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Song JE, Ji E, Kim NH, Ohn JH, Lim Y, Lee J, Kim HW, Kim SW, Ryu J, Park HS, Kim ES. Efficacy of an Aspiration Prevention Program That Utilizes the Gugging Swallowing Screen in Older Patients. Clin Interv Aging 2024; 19:1461-1470. [PMID: 39188524 PMCID: PMC11346477 DOI: 10.2147/cia.s474569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. Patients and Methods This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Results Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001). Conclusion The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.
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Affiliation(s)
- Ji Eun Song
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nak-Hyun Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jung Hun Ohn
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yejee Lim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jongchan Lee
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hye Won Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sun-Wook Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jiwon Ryu
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Sun Park
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Sun Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Tanaka K, Kimura H, Ejiri H, Saito H, Watanabe K, Kazama S, Shimabukuro M, Asahi K, Watanabe T, Kazama JJ. Geriatric Nutritional Risk Index is associated with adverse outcomes in patients with hypertension: the Fukushima Cohort study. Hypertens Res 2024; 47:2041-2052. [PMID: 38769135 DOI: 10.1038/s41440-024-01716-5] [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: 01/12/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024]
Abstract
Malnutrition is reportedly associated with adverse clinical outcomes in various populations. However, associations between nutritional status and adverse outcomes in patients with hypertension have not been sufficiently elucidated. We therefore aimed to investigate the impact of nutritional status as evaluated by the Geriatric Nutritional Risk Index (GNRI) on adverse outcomes in patients with hypertension. We conducted a retrospective cohort study of 1588 hypertensive patients enrolled in the Fukushima Cohort Study. Participants were categorized into tertiles (T1-T3) according to GNRI at baseline. The primary endpoint of the present study was a kidney event, defined as a combination of a 50% decline in eGFR from baseline and end-stage kidney disease requiring kidney replacement therapy. Associations between GNRI and kidney events were assessed using Kaplan-Meier curves and multivariate Cox regression analyses. Median age was 64 years, 55% were men, median eGFR was 63.1 mL/min/1.73 m2, and median GNRI was 101.3. The lower GNRI group (T1) showed an increased incidence of kidney events in the Kaplan-Meier curve analysis. Compared to the highest GNRI group (T3), lower GNRI carried a higher risk of kidney events for both T2 (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.71-2.68) and T1 (HR 3.59, 95%CI 1.96-6.63). Similar relationships were observed for risks of all-cause death and cardiovascular events. Lower GNRI was associated with kidney events, all-cause death, and cardiovascular events in patients with hypertension. Nutritional status as evaluated by GNRI could offer a simple and useful predictor of adverse outcomes in this population.
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Affiliation(s)
- Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan.
| | - Hiroshi Kimura
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Ejiri
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Hirotaka Saito
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Kimio Watanabe
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Sakumi Kazama
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Michio Shimabukuro
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan
| | - Koichi Asahi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
- Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan
| | - Tsuyoshi Watanabe
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
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Brígido JA, da Rosa WLDO, Lund RG. Influence of prosthodontic rehabilitation and dietary advice on glycaemic control, nutritional status and oral health-related quality of life of older adults with type 2 diabetes. Gerodontology 2024. [PMID: 38995836 DOI: 10.1111/ger.12777] [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: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES This prospective clinical study aimed to determine the influence of oral prosthodontic rehabilitation with partial removable dentures and simplified dietary advice on glycaemic control, nutritional status and oral health-related quality of life (OHRQoL) of older adults with type 2 diabetes. BACKGROUND Individuals with tooth loss who did not wear complete or partial dentures are more likely to be at nutritional risk, suggesting that using dental prostheses would benefit the re-establishment of an adequate nutritional status and potentially improve quality of life. Nutritional therapy is essential for diabetes prevention, treatment and management, favouring glycaemic control. The literature provides little evidence on the contribution of partial removable dentures to improving diabetes control, nutritional profile and satisfaction in older adults, especially those with type 2 diabetes. MATERIALS AND METHODS Older individuals diagnosed with type 2 diabetes mellitus, aged 60 years or older and needing oral rehabilitation with partial removable dentures were eligible for this prospective study. The primary outcome measure was glycaemic control, measured by glycated haemoglobin (HbA1c) levels. The Oral Health Impact Profile (OHIP-14) questionnaire and the Mini Nutritional Assessment short-form (MNA-SF) represented secondary outcome measures. These measures were assessed at baseline and 12 months of follow-up after prosthesis delivery, combined with simple dietary advice in pamphlet form. The data were analysed using the Wilcoxon matched-pairs test. RESULTS Forty-four patients who met the inclusion criteria and required treatment with removable partial dentures were selected for this study, which was carried out for a year. During this period, seven participants declined to participate because they moved to another city. Hence, a final sample of 37 participants (16 men and 21 women, average age of 65.8 years, ranging from 60 to 83 years) were included in the study. No laboratory parameter (HbA1c levels) changed significantly during the investigation. The number of older adults at risk of malnutrition was significantly lower at 12 months than at baseline. Furthermore, nutritional status significantly improved 12 months after prosthodontic treatment combined with dietary advice, and the effect sizes were large. OHRQoL significantly improved after prosthodontic therapy combined with dietary advice. CONCLUSIONS Prosthodontic treatment with partial dentures associated with simple dietary advice did not influence glycaemic control but improved the nutritional status and OHRQoL of older adults with type 2 diabetes.
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Affiliation(s)
- Jandenilson Alves Brígido
- School of Dentistry, Fametro University Centre (UNIFAMETRO), Fortaleza, Brazil
- Graduate Program in Dentistry, Pelotas Dental School, Federal University of Pelotas (UFPEL), Pelotas, Rio Grande do Sul, Brazil
| | | | - Rafael Guerra Lund
- Graduate Program in Dentistry, Pelotas Dental School, Federal University of Pelotas (UFPEL), Pelotas, Rio Grande do Sul, Brazil
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Feng W, Wang J, Zhang H, Wang Y, Sun Z, Chen Y. Association between malnutrition and cognitive frailty in older adults: A systematic review and meta-analysis. Geriatr Nurs 2024; 58:488-497. [PMID: 38970917 DOI: 10.1016/j.gerinurse.2024.06.020] [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: 01/29/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND To systematically assess the association between cognitive frailty (CF) and malnutrition in older adults. METHODS 8 databases were retrieved up until April 2023 by two reviewers in dependently, and meta-analysis was performed by Stata 16.0 software. RESULTS A total of 19 studies were meta-analyzed to assess the relationship between CF and malnutrition in older adults. The pooled prevalence of CF from 17 studies was 23 %, and the pooled prevalence of malnutrition among patients with CF from 12 studies was 57 %. Data from 13 studies on the association between CF and malnutrition unveiled a high risk of CF in older adults with malnutrition (OR = 3.77, 95 % CI: 2.49-5.69). CONCLUSION The prevalence of malnutrition is high in older adults with CF, and there is a significant delve into targeted treatment and preventive measures to ameliorate the quality of life of older adults.
