Locomotive syndrome (LS) is associated with weakness and loss of function in the musculoskeletal organs. We aimed to determine the association between LS components and blood parameters in middle-aged and elderly individuals.

Methods

We included 223 middle-aged and elderly individuals in this study (104 men and 119 women; age: 40–85 years). All participants were asked to fast for at least 3 h before the venous blood samples were obtained and the hemoglobin, total protein, glycated hemoglobin (HbA1c), growth hormone, albumin and lipid profile were measured. Three functional tests, the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale (GLFS) were used to assess the risk of LS. Walking speed was assessed by the 10-m walking test. Maximal isometric muscle strengths of the knee extensors were examined, and the weight bearing index (knee extension strength/body weight) was calculated. To assess an independent association between blood parameters and LS, the area under the receiver operating characteristic curve analysis (area under the curve, sensitivity, and specificity) and a binary logistic regression analysis were performed with adjustment for age.

Results

Of the 223 subjects, 119 (53.3%) fulfilled the diagnostic criteria for LS (including a two-step test score < 1.3, difficulty with one-leg standing from 40 cm in the stand-up test, and a 25-question GLFS score ≥ 7). Increased levels of HbA1c were significant risk factors for LS with an OR of 2.62 (OR_95%CI = 1.43–4.80), as determined by a logistic regression analysis. Additionally, dehydroepiandrosterone-sulfate (DHEA-S) levels were significant only in the male subjects (OR = 0.992 [OR_95%CI = 0.986–0.998]), at a threshold of 88 (AUC; 0.70, sensitivity; 79.6%, specificity; 49.1%). Moreover, 101 of 223 participants (41 men, 60 women) were analyzed for serum albumin levels, with a prevalence of LS at 55.4%, indicating that low levels of albumin were significant risk factors for LS (OR = 0.148 [OR_95%CI = 0.023–0.954], p = 0.0445).

Conclusions

These results suggest that higher HbA1c and lower albumin are associated with the prevalence of LS in Japanese middle-aged and elderly individuals. Furthermore, low DHEA-S levels may be useful screening tools for LS in men.

Preoperative prealbumin and transferring: Relation to 30-day risk of complication in elective spine surgical patients

OF BACKGROUND DATA

There is growing interest in identifying nutritional biomarkers associated with poor outcomes of elective spine surgery. Prealbumin and transferrin are both biomarkers of nutritional status that can be obtained from clinical laboratories. However, associations of preoperative measures of these nutritional biomarkers across their range with risk of complications from spine surgery have not been fully investigated.

OBJECTIVE

Determine associations of preoperative prealbumin and transferrin levels with 30-day risk of complication among elective spine surgery patients.

STUDY DESIGN

Cohort study with preoperative prealbumin and transferrin collected as standard of care.

OUTCOME MEASURES

30-day risk of medical complication.

METHODS

Data were obtained from medical records of 274 consecutive adult patients ages ≥50 years who underwent elective spine surgery from June 2013 to June 2014. Prealbumin (mg/dL), serum transferrin (mg/dL), and preoperative factors were abstracted from medical records. Prealbumin and transferrin levels were categorized into quartiles and as below versus median or higher. The primary outcome measure was 30-day risk of medical complication, such as renal failure or infections. Associations of the biomarkers with outcome risk were assessed with chi-square tests and with risk ratios (RR) and 95% confidence intervals (CI) estimated with multivariable log-binomial regression.

RESULTS

The 274 adults studied had a median prealbumin level of 27.4 mg/dL and a median transferrin level of 265.0 mg/dL. The 30-day risk of complication was 12.8% (95% CI: 8.8%-16.7%). Risk of complication did not vary by quartile for either prealbumin (P = .26) or transferrin (P = .49) and was not associated either with prealbumin (below median, RR = 1.1, 95% CI: 0.8, 1.5) or transferrin (below median, RR = 1.1, 95% CI: 0.8, 1.6).

CONCLUSIONS

Among adults undergoing elective spine surgery, the 30-day risk of complication was not associated with prealbumin or transferrin. Nutrition status, as measured by prealbumin and transferrin, does not appear to be associated with complication risk.

LEVEL OF EVIDENCE

Level III.