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Affiliation(s)
- Wanqiu Feng
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China
| | - Jinyang Wang
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China
| | - Hailian Zhang
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China.
| | - Yu Wang
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China
| | - Zihan Sun
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China
| | - Yuanyuan Chen
- School of Nursing, Yanbian University of China, Yanji, Jilin, 133000, China
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Kanda D, Ohishi M. Malnutrition is one of new risk factors in patients with hypertension: the message form Fukushima Cohort Study. Hypertens Res 2024:10.1038/s41440-024-01751-2. [PMID: 38914706 DOI: 10.1038/s41440-024-01751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Atasoy B, Balsak S, Alkan A, Akcay A, Peker AA, Toluk O, Atila N, Kaya A, Ipar O, Soysal P. The relationship between nutritional status and white matter integrity in older adults: A diffusion tensor imaging study. Clin Nutr 2024; 43:1065-1072. [PMID: 38579368 DOI: 10.1016/j.clnu.2024.03.025] [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: 02/20/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES The purpose of this study to determinate whether there is a relationship between the nutritional status and white matter integrity in older patients by using Diffusion Tensor Imaging (DTI). METHODS The patients were evaluated by Mini-Nutritional Assessment Scale. The patients are categorized in the groups of well-nourished, risk of malnutrition, or malnourished, depending on the overall score> 23.5, 17-23.5, or 17; respectively. All patients had brain MRI and DTI. The mean diffusivity (MD), fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) values were calculated by ROI-based method in white matter tracts. RESULTS Total of the 224 patients; 86 patients had normal nutrition status (group 1), 107 patients were diagnosed with malnutrition risk (group 2) and 31 patients were diagnosed with malnutrition (group 3). Significantly decreased FA values of genu of corpus callosum, forceps minor and significantly increased MD values of middle cerebellar peduncle, and superior frontooccipital fasciculus were detected in group 2 in comparison to group 1 (p < 0.05). After adjusting for the folate and age, MD and RD values of cingulum remained significantly higher and the AD values of superior cerebellar peduncle remained significantly lower in group 3 (p < 0.05). CONCLUSIONS Malnutrition was associated with deteriorated DTI values, especially in cingulum and superior cerebellar peduncle. Assessing the nutritional status of older individuals is crucial to avoid its negative impact on brain. ADVANCES IN KNOWLEDGE Early diagnosis of malnutrition-related impaired WM integrity is important for prevention and intervention, and DTI is a useful non-invasive technique to be used for this purpose.
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Affiliation(s)
- Bahar Atasoy
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Serdar Balsak
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Alpay Alkan
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Ahmet Akcay
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Abdusselim Adil Peker
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Ozlem Toluk
- Bezmialem Vakıf University Hospital, Department of Bioistatistics and Medical Informatics, 34093, Istanbul, Turkey.
| | - Naz Atila
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093, Istanbul, Turkey.
| | - Ahmet Kaya
- Salmaniya Medical Complex, Department of Radiology, Manama, Bahrain.
| | - Ozlem Ipar
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093, Fatih, Istanbul, Turkey.
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093, Fatih, Istanbul, Turkey.
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Kinugasa Y, Ida M, Kawaguchi M. Fried Frailty Phenotype Questionnaire scores and postoperative patient-reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis. Geriatr Gerontol Int 2024; 24:464-469. [PMID: 38597119 DOI: 10.1111/ggi.14872] [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: 11/04/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
AIM This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient-reported postoperative outcomes. METHODS This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery-15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability-free survival, defined as a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. RESULTS After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery-15 score on postoperative day 2 (β = -2.67, 95% confidence interval -5.20, -0.15), 4 (β = -3.54, 95% confidence interval -5.77, -1.30) and 7 (β = -3.70, 95% confidence interval -5.75, -1.65). The adjusted odds ratio of the FFPQ score for disability-free survival postoperatively was 0.66 (95% confidence interval 0.49-0.90). CONCLUSIONS Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery-15 scores and poor disability-free survival. Geriatr Gerontol Int 2024; 24: 464-469.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Tsuji T, Yamasaki K, Kondo K, Hongu N, Matsumoto Y, Fukuo K, Habu D. Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study. J Hum Nutr Diet 2024; 37:574-582. [PMID: 38229274 DOI: 10.1111/jhn.13281] [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: 08/18/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS At-risk of malnutrition was associated with discontinuation of home medical care among older patients.
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Affiliation(s)
- Taeko Tsuji
- Department of Health and Nutrition, Faculty of Human Science, Osaka Aoyama University, Minoh, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Nishinomiya, Japan
| | - Kyoko Kondo
- Research Support Platform, Osaka Metropolitan University Graduate School of Medicine, Osaka-shi, Japan
| | - Nobuko Hongu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Daiki Habu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
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9
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Hu YS, Lo YT, Yang YC, Wang JL. Frailty in Older Adults with Dengue Fever. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:537. [PMID: 38674183 PMCID: PMC11052058 DOI: 10.3390/medicina60040537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Background and objectives: Dengue is one of the most common epidemic infections around the world. Dengue infections in older adults are related to an atypical presentation and a high mortality. Frailty is associated with poor recovery from hospitalization due to infection. However, few studies describe frailty and functional decline after dengue infection. The current case series study aims to investigate the baseline frailty status, functional decline, and time to recovery in older adults after dengue infection. Method: We studied seven patients with post-dengue frailty who had been admitted to the geriatric ward in one tertiary medical center in Taiwan during the 2023 dengue fever outbreak. Result: The mean age was 82 years old. The clinical frailty scale worsened from a mean of 4.7 at baseline to 6.3 at dengue diagnosis. The mean Katz Index of independence in activities of daily living decreased from 10.6 at baseline to 4.7 with dengue, and it recovered to 6.7 one month after discharge. Conclusions: Our preliminary data suggest that there is indeed an increase in frailty in older adults due to dengue. Post-dengue frailty and functional decline might be profound and persistent. Acute geriatric care intervention rehabilitation for frailty after dengue may benefit this population.
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Affiliation(s)
- Yu-Sheng Hu
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan or (Y.-S.H.); (Y.-T.L.)
| | - Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan or (Y.-S.H.); (Y.-T.L.)
| | - Yi-Ching Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan or (Y.-S.H.); (Y.-T.L.)
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 701, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
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10
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Lo Buglio A, Bellanti F, Carmignano DFP, Serviddio G, Vendemiale G. Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients. Nutrients 2024; 16:576. [PMID: 38474705 DOI: 10.3390/nu16050576] [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: 01/25/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
The Controlling Nutritional Status (CONUT) score has demonstrated its ability to identify patients with poor nutritional status and predict various clinical outcomes. Our objective was to assess the association between the CONUT score, inflammatory status, and body composition, as well as its ability to identify patients at risk of frailty in hospitalized elderly patients. METHODS a total of 361 patients were retrospectively recruited and divided into three groups based on the CONUT score. RESULTS patients with a score ≥5 exhibited significantly higher levels of inflammatory markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Neutrophil/Lymphocytes ratio (NLR), main platelet volume (MPV), and ferritin, compared to those with a lower score. Furthermore, these patients showed unfavorable changes in body composition, including a lower percentage of skeletal muscle mass (MM) and fat-free mass (FFM) and a higher percentage of fatty mass (FM). A positive correlation was found between the CONUT score and inflammatory markers, Geriatric Depression Scale Short Form (GDS-SF), and FM. Conversely, the Mini Nutritional Assessment (MNA), Mini-Mental Status Examination, activity daily living (ADL), instrumental activity daily living (IADL), Barthel index, FFM, and MM showed a negative correlation. Frailty was highly prevalent among patients with a higher CONUT score. The receiver operating characteristic (ROC) curve demonstrated high accuracy in identifying frail patients (sensitivity). CONCLUSIONS a high CONUT score is associated with a pro-inflammatory status as well as with unfavorable body composition. Additionally, it is a good tool to identify frailty among hospitalized elderly patients.
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Affiliation(s)
- Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | | | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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11
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Kinugasa Y, Ida M, Nakatani S, Uyama K, Kawaguchi M. Effects of preoperative nutritional status on postoperative quality of recovery: a prospective observational study. Br J Nutr 2023; 130:1898-1903. [PMID: 37144392 DOI: 10.1017/s0007114523001046] [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] [Indexed: 05/06/2023]
Abstract
Quality of Recovery-15 (QoR-15) has received attention as a postoperative patient-reported outcome measure. Preoperative nutritional status has negative effects on postoperative outcomes; however, these associations have not yet been investigated. We included inpatients aged ≥ 65 years who underwent elective abdominal cancer surgery under general anaesthesia between 1 June 2021 and 7 April 2022 at our hospital. Preoperative nutritional status was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), and patients with an MNA-SF score ≤ 11 were categorised into the poor nutritional group. The outcomes in this study were the QoR-15 scores at 2 d, 4 d and 7 d after surgery, which were compared between groups by unpaired t test. Multiple regression analysis was applied to assess the effects of poor preoperative nutritional status on the QoR-15 score on postoperative day 2 (POD 2). Of the 230 included patients, 33·9 % (78/230) were categorised into the poor nutritional status group. The mean QoR-15 value was significantly lower in the poor nutritional group than in the normal nutritional group at all postoperative time points (POD 2:117 v. 99, P = 0·002; POD 4:124 v. 113, P < 0·001; POD 7:133 v. 115, P < 0·001). Multiple analyses showed that poor preoperative nutritional status was associated with the QoR-15 score on POD 2 (adjusted partial regression coefficient, -7·8; 95 % CI -14·9, -0·72). We conclude that patients with a poor preoperative nutritional status were more likely to have a lower QoR-15 score after abdominal cancer surgery.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Shohei Nakatani
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
- Department of Anaesthesiology, Akashi Medical Centre, Akashi, Japan
| | - Kayo Uyama
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, Nara634-8522, Japan
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12
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Chou KR, Huang MS, Chiu WC, Chen YH, Chen YY, Xiao Q, Yang SC. A comprehensive assessment of oral health, swallowing difficulty, and nutritional status in older nursing home residents. Sci Rep 2023; 13:19914. [PMID: 37964096 PMCID: PMC10645724 DOI: 10.1038/s41598-023-47336-w] [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: 05/25/2023] [Accepted: 11/12/2023] [Indexed: 11/16/2023] Open
Abstract
Declines in oral consumption and swallowing function are common reasons which may elevate the risk of malnutrition in the older adults. This study aimed to provide valuable information and contribute to the existing body of knowledge in this field as well as highlight the importance of a comprehensive assessment of oral health, swallowing function, and nutritional status in long-term care residents. This was a cross-sectional study. Thirty-nine participants were recruited from a nursing home. The comprehensive assessment was evaluated in participants, including oral health (Oral Health Assessment Tool (OHAT)), swallowing function (Functional Oral Intake Scale (FOIS) and Eating Assessment Tool (EAT)-10), and nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF). The average age of participants was 80.4 ± 11.7 years, and 46% of these older adults were found to be at the risk of malnutrition. There was a negative correlation between the OHAT and MNA-SF scores. In addition, subjects with poor oral health (OHAT score = 5~8), oral consumption of a modified diet (FOIS score = 4~6), and reduced swallowing function (EAT-10 score ≥ 3) were more likely to be at risk of malnutrition. A comprehensive evaluation of oral health and swallowing function was closely connected with the nutritional status of older nursing home dwellers.
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Affiliation(s)
- Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Mao-Suan Huang
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wan-Chun Chiu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
- Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan
- Department of Nutrition, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsiu Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Yu-Yoh Chen
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan
| | - Qian Xiao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Suh-Ching Yang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
- Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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13
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Kujala MA, Hongisto MT, Luukkaala T, Stenholm S, Nuotio MS. Pertrochanteric hip fracture is associated with mobility decline and poorer physical performance 4 to 6 months post-hip fracture. BMC Geriatr 2023; 23:722. [PMID: 37940840 PMCID: PMC10631110 DOI: 10.1186/s12877-023-04415-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: 06/04/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND To study the effect of hip fracture type on physical performance, functional ability and change in mobility four to six months after the injury. METHODS A total of 1331 patients out of consecutive 2052 patients aged ≥ 65 years who underwent hip fracture surgery were included in the study. Patient information was collected on admission, during hospitalization, by phone interview and at the geriatric outpatient clinic 4 to 6 months after the fracture. Of the 1331 eligible patients, Grip strength, Timed Up and Go -test (TUG), Elderly Mobility Scale (EMS), mobility change compared to pre-fracture mobility level, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) were used to determine physical performance and functional ability. Logistic regression was used for the analyses which was adjusted for gender, age, American Society of Anesthesiologists score, diagnosis of cognitive disorder, pre-fracture living arrangements, mobility and need of mobility aid. RESULTS Patients with pertrochanteric hip fracture had an EMS lower than 14 (Odds Ratio (OR) 1.38, 95% confidence intervals (CI) 1.00-1.90), TUG time ≥ 20 s (OR 1.69, 95% CI 1.22-2.33) and they had declined in mobility (OR 1.58, 95% CI 1.20-2.09) compared to femoral neck fracture patients 4 to 6 months post-hip fracture in multivariable-adjusted logistic regression analyses. Grip strength and functional ability (IADL, BADL) 4 to 6 months after hip fracture did not differ between fracture types. There were no statistically significant differences in physical performance in patients with a subtrochanteric fracture compared to patients with a femoral neck fracture. CONCLUSIONS Pertrochanteric hip fracture independently associated with poorer physical performance 4 to 6 months post hip fracture compared to other hip fracture types. Pertrochanteric hip fracture patients should be given special attention in terms of regaining their previous level of mobility.
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Affiliation(s)
- Minna A Kujala
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
- Department of Geriatric Medicine, University of Turku, Turku, Finland.
| | - Markus T Hongisto
- Division of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tiina Luukkaala
- Research and Innovation Centre, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Department of Geriatric Medicine, University of Turku and Turku University Hospital, Turku, Finland
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Sucuoglu Isleyen Z, Besiroglu M, Yasin AI, Simsek M, Topcu A, Smith L, Akagunduz B, Turk HM, Soysal P. The risk of malnutrition and its clinical implications in older patients with cancer. Aging Clin Exp Res 2023; 35:2675-2683. [PMID: 37644257 DOI: 10.1007/s40520-023-02538-0] [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: 03/06/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
AIM Malnutrition is a common geriatric syndrome with multiple negative outcomes including mortality. However, there is a scarcity of literature that focuses on the relationship between malnutrition risk and its clinical implications on geriatric syndromes and mortality among cancer patients. The aim of this study is to determine the clinical importance of malnutrition risk in geriatric oncology practice. METHOD 180 patients with cancer who were ≥ 65 years were included in the study. All patients were questioned in terms of geriatric syndromes, including polypharmacy, frailty, probable sarcopenia, fall risk, dynapenia, depression, cognitive impairment, insomnia, and excessive daytime sleepiness. Mini Nutritional Assessment scores > 23.5 and 17-23.5 were categorized as well-nourished and malnutrition risk, respectively. RESULTS Of the 180 patients (mean age 73.0 ± 5.6 years, female: 50%), the prevalence of malnutrition risk was 28.9%. There was no statistically significant difference between the groups in terms of age, gender, education, marital status, body mass index, and comorbidities except for chronic obstructive pulmonary disease (p > 0.05). After adjustment for age, sex, and body mass index; polypharmacy (odds ratio [OR]: 3.17; 95% confidence interval [CI], 1.48-6.81), reduced calf circumference (OR: 3.72; 95% CI, 1.22-11.38), fall risk (OR: 2.72; 95% CI, 1.03-7.23), depression (OR: 6.24; 95% CI, 2.75-14.18), insomnia (OR: 4.89; 95% CI, 2.16-11.05), and frailty (OR: 2.44; 95% CI, 1.75-3.40) were associated with malnutrition risk compared to well-nourished patients (p < 0.05). Median survival in patients with malnutrition risk was 21.3 months (range 14.1-28.4 95% CI) and median survival in patients who were defined as well nourished was not reached (p < 0.001). CONCLUSION The risk of malnutrition was associated with a higher risk for all-cause mortality in older patients with cancer, and was associated with many geriatric syndromes, including polypharmacy, fall risk, frailty, insomnia, and depression.
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Affiliation(s)
| | - Mehmet Besiroglu
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Irem Yasin
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Melih Simsek
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Atakan Topcu
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Baran Akagunduz
- Department of Medical Oncology, Erzincan Binali Yildirim University Medical School, Erzincan, Turkey
| | - Haci Mehmet Turk
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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15
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Bag Soytas R, Levinoff EJ, Smith L, Doventas A, Morais JA, Veronese N, Soysal P. Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review. EPIDEMIOLOGIA 2023; 4:382-407. [PMID: 37873884 PMCID: PMC10594531 DOI: 10.3390/epidemiologia4040035] [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: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.