Designing an Internet-Based Multidomain Intervention for the Prevention of Cardiovascular Disease and Cognitive Impairment in Older Adults: The HATICE Trial

BACKGROUND

Many dementia and cardiovascular disease (CVD) cases in older adults are attributable to modifiable vascular and lifestyle-related risk factors, providing opportunities for prevention. In the Healthy Aging Through Internet Counselling in the Elderly (HATICE) randomized controlled trial, an internet-based multidomain intervention is being tested to improve the cardiovascular risk (CVR) profile of older adults.

OBJECTIVE

To design a multidomain intervention to improve CVR, based on the guidelines for CVR management, and administered through a coach-supported, interactive, platform to over 2500 community-dwellers aged 65+ in three European countries.

METHODS

A comparative analysis of national and European guidelines for primary and secondary CVD prevention was performed. Results were used to define the content of the intervention.

RESULTS

The intervention design focused on promoting awareness and self-management of hypertension, dyslipidemia, diabetes mellitus, and overweight, and supporting smoking cessation, physical activity, and healthy diet. Overall, available guidelines lacked specific recommendations for CVR management in older adults. The comparative analysis of the guidelines showed general consistency for lifestyle-related recommendations. Key differences, identified mostly in methods used to assess the overall CVR, did not hamper the intervention design. Minor country-specific adaptations were implemented to maximize the intervention feasibility in each country.

CONCLUSION

Despite differences in CVR management within the countries considered, it was possible to design and implement the HATICE multidomain intervention. The study can help define preventative strategies for dementia and CVD that are applicable internationally.

The Role of Nutrition and Literacy on the Cognitive Functioning of Elderly Poor Individuals

Maintaining cognitive function is a prerequisite of living independently, which is a highly valued component in older individuals' well-being. In this article we assess the role of early-life and later-life nutritional status, education, and literacy on the cognitive functioning of older adults living in poverty in Peru. We exploit the baseline sample of the Peruvian noncontributory pension program Pension 65 and find that current nutritional status and literacy are strongly associated with cognitive functioning for poor older adults. In a context of rising popularity of noncontributory pension programs around the world, our study intends to contribute to the discussion of designing accompanying measures to the pension transfer, such as adult literacy programs and monitoring of adequate nutrition of older adults.

Disease Specific Aspects of Malnutrition in Neurogeriatric Patients

Malnutrition in elderly patients is a common condition. Nevertheless, there is evidence on specific risk factors and problems of malnutrition in geriatric patients with neurological diseases. In this review, we summarize recent knowledge on malnutrition in different neurological diseases with a focus on elderly patients. This overview also provides strategies for a more specific and profound assessment of neurogeriatric patients to improve identification and treatment of malnutrition. Early and consequent treatment of malnutrition can lead to a decreased progression of the neurological disease and to a better quality of life in geriatric patients.

Baseline level and change in serum albumin concentration and the risk of incident type 2 diabetes

AIMS

We aimed to determine whether baseline level and change in serum albumin concentration are predictive of future development of type 2 diabetes (T2D).

METHODS

A total of 15,428 subjects (8764 men and 6664 women) without diabetes at baseline, aged 21-88years (mean age of 51.0years), were enrolled from a health screening program.

RESULTS

During the 5-year follow-up period, a total of 599 incident cases (3.9%) of T2D developed. Higher baseline serum albumin concentration was associated with increased T2D risk, independent of age, sex, or body mass index; however, this association was confounded and was not significant after further adjustment for other T2D risk factors. Compared with subjects in the lowest tertile of change in serum albumin concentration, subjects in the highest tertile showed a lower risk for T2D development, independent of risk factors for T2D and baseline serum albumin concentration [OR (95% CI), 0.30 (0.21-0.43), p for trend <0.001].

CONCLUSION

Higher baseline serum albumin concentration was not an independent risk factor of future T2D, whereas an increase in serum albumin concentration was independently associated with a lower diabetes risk.

An Even Distribution of Protein Intake Daily Promotes Protein Adequacy but Does Not Influence Nutritional Status in Institutionalized Elderly

OBJECTIVE

Although it has been established that sufficient protein is required to maintain good nutritional status and support healthy aging, it is not clear if the pattern of protein consumption may also influence nutritional status, especially in institutionalized elderly who are at risk of malnutrition. Therefore, we aim to determine the association between protein intake distribution and nutritional status in institutionalized elderly people.