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Affiliation(s)
- Rabia Bag Soytas
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Elise J. Levinoff
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey;
| | - José A. Morais
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90133 Palermo, Italy;
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34320, Turkey;
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16
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Agrawal S, Sathe S, Paul P, Doshi K, Agrawal A, Rathi N. Evaluation of the Role of Dentures & Dietary Advice on Nutritional Status of Complete Edentulous Patients Using MNA®-SF: An Observational Study. Cureus 2023; 15:e47736. [PMID: 38021918 PMCID: PMC10676211 DOI: 10.7759/cureus.47736] [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: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Aim This study aims to evaluate the role of dentures and dietary advice on the nutritional status of complete edentulous patients using the mini nutritional assessment-short form (MNA®-SF). Objective The objective of this study is to assess patients' nutrition using MNA®-SF before denture insertion and nutritional advice, to evaluate patients' nutrition using MNA®-SF after denture insertion and nutritional advice at one month and three months, and to assess and compare pre- and post-insertion differences in nutrition using MNA®-SF. Material and Method An observational study was conducted among 50 completely edentulous patients using the MNA®-SF questionnaire. They were asked the questions at baseline and then after they were given complete dentures, after which they were recalled after one month and three months to assess the nutritional status using MNA®-SF. All the questions were in the native language, so it was easy to understand the question and respond to it. Result It was found that the patient's nutritional status had significant changes, which shows that the dietary advice and complete denture affected the patient's nutritional status. Conclusions This study helped assess the efficacy and application of MNA®-SF in completely edentulous patients. In this study, we provided nutritional guidance to patients in addition to complete denture prostheses to encourage them to have healthy eating habits.
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Affiliation(s)
- Sakshi Agrawal
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Seema Sathe
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Priyanka Paul
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Khushbu Doshi
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Aastha Agrawal
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Nishant Rathi
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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17
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Murdaca G, Banchero S, Casciaro M, Paladin F, Tafuro M, Monacelli F, Nencioni A, Bruschetta R, Pioggia G, Tartarisco G, Gangemi S. Multiparametric Evaluation of Geriatric Patients Admitted to Intermediate Care: Impact on Geriatric Rehabilitation. Diagnostics (Basel) 2023; 13:2906. [PMID: 37761272 PMCID: PMC10529473 DOI: 10.3390/diagnostics13182906] [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: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Optimizing the functional status of patients of any age is a major global public health goal. Rehabilitation is a process in which a person with disabilities is accompanied to achieve the best possible physical, functional, social, intellectual, and relational outcomes. The Intermediate Care Unit within the O.U. of Geriatrics and Gerontology of the San Martino Hospital in Genoa is focused on the treatment and motor reactivation of patients with geriatric pathologies. The objective of this study was to identify which factor, among the characteristics related to the patient and those identified by the geriatric evaluation, had the greatest impact on rehabilitation outcomes. Our findings revealed significant correlations between the Barthel Index delta, the 4AT Screening Test, and the number of drugs taken. This association highlights the potential benefits of medication management in enhancing the overall well-being and functional abilities of frail older adults, despite the literature suggesting that polypharmacotherapy is associated with a reduction in functional status and an increase in mortality. These findings underscore the significance of a multidimensional geriatric assessment. Refining and optimising these multidisciplinary approaches is the objective of a more effective geriatric rehabilitation strategy.
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Affiliation(s)
- Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
| | - Sara Banchero
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
| | - Marco Casciaro
- Department of Medical Sciences, University Hospital of Messina, 98125 Messina, Italy;
| | - Francesca Paladin
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Michele Tafuro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.P.); (M.T.); (F.M.); (A.N.)
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (R.B.); (G.P.); (G.T.)
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy;
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18
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Mohd Rosnu NS, Ishak WS, Abd Rahman MH, Shahar S, Musselwhite C, Mat Ludin AF, Hamid TA, Abdul Latiff AR, Singh DKA. Associations between biopsychosocial factors and transportation patterns of older adults residing in Klang Valley, Malaysia. Front Public Health 2023; 11:1153822. [PMID: 37275505 PMCID: PMC10234101 DOI: 10.3389/fpubh.2023.1153822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults. Methods One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking). Results Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs. Discussion The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p < 0.001); (b) being Malay (AdjOR 21.72, 95% CI 0.36-16.12, p < 0.001); (c) having higher number of comorbidities (AdjOR 14.01, 95% CI 0.20-13.21, p = 0.007); and (d) being dependent in IADL (AdjOR 13.48, 95% CI 0.51-1.78, p = 0.002).
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Affiliation(s)
- Nurul Syuhada Mohd Rosnu
- Center for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wan Syafira Ishak
- Center for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Harimi Abd Rahman
- Optometry and Vision Sciences Programme, Center for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Center for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Charles Musselwhite
- Centre for Ageing and Dementia Research, Aberystwyth University, Aberystwyth, United Kingdom
| | - Arimi Fitri Mat Ludin
- Center for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | - Devinder Kaur Ajit Singh
- Center for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Kim N, Kim GS, Won CW, Lee JJ, Park MK, Shin J, Kim M. Two-year longitudinal associations between nutritional status and frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study. BMC Geriatr 2023; 23:216. [PMID: 37020292 PMCID: PMC10074647 DOI: 10.1186/s12877-023-03903-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Korea is expected to become a super-aged society in 2026, and improving nutritional status, which is directly related to health problems, is therefore important for increasing healthy life expectancy. Frailty is the most complex phenotype of aging, and leads to adverse health outcomes, disability, poor quality of life, hospitalization, and mortality. Malnutrition is a major risk factor for frailty syndrome. This study aimed to investigate the incidence of pre-frailty or frailty in the second wave (T2, 2018-2019) according to general characteristics and nutritional status in the first wave (T1, 2016-2017); and examine the longitudinal association of nutritional status in T1 and the incidence of pre-frailty or frailty in T2 among older adults living in a community. METHODS A secondary data analysis was performed using the Korean Frailty and Aging Cohort Study (KFACS). Participants comprised 1125 community-dwelling older Korean adults aged 70-84 years (mean age: 75.03 ± 3.56 years; 53.8% males). Frailty was assessed using the Fried frailty index, and nutritional status was assessed using the Korean version of the Mini Nutritional Assessment Short-Form and blood nutritional biomarkers. Binary logistic regression was used to identify longitudinal associations between the nutritional status at T1 and pre-frailty or frailty at T2. RESULTS Over the two-year follow-up period, 32.9% and 1.7% of the participants became pre-frail and frail, respectively. After the potential confounders were adjusted (sociodemographic, health behaviors, and health status characteristics), pre-frailty or frailty had a significant longitudinal association with severe anorexia (adjusted odds ratio [AOR], 4.17; 95% confidence interval [CI], 1.05-16.54), moderate anorexia (AOR, 2.31; 95% CI, 1.46-3.64), psychological stress or acute disease (AOR, 2.61; 95% CI, 1.26-5.39), and body mass index (BMI) less than 19 (AOR, 4.11; 95% CI, 1.20-14.04). CONCLUSIONS Anorexia, psychological stress, acute disease, and low BMI are the most significant longitudinal risk factors for pre-frailty or frailty in older adults. As nutritional risk factors may be preventable or modifiable, it is important to develop interventions targeting the same. Community-based health professionals in health-related fields should recognize and manage these indicators appropriately to prevent frailty among older adults living in the community.
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Affiliation(s)
- Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, 26, Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, Republic of Korea.
| | - Jae Jun Lee
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-Do, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Urinary and double incontinence in older women with hip fracture - risk of death and predictors of incident symptoms among survivors in a 1-year prospective cohort study. Arch Gerontol Geriatr 2023; 107:104901. [PMID: 36521394 DOI: 10.1016/j.archger.2022.104901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the association of urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) with one-year mortality among older female hip fracture patients and to identify predictors of incident UI and DI. DESIGN A prospective cohort study SETTING AND SUBJECTS: 1,468 female patients aged ≥ 65 treated for their first hip fracture during the period 2007-2019 METHODS: Continence status was elicited at baseline and one-year post-fracture. Age- and multivariable-adjusted Cox proportional hazards and multinomial logistic regression models were used to determine the associations of incontinence with one-year mortality and to examine the associations of baseline predictors with incident UI and DI respectively. RESULTS Of the women with no incontinence, UI and DI, 78 (13%), 159 (23%) and 60 (34%), died during follow-up. UI (HR 1.72, 95% CI 1.31-2.26) and DI (HR 2.61, 95% CI 1.86-3.66) were associated with mortality after adjusting for age. These associations lost their predictive power in multivariable analysis while age over 90, living in an institution, impaired mobility, poor nutrition, polypharmacy, and late removal of urinary catheter remained associated with mortality. Of continent women, 128 (21%) developed UI and 23 (4%) DI during follow-up. In multivariable analysis, impaired mobility was associated with incident UI (OR 2.56, 95% CI 1.48-4.44) and DI (OR 4.82, 95% CI 1.70-13.7), as well as living in an institution (OR 3.44, 95% CI 1.56-7.61 and OR 3.90, 95% CI 1.17-13.0). CONCLUSIONS AND IMPLICATIONS Underlying vulnerability likely explains differences in mortality between continence groups and development of incident UI and DI.
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Ahmed H, Tadesse A, Alemu H, Abebe A, Tadesse M. Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia. Front Nutr 2022; 9:962497. [DOI: 10.3389/fnut.2022.962497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundUndernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association.ResultsA total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9–34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5–53.1%) were at risk of undernutrition (MNA-FL = 17–23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2–29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012–9.134, P-value < 0.001), with a duration of illness of 3–5 years (AOR = 3.225, CI: 1.138–9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592–11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06–4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407–6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481–10.560, P-value < 0.001) were at risk of developing undernutrition.ConclusionUndernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.
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22
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Normann M, Ekerstad N, Angenete E, Prytz M. Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial. Trials 2022; 23:948. [PMID: 36397083 PMCID: PMC9670054 DOI: 10.1186/s13063-022-06883-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts. Methods This randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality. Discussion The trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC. Trial registration ClinicalTrials.gov NCT04358328. Registered on 4 February 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06883-9.
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Affiliation(s)
- Maria Normann
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Niklas Ekerstad
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Eva Angenete
- grid.8761.80000 0000 9919 9582Department of Surgery, SSORG – Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Prytz
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
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Leininger S, Davis Micco RN. The Future of Assessing Frailty in the Patient With Advanced Heart Failure: A Review of Current Literature. Crit Care Nurs Q 2022; 45:359-375. [PMID: 35980798 DOI: 10.1097/cnq.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frailty is becoming an important component of health care outcomes in patients with a diagnosis of heart failure. A literature search was completed to determine whether a best practice guideline existed to assess frailty in patients who were considering ventricular assist device placement. The literature search revealed that best practice guidelines did not exist. A second comprehensive literature search was completed specifically for frailty including the definition, criteria, assessment, and outcomes. The studies revealed that there were challenges with defining frailty, the age of frailty, assessments tools, and study designs. Cardiologists are primarily interested in screening for frailty, but other physician specialty practices are interested in a frailty screening tool as well. This article discusses the inconsistent research studies and the need for a valid and reliable tool to assess for frailty. It is important that nurse leaders and those working with heart failure patients determine the best practice guidelines for assessing frailty.
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Solsona Fernández S, Caverni Muñoz A, Labari Sanz G, Monterde Hernandez B, Martínez Marco MA, Mesa Lampré P. Preliminary Evidence on the Effectiveness of a Multidisciplinary Nutritional Support for Older People with Femur Fracture at an Orthogeriatric Unit in Spain. J Nutr Gerontol Geriatr 2022; 41:270-293. [PMID: 36503421 DOI: 10.1080/21551197.2022.2153959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To describe the nutritional and functional changes that occurred in older patients with a femur fracture following a dietary intervention and oral nutritional support implemented at an orthogeriatric unit in Aragon, Spain. Open-label, prospective study. Patients were consecutively recruited and arranged into three groups based on their CONtrolling NUTritional (CONUT®) score and nutritional needs. Nutritional status was assessed while in hospital, and at 45-, 100- and 180-days post-hospital discharge. One hundred and sixty-nine patients [mean age: 86 years (SD ± 5.48)] were recruited (July 2017 to January 2020). At admission, 53.3% were at risk of malnutrition; 26.6% were malnourished; 20.1% were well-nourished. Variable proportions of malnourished patients at admission were well-nourished 45-, 100-, and 180-days post-discharge. CONUT® and Barthel index correlations showed that as nutritional status enhanced, patients gained functionality. Dietary interventions and nutritional support may help restoring the nutritional and functional status of older patients with a femur fracture.
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Affiliation(s)
| | | | - G Labari Sanz
- Nursing Liaison Service, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - B Monterde Hernandez
- Dietetics and Clinical Nutrition Service, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - M A Martínez Marco
- Orthogeriatric Unit, Nursing Department, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - P Mesa Lampré
- Geriatric Department, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
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Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
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Campo-Rivera N, Ocampo-Chaparro JM, Carvajal-Ortiz R, Reyes-Ortiz CA. Sarcopenic Dysphagia Is Associated With Mortality in Institutionalized Older Adults. J Am Med Dir Assoc 2022; 23:1720.e11-1720.e17. [PMID: 35868351 DOI: 10.1016/j.jamda.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate mortality associated with sarcopenic dysphagia. DESIGN A 3-year follow-up cohort. SETTING AND PARTICIPANTS Ninety-five nursing home residents were evaluated to determine the baseline presence or absence of oropharyngeal dysphagia and followed up for 3 years. METHODS The primary outcome was the risk of death. Dysphagia was assessed using a volume-viscosity swallow test. We used an algorithm to determine sarcopenic dysphagia based on grip strength, walking speed, calf circumference, and exclusion of neurologic or structural causes of dysphagia. We constructed 3 subgroups: without dysphagia, nonsarcopenic dysphagia, and sarcopenic dysphagia. Cox proportional regression analyses were used to predict the risk of death. RESULTS Thirty-five percent of participants had no dysphagia, 20% nonsarcopenic dysphagia, and 45% sarcopenic dysphagia. Sarcopenic dysphagia was independently associated with a higher risk of death [hazard ratio (HR) 2.44, 95% CI 1.02-5.80, P = .043] than without dysphagia. In addition, a higher Charlson Comorbidity Index score was associated with a higher risk of death (HR 1.33, 95% CI 1.01-1.75, P = .040). CONCLUSIONS AND IMPLICATIONS This study shows that sarcopenic dysphagia was associated with increased mortality among institutionalized older adults. These deaths could be potentially preventable.
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Affiliation(s)
| | - Jose Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Programa de Geriatria, Universidad del Valle, Facultad de Salud, Cali, Colombia
| | | | - Carlos A Reyes-Ortiz
- Geriatrics, Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA.
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Moradell A, Fernández-García ÁI, Navarrete-Villanueva D, Pérez-Gómez J, Gesteiro E, Ara Royo I, Casajús JA, Gómez-Cabello A, Vicente-Rodríguez G. Does nutritional status influence the effects of a multicomponent exercise programme on body composition and physical fitness in older adults with limited physical function? Eur J Sport Sci 2022:1-10. [PMID: 35816744 DOI: 10.1080/17461391.2022.2092426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Physical exercise effects and ageing on fitness may be influenced by nutritional status. This study investigates the effects of a 6-month multicomponent exercise training (MCT) on nutritional status and evaluates if this type of exercise could affect differently body composition and physical fitness depending on the nutritional status of older adults with decreased functional capacity. Ninety-three participants (80.4 ± 6.0 y) were divided into control (n = 45) and intervention (n = 48) groups. The intervention consisted of a 6-month multicomponent training. Comparisons between changes in body composition and fitness during the 6-months were performed between individuals at risk of malnutrition and those well-nourished, according to the Mini Nutritional Assessment. Model mixed-effect analyses were used to investigate differences after the 6 months of MCT between groups. Well-nourished participants compared with those at risk of malnutrition had higher: arm (13.4 ± 3.5 vs 14.3 ± 33.6 repetitions) and leg strength (9.0 ± 3.0 vs 11.1 ± 3.3 repetitions), maximum walking speed (31.6 ± 13.1 vs 23.7 ± 6.3s), agility (11.9 ± 5.8 vs 8.3 ± 2.1s), and aerobic capacity (31.6 ± 13.1 vs 23.7 ± 6.3 m), at baseline. After the training, those without risk of malnutrition in CON decreased their nutritional status (-1.7 + 0.7 points). Those well-nourished that performed the intervention decreased total fat mass (-1.0 ± 0.3 kg) and body fat percentage (-1.2 ± 0.4%). Both groups of training improved similarly in all tests, except for balance, in which the well-nourished showed improvements of 6.3 ± 1.9s. These results underline the usefulness of MCT in improving physical fitness regardless of nutritional status and preventing nutritional status detriment in well-nourished older adults, who are fitter and benefit more, in terms of body composition.Trial registration: ClinicalTrials.gov identifier: NCT03831841.Highlights Multicomponent exercise programme seems to be effective in delaying detriments in the nutritional status of well-nourished people.Well-nourished older people obtain more benefits in body composition from the multicomponent exercise than those at risk of malnutrition, decreasing adiposity.The positive effect of multicomponent exercise was observed in physical fitness independently of nutritional status.