DESIGN

Cross-sectional study among 481 institutionalized older adults.

METHODS

Dietary data from 481 ambulant elderly people (68.8% female, mean age 87.5 ± 6.3 years) residing in 52 aged-care facilities in Victoria, Australia, were assessed over 2 days using plate waste analysis. Nutritional status was determined using the Mini-Nutritional Assessment tool and serum (n = 208) analyzed for albumin, hemoglobin, and IGF-1. Protein intake distribution was classified as: spread (even distribution across 3 meals, n = 65), pulse (most protein consumed in one meal, n = 72) or intermediate (n = 344). Regression analysis was used to investigate associations.

RESULTS

Mean protein intakes were higher in the spread (60.5 ± 2.0 g/d) than intermediate group (56.0 ± 0.8 g/d, P = .037), and tended to be higher than those in the pulse group (55.9 ± 1.9 g/d, P = .097). Residents with an even distribution of protein intake achieved a higher level of the recommended daily intake for protein (96.2 ± 30.0%) than the intermediate (86.3 ± 26.2%, P = .008) and pulse (87.4 ± 30.5%, P = .06) groups, and also achieved a greater level of their estimated energy requirements (intermediate; P = .039, pulse; P = .001). Nutritional status (Mini-Nutritional Assessment score) did not differ between groups (pulse; 20.5 ± 4.5, intermediate; 21.0 ± 2.5, spread; 20.5 ± 3.5), nor did any other indices of nutritional status.

CONCLUSIONS

Meeting protein requirements is required before protein distribution may influence nutritional status in institutionalized elderly. Achieving adequate protein and energy intakes is more likely when protein is distributed evenly throughout the day. Provision of high protein foods especially at breakfast, and in the evening, may support protein adequacy and healthy aging, especially for institutionalized elderly.

Validation of the Malnutrition Screening Tool for use in a Community Rehabilitation Program

AIM

The aim of the present study was to determine if the Malnutrition Screening Tool (MST) is valid for use within the Community Rehabilitation Program (CRP) setting. Secondary outcome measures were to assess malnutrition prevalence in the CRP population and to determine trends between malnutrition and age, body mass index (BMI) and falls history.

METHODS

This study used a cross-sectional design. All clients admitted to a Melbourne metropolitan CRP during the study period had the MST completed at intake. A total of 160 participants were then selected at random and a Subjective Global Assessment (SGA) was completed by an experienced dietitian. Participants were classified as well nourished or malnourished, and this result was compared to their MST score. Data analysis was completed to determine the predictive value of the MST compared to SGA, which was expressed using sensitivity, specificity, positive and negative predictive values.

RESULTS

Out of the 160 participants, 34.0% were identified as malnourished. The MST achieved a sensitivity of 72.2% and a specificity of 83.8% with positive predictive value of 69.6% and negative predictive value of 85.4% compared to the SGA. Participants in the malnourished group were older and had a lower BMI (P < 0.05).

CONCLUSIONS

Considering the demographics and needs of the CRP population group and the predictive value of the MST compared to SGA, it can be concluded that the MST is a valid screening tool for use in this population and has relatively low burden to complete. Consequently, the MST could be included in the client initial needs identification to be completed when admitted to the program.

Successful ageing and multi-dimensional poverty: the case of Peru

This study investigated the determinants of Successful Ageing (SA) in a sample of 4,151 Peruvians aged between 65 and 80 years and living in poverty. A key contribution of this study is to combine the conceptual appeal of SA to measure wellbeing in old age with the multi-dimensional poverty counting approach developed in the economic literature. This setting allows for moving beyond the dichotomy of successful and usual ageing to take advantage of the full distribution of success along a set of dimensions of wellbeing. The data are drawn from the Encuesta de Salud y Bienestar del Adulto Mayor (ESBAM) survey, which is the baseline to evaluate the non-contributory public pension programme Pension 65. Nine indicators of SA have been used to assess the dimensions of physical health, functioning, cognition, emotional health and life satisfaction. The variables associated with a higher number of satisfied indicators were male gender, younger old age, literate, employed, low food insecurity, good nutritional status, normal blood pressure, absence of disabilities, non-smoker, empowerment, good self-esteem, absence of mental disability and less frequent contact with a social network. From a policy perspective, the results of this study report a remarkably stable effect of three variables affecting SA that can be relatively easy to measure, monitor and influence by public intervention. These variables are food security, nutrition quality and self-esteem.