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Affiliation(s)
- Ana Moradell
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health and Sport Science FCSD, University of Zaragoza, Zaragoza, Spain
| | - Ángel I Fernández-García
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health and Sport Science FCSD, University of Zaragoza, Zaragoza, Spain
| | - David Navarrete-Villanueva
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health, University of Zaragoza, Zaragoza, Spain
| | - Jorge Pérez-Gómez
- Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,HEME Research Group, University of Extremadura, Cáceres, Spain
| | - Eva Gesteiro
- Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Polytechnic University of Madrid, Madrid, Spain
| | - Ignacio Ara Royo
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Biomedical Research Net in Physiopatology, Obesity and Nutricition (CIBERObn) Madrid, Spain
| | - Jose Antonio Casajús
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health, University of Zaragoza, Zaragoza, Spain.,Biomedical Research Net in Physiopatology, Obesity and Nutricition (CIBERObn) Madrid, Spain
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health and Sport Science FCSD, University of Zaragoza, Zaragoza, Spain.,Biomedical Research Net in Physiopatology, Obesity and Nutricition (CIBERObn) Madrid, Spain.,Defense University Center, Zaragoza, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain.,Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, Zaragoza, Spain.,Exercise and Health in Special Population Spanish Research Net (EXERNET), Spain.,Department of Physiatry and Nursing, Faculty of Health and Sport Science FCSD, University of Zaragoza, Zaragoza, Spain.,Biomedical Research Net in Physiopatology, Obesity and Nutricition (CIBERObn) Madrid, Spain
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Ozturk Y, Sarikaya D, Emin Kuyumcu M, Yesil Y, Koca M, Guner Oytun M, Unsal P, Balci C, Balam Dogu B, Cankurtaran M, Halil M. Comparison of Mini Nutritional Assessment-Short and Long Form to predict all-cause mortality up to 7 years in geriatric outpatients. Nutr Clin Pract 2022; 37:1418-1428. [PMID: 35678359 DOI: 10.1002/ncp.10878] [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: 02/25/2022] [Revised: 05/07/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We aimed to find out whether the Mini Nutritional Assessment-Short Form (MNA-SF) can predict mortality up to 7 years when compared with the Mini Nutritional Assessment-Long Form (MNA-LF) in geriatric outpatients. METHODS This retrospective study was conducted in patients (≥65 years) who were admitted to the geriatric outpatient clinic of a university hospital. MNA-SF and MNA-LF results were available for all patients. Patients were grouped as normal nutrition status (score 12-14), at risk of malnutrition (score between 8 and 11), or malnourished (score ≤7) according to MNA-SF. Based on MNA-LF, patients had normal nutrition status (score ≥24), were at risk of malnutrition (score 17-23.5), or were malnourished (score <17). Survival of the patients was assessed retrospectively. RESULTS The study included 209 patients (62.2% female). During the 7-year follow-up, 77 (36.8%) patients died. After adjusting for age, sex, and Charlson comorbidity index, MNA-SF was significantly associated with all-cause mortality during 6-month, 1-year, 3-year, 5-year, and 7-year follow-up time. MNA-LF was superior to MNA-SF to estimate 6-month (P = 0.004) and 1-year mortality (P = 0.031). There was no difference between MNA-SF and MNA-LF regarding 3-year, 5-year, and 7-year mortality. CONCLUSION MNA-SF can predict short-term and long-term mortality in geriatric outpatients as well as MNA-LF. A cut-off value of 11, indicating risk of malnutrition according to MNA-SF, may be used for the risk estimation of 1-year, 3-year, and 5-year mortality. Therefore, this study highlights the importance of screening all geriatric outpatients for malnutrition and especially the risk of malnutrition for early intervention and treatment.
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Affiliation(s)
- Yelda Ozturk
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Derya Sarikaya
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Emin Kuyumcu
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yusuf Yesil
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Koca
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Merve Guner Oytun
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pelin Unsal
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cafer Balci
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Dogu
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women. Aging Clin Exp Res 2022; 34:1407-1418. [PMID: 34984652 PMCID: PMC9151507 DOI: 10.1007/s40520-021-02046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. AIMS We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. METHODS A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. RESULTS At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16-2.84) and constipation (OR 1.48, 95% CI 1.02-2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31-4.14), impaired mobility (OR 2.08, 95% CI 1.05-4.15), and poor nutrition (OR 2.31, 95% CI 1.11-4.79) associated with DI. CONCLUSIONS This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.
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Ida M, Naito Y, Tanaka Y, Inoue S, Kawaguchi M. Factors associated with functional disability or mortality after elective noncardiac surgery: a prospective cohort study. Can J Anaesth 2022; 69:704-714. [PMID: 35396651 DOI: 10.1007/s12630-022-02247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Preoperative prediction of functional status after surgery is essential when practicing patient-centered medicine. We aimed to evaluate the incidence and factors associated with postoperative functional disability or all-cause mortality. Secondarily, we sought to describe the trajectory of disability in this population. METHODS Adults aged ≥ 55 yr who underwent elective noncardiac surgery under general anesthesia in a tertiary care hospital were followed up one year after surgery. Pre- and intraoperative factors associated with a composite outcome of postoperative functional disability or all-cause mortality were assessed using a multiple logistic regression. The sequential changes in the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score were described and stratified by surgical invasiveness. RESULTS Of the 2,921 patients included, 293 experienced postoperative functional disability (10.0%; 95% confidence interval [CI], 8.9 to 11.1) and 124 died (4.2%; 95% CI, 3.5 to 5.0). In a multiple regression model, the potentially modifiable risk factors, body mass index ≥ 30 kg·m-2 and poor preoperative nutritional status, were significantly associated with the primary composite outcome, as well as nonmodifiable factors such as age, preoperative comorbidities, and blood loss volume. Changes in the 12-item WHODAS 2.0 disability score varied between different levels of surgical invasiveness and types of surgery. CONCLUSION Within one year after surgery, one in ten patients experienced postoperative functional disability and one in 20 died. We identified potentially modifiable factors (obesity, poor nutritional status) associated with these adverse outcomes. STUDY REGISTRATION University Hospital Medical Information Network (UMIN000021671); registered 31 December 2015.
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Affiliation(s)
- Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yuu Tanaka
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoki Inoue
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Arshad S, Khan S, Karim A, Gupta VA. The burden of malnutrition & frailty in patients with coronary artery disease: An under-recognized problem. JRSM Cardiovasc Dis 2022; 11:20480040221102741. [PMID: 35651591 PMCID: PMC9149616 DOI: 10.1177/20480040221102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Elderly patients with coronary artery disease have a high prevalence of frailty
and malnutrition. Frailty syndrome is associated with poor outcomes in patients
with myocardial infarction. There is a known overlap between frailty and
malnutrition, yet these are two different entities. Fried Frailty Phenotype,
Frail Scale, timed up and go test, and gait speed are rapid screening tests that
may identify patients with frailty in everyday clinical setting. Short Form MNA
is a sensitive tool to screen for malnutrition. Despite the availability of
several tools for screening for both these conditions, the screening rates
remain low. We aim to create awareness about the impacts of frailty and
malnutrition, provide a brief overview of tools available and highlight the
importance of screening in this high-risk population.