High degree of BMI misclassification of malnutrition among Swedish elderly population: Age-adjusted height estimation using knee height and demispan

BACKGROUND/OBJECTIVES

The degree of misclassification of obesity and undernutrition among elders owing to inaccurate height measurements is investigated using height predicted by knee height (KH) and demispan equations.

SUBJECTS/METHODS

Cross-sectional investigation was done among a random heterogeneous sample from five municipalities in Southern Sweden from a general population study 'Good Aging in Skåne' (GÅS). The sample comprised two groups: group 1 (KH) including 2839 GÅS baseline participants aged 60-93 years with a valid KH measurement and group 2 (demispan) including 2871 GÅS follow-up examination participants (1573 baseline; 1298 new), aged 60-99 years, with a valid demispan measurement. Participation rate was 80%. Height, weight, KH and demispan were measured. KH and demispan equations were formulated using linear regression analysis among participants aged 60-64 years as reference. Body mass index (BMI) was calculated in kg/m(2).

RESULTS

Undernutrition prevalences in men and women were 3.9 and 8.6% by KH, compared with 2.4 and 5.4% by standard BMI, and more pronounced for all women aged 85+ years (21% vs 11.3%). The corresponding value in women aged 85+ years by demispan was 16.5% vs 10% by standard BMI. Obesity prevalences in men and women were 17.5 and 14.6% by KH, compared with 19.0 and 20.03% by standard BMI. Values among women aged 85+ years were 3.7% vs 10.4% by KH and 6.5% vs 12.7% by demispan compared with the standard.

CONCLUSIONS

There is an age-related misclassification of undernutrition and obesity attributed to inaccurate height estimation among the elderly. This could affect the management of patients at true risk. We therefore propose using KH- and demispan-based formulae to address this issue.

Capturing the data: nutrition risk screening of adults in hospital

This study aims to explore limitations with the Malnutrition Screening Tool in identifyingmalnutrition risk, in a cohort of 3,033 adult Australian medical and surgical hospital inpatients. Seventy-two percent of patients were screened; illness and medical care limited access to others. Malnutrition risk (16.5%; n = 501) was found in all age groups with a trend to higher risk in medical wards; 10% (n = 300) of patients with communication barriers were excluded. Systematic screening increased dietitians’ referrals by 39%. Further research is required to enable screening of all patients, including those with communication issues with an easy to use valid tool.

Geriatric surgery is about disease, not age

Maintaining life span and quality of life remains a valid aim of surgery in elderly people. Surgery can be an effective way of restoring both length and quality of life to older people. Minimally invasive techniques and surgery under local anaesthesia make fewer demands on geriatric physiology; given that co-morbidity is a stronger predictor of outcome from surgery than age, this is a significant consideration.

Usefulness of the Chinese Nutrition Screening (CNS) tool in predicting 12 month mortality in elderly Hong Kong Chinese living in institutions

OBJECTIVES

To determine the cut off score of the CNS in predicting 12 months mortality.

DESIGN

Data was collected and followed up from a previous study among elderly subjects (n = 515) living in community institutional setting. The risk of malnutrition and 12 months mortality was ranked by the CNS and compared with that by SGA. Reliability was assessed by the sensitivity and specificity of the prediction with SGA as well as BMI alone. Sensitivity and specificity was calculated to determine validity as well as using positive and negative predictive values in predicting mortality at 12 months.

RESULTS

All three tools (BMI, SGA, CNS) demonstrated significant difference of higher mortality rate (P < .001) in the malnourished group. CNS at score < or = 21 showed comparable results to SGA tool and BMI at classifying malnutrition. And using cut off score > or = 22 also show significant results with SGA in classifying patients with normal nutrition. CNS score at > or = 22 sensitivity was 60.9% and specificity was 72.9% with a Negative Predictive value of 92.3% and a Positive Predictive value of 25.8%.

CONCLUSION

CNS tool at cut off > or = 22 is just as good as using BMI or SGA in identifying those who have a normal nutritional status. This is useful in particular, when biochemical or anthropometric data is not available. This further validates the use of > or = 22 as the best cut off point with the CNS tool and just as good at predicting of mortality when compared with SGA and BMI assessments.