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Affiliation(s)
- Samiullah Arshad
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
| | - Samina Khan
- Department of Medicine, Royal Alexandra Hospital, Alberta Health Services, Alberta, Canada
| | - Adham Karim
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
| | - Vedant A. Gupta
- Department of Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington Kentucky, USA
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The prevalence of undernutrition and associated factors in older obese patients. Aging Clin Exp Res 2022; 34:2023-2030. [PMID: 35575948 DOI: 10.1007/s40520-022-02143-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Both obesity and malnutrition are common health problems in older adults. AIM The aim of our study is to investigate the prevalence of undernutrition and related factors in older obese patients. METHODS 1911 older outpatients who underwent comprehensive geriatric assessment were included in this cross-sectional study. Body mass index (BMI) was categorized as follows: 'Underweight' = BMI < 18.5, 'Normal weight' = 18.5 ≤ BMI < 25, 'Overweight' 25 ≤ BMI < 30, and 'Obesity' ≥ BMI 30. Mini-Nutritional Assessment scores > 23.5, 17-23.5, or < 17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Those who were not well-nourished were considered undernutrition. RESULTS Of 1911 patients, with a mean age of 77.34 ± 8.0 years, 931 (48.7%) were obese. Of whom 6.0% were malnourished and 26.3% were at risk of malnutrition. Age, females, widowed and those living with their children, the number of drugs used, and the presence of heart failure, Parkinson's disease, and dementia, decreased calf circumference and muscle strength were higher in obese patients with undernutrition than obese well-nourished patients (p < 0.05). After adjustment for the aforementioned factors, basic and instrumental activities of daily livings, and Tinetti scores were lower, and falls and Geriatric Depression Scale-15 scores were higher in those with undernutrition compared to those with well-nourished among older obese patients (p < 0.05). CONCLUSIONS Half of the older patients were obese and undernutrition was observed in one out of every three older obese patients. Undernutrition was associated with decreased functional capacity, impairment in balance and gait functions, falls, and depressed mood. Therefore, we recommend to screen older obese patients for nutritional status.
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Zhang XM, Jiao J, Xu T, Wu XJ. The association between frailty of older stroke patients during hospitalization and one-year all-cause mortality: A multicenter survey in China. Int J Nurs Sci 2022; 9:162-168. [PMID: 35509704 PMCID: PMC9052266 DOI: 10.1016/j.ijnss.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/04/2022] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Frailty is a common geriatric syndrome defined as multiple deficits, impairing the capacity to figure out insult. Previous studies have reported a significant association between frailty and mortality in stroke patients. This study aimed to explore the association between frailty and mortality among older Chinese stroke patients. Methods This study was a secondary analysis of a multicenter prospective cohort study conducted in older Chinese inpatients from October 2018 to February 2020, and patients with a primary diagnosis of stroke including hemorrhage and ischemia, were included in our study. Frailty of older inpatients with stroke from six hospitals was measured by the FRAIL scale, and a one-year follow-up was performed by well-trained nurses of these hospitals via telephone. Multivariable logistic regression was used to detect the association between frailty and one-year mortality. Results A total of 530 stroke patients with an average age of 72.94 (SD = 5.79) years were included in the present study. There were 37 (7.0%) hemorrhagic strokes and 493 (93.0%) ischemic strokes, with 228 (43.0%) females in this population. The prevalence of frailty was 22.5%. In the logistic regression model with adjustment for age, sex, instrumental activities of daily living (IADL), basic activities of daily living (ADL), education, history of falls, BMI, smoking, alcohol consumption, low handgrip strength, type of stroke and polypharmacy, stroke patients with frailty had an increased risk of one-year mortality compared to those without frailty (OR = 3.38, 95% CI: 1.22–9.37, P = 0.019). Conclusion Our study indicated that frailty was an independent risk factor for one-year all-cause mortality among older stroke patients in China. Frailty may be an essential factor for clinicians to consider before making a comprehensive treatment, and corresponding mixed interventions, including exercise training and nutritional programs, need to be conducted among older stroke patients.
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Nasir K, Sultan S, Qureshi R, Dhrolia M, Ahmad A. Mini Nutritional Assessment (MNA) as a Reliable Tool for Nutritional Assessment of Hemodialysis Patients: A Single-Center Observation. Cureus 2022; 14:e21024. [PMID: 35154994 PMCID: PMC8820469 DOI: 10.7759/cureus.21024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
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Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study. Nutrients 2021; 13:nu13113817. [PMID: 34836073 PMCID: PMC8620899 DOI: 10.3390/nu13113817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Sarcopenic obesity is closely associated with knee osteoarthritis (KOA) and has high risk of total knee replacement (TKR). In addition, poor nutrition status may lead to sarcopenia and physical frailty in KOA and is negatively associated with surgery outcome after TKR. This study investigated the effects of sarcopenic obesity and its confounding factors on recovery in range of motion (ROM) after total knee replacement (TKR) in older adults with KOA. A total of 587 older adults, aged ≥60 years, who had a diagnosis of KOA and underwent TKR, were enrolled in this retrospective cohort study. Sarcopenia and obesity were defined based on cutoff values of appendicular mass index and body mass index for Asian people. Based on the sarcopenia and obesity definitions, patients were classified into three body-composition groups before TKR: sarcopenic-obese, obese, and non-obese. All patients were asked to attend postoperative outpatient follow-up admissions. Knee flexion ROM was measured before and after surgery. A ROM cutoff of 125 degrees was used to identify poor recovery post-surgery. Kaplan-Meier curve analysis was performed to measure the probability of poor ROM recovery among study groups. Cox multivariate regression models were established to calculate the hazard ratios (HRs) of postoperative poor ROM recovery, using potential confounding factors including age, sex, comorbidity, risk of malnutrition, preoperative ROM, and outpatient follow-up duration as covariates. Analyses results showed that patients in the obese and sarcopenic-obese groups had a higher probability of poor ROM recovery compared to the non-obese group (all p < 0.001). Among all body-composition groups, the sarcopenic-obese group yielded the highest risk of postoperative physical difficulty (adjusted HR = 1.63, p = 0.03), independent to the potential confounding factors. Sarcopenic obesity is likely at the high risk of poor ROM outcome following TKR in older individuals with KOA.
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Sella-Weiss O. Association between swallowing function, malnutrition and frailty in community dwelling older people. Clin Nutr ESPEN 2021; 45:476-485. [PMID: 34620358 DOI: 10.1016/j.clnesp.2021.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants. METHODS Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65-91 years, and 107 women aged 75.9 ± 8.0, 65-95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale - Short Form (GDS-SF). RESULTS 18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p < .05) and more time (p < .05) to eat a cracker and drink 150 mL of water (p < .05), and had reduced swallowing capacity (volume/sec) in the TWST (p < .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p < .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score. CONCLUSION A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.
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Affiliation(s)
- Oshrat Sella-Weiss
- Department of Communication Sciences and Disorders, University of Haifa, Israel; Department of Communication Disorders, Ono Academic Collage, Israel.
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Chen L, Wang W. Application effect of continuous nursing in patients with advanced esophageal cancer after esophageal stent implantation. Am J Transl Res 2021; 13:9743-9749. [PMID: 34540104 PMCID: PMC8430137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the advantages of continuous nursing for patients with advanced esophageal cancer after esophageal stent implantation. METHODS A total of 48 patients with advanced esophageal cancer who successfully received esophageal stent implantation in the Department of Oncology, at the First People's Hospital Affiliated with Shanghai Jiao Tong University were divided into the control group (24 cases, receiving routine discharge guidance) and the experimental group (24 cases, receiving continuous nursing through the issuance of a home nursing instruction handbook, dietary transition guidance after discharge, nutrition and food evaluation, and guidance on daily activities, medication, and prevention of complications, etc.). The quality of life (EORTCQLQ-C30), nutritional status (MNA score and the levels of hemoglobin (Hb), serum total protein (TP) and albumin (Alb)), anxious/depressive mental state (HAMA, HAMD), complications and satisfaction were compared between the two groups. RESULTS EORTCQLQ-C30, HAMA and HAMD scores of the two groups three months after discharge were lower than those before discharge, and those of the experimental group were lower than those of the control group (all P<0.05). The MNA score and the levels of Hb, TP and Alb in the experimental group three months after discharge had no significant changes compared with those before discharge (all P>0.05), while the MNA score and the levels of Hb, TP and Alb in the control group three months after discharge were lower than those before discharge and those in the experimental group (all P<0.05). The experimental group's nursing satisfaction was higher than that of the control group (P<0.05). CONCLUSION The application of continuous nursing in patients with advanced esophageal cancer after esophageal stent implantation can effectively improve the patients' adverse mental state, nutritional status and quality of life.
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Affiliation(s)
- Lijun Chen
- Department of Nursing, Wanbei Vocational College of HealthSuzhou, Anhui Province, China
| | - Weiyu Wang
- Department of Interventional Oncology, Shanghai General Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
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Sato R, Sawaya Y, Shiba T, Hirose T, Sato M, Ishizaka M. Malnutrition is associated with depression in Japanese older adults requiring long-term care or support. J Phys Ther Sci 2021; 33:585-590. [PMID: 34393368 PMCID: PMC8332641 DOI: 10.1589/jpts.33.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/13/2021] [Indexed: 01/22/2023] Open
Abstract
[Purpose] To characterize depression related to nutritional status in older adults
requiring long-term care. [Participants and Methods] One hundred and six individuals (66
males and 40 females) over the age of 65 who required support level 1/2 or care level 1
and were receiving day care through the long-term care insurance (LTCI) system, were
enrolled. The survey items included basic attributes, comorbidities, previous medical
history, requiring support/care under Japan’s LTCI system, the Mini Nutritional
Assessment–Short Form, the Geriatric Depression Scale 15 (GDS-15), and body mass index
(BMI). The factors associated with malnutrition/risk of malnutrition were evaluated. In
addition, the relationship between nutritional status and the GDS-15 items was evaluated.
[Results] Depression, LTCI, BMI, and gender were identified as related factors for
malnutrition/risk of malnutrition. Compared with the favorable nutritional status group,
the malnutrition/risk of malnutrition group reported GDS-15 items such as “Dropped
activities and interests”, “Feel that life is empty”, “In good spirits most of the time
(reversed)”, “Afraid of something bad”, “Prefer to stay at home”, and “Feel full of energy
(reversed)”. [Conclusion] The results show certain parameters characteristic of depression
in Japanese older adults with malnutrition requiring long-term care/support. These data
will help guide future research and interventions.
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Affiliation(s)
- Ryo Sato
- Division of Physical Therapy, Master Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Yohei Sawaya
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Japan
| | - Takahiro Shiba
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Japan
| | - Tamaki Hirose
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Japan
| | - Minami Sato
- Division of Physical Therapy, Master Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Masahiro Ishizaka
- Division of Physical Therapy, Master Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
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Zhang XM, Jiao J, Zhu C, Guo N, Liu Y, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu X, Xu T. Association Between Low Handgrip Strength and 90-Day Mortality Among Older Chinese Inpatients: A National Multicenter Prospective Cohort Study. Front Nutr 2021; 8:628628. [PMID: 34268327 PMCID: PMC8275644 DOI: 10.3389/fnut.2021.628628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The knowledge of the association between low handgrip strength and mortality among older Chinese inpatients is limited. Given China's aging society, a great number of older adults require hospital admission. Objective: To explore the association between low handgrip strength and 90-day mortality, providing evidence for clinicians to predict the risk of mortality and improve clinical outcomes for older inpatients. Materials and Methods: We conducted a national multicenter cohort study with a baseline survey from October 2018 to February 2019 and followed up for 90 days to record mortality outcomes. The assessment of handgrip strength was conducted using a hand dynamometer with the cutoff (handgrip strength < 28 kg for men and < 18 kg for women) to define low handgrip strength. Multivariable logistic regression analysis was applied to explore the association between low handgrip strength and 90-day mortality. Results: A total of 8,910 older Chinese inpatients [mean (SD) age, 72.39 (5.68) years; 3,750 women (42.09%)], with a prevalence of low handgrip strength, at 49.57%, were included. Compared to inpatients with normal handgrip strength, inpatients with low handgrip strength were older, had less education, more were female, had lower activities of daily living (ADL) score, had lower BMI, higher frailty, higher rates of depression, and poorer cognitive function (all p < 0.05). At 90 days, after adjusting for gender, age, education, frailty, depression, ADL score, malnutrition, and diagnosis, low handgrip strength was independently associated with 90-day mortality, compared to normal handgrip strength (OR = 1.64, 95% CI:1.14-2.37; P = 0.008). Additionally, subgroup and interaction analysis showed a significant interaction effect (P = 0.031) between two age groups (65-74 years older vs. ≥ 75 years old), with the OR being 3.19 (95%CI:2.07-4.93) and 1.49 (95%CI:0.87-2.55), respectively. Conclusion: Older Chinese inpatients with low handgrip strength had a 1.64-fold risk of 90-day mortality, compared to those with normal handgrip strength, indicating that clinicians need to screen early for handgrip strength and recommend corresponding interventions, such as resistance training and nutrition, as a priority for older inpatients. Clinical Trial Registration: Chinese Clinical Trial Registry, Identifier: ChiCTR1800017682.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Na Guo
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
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Lee YC, Chiu EC. Nutritional status as a predictor of comprehensive activities of daily living function and quality of life in patients with stroke. NeuroRehabilitation 2021; 48:337-343. [PMID: 33814468 DOI: 10.3233/nre-201540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nutritional status could affect functional capacity and reduce quality of life in patients with stroke. Although the associations between nutritional status, basic activities of daily living (BADL)/Instrumental ADL, and quality of life (QOL) in older people have been identified, the relationships have not yet been examined in patients with stroke, using the full Mini Nutritional Assessment (MNA) or MNA-short form (MNA-SF). OBJECTIVE This study aimed to examine the relationship between nutritional status (using full MNA and MNA-SF), comprehensive ADL function, and QOL in patients with stroke. METHODS Eighty-two patients with ischemic stroke participated in this cross-sectional design study. Each participant was assessed with the full MNA, MNA-SF, comprehensive ADL function (including Barthel Index and Frenchay Activities Index), and WHO Quality of Life Questionnaire (WHOQOL-BREF) once. RESULTS The MNA-SF was only significantly correlated with the comprehensive ADL function (rho = 0.27, p = 0.013), whereas, the full MNA was found to be significantly correlated with the comprehensive ADL function and WHOQOL-BREF (rho = 0.24, p = 0.029 and rho = 0.30, p = 0.005, respectively). The MNA-SF was a significant predictor of comprehensive ADL function, accounting for 44% of the variance. The full MNA was the only significant predictor of the WHOQOL-BREF, explaining 17% of the variance. CONCLUSIONS This study has revealed a relationship between nutritional status, comprehensive ADL function, and QOL among patients with stroke. Patients with stroke with better nutritional status had higher ADL function as well as better QOL. The MNA-SF was useful in predicting comprehensive ADL, whereas, the full MNA could be used to predict QOL. Knowledge and evidence of the association and predictive power of the MNA-SF and full MNA could guide clinicians to choose tools for assessing the nutritional status of patients with stroke more effectively.
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Affiliation(s)
- Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Malnutrition among the Elderly in Malaysia and Its Associated Factors: Findings from the National Health and Morbidity Survey 2018. J Nutr Metab 2021; 2021:6639935. [PMID: 33953978 PMCID: PMC8057910 DOI: 10.1155/2021/6639935] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 12/30/2022] Open
Abstract
Background Malaysia is predicted to become an ageing population by 2035. Malnutrition among the elderly is one of growing concern. This study aims to identify the prevalence of malnutrition and its associated factors among the elderly in Malaysia. Methods Data from the National Health and Morbidity Survey (NHMS) 2018 was analysed. This survey applied a multistage stratified cluster sampling design to ensure national representativeness. Malnutrition was identified using a validated Mini Nutrition Assessment-Short Form (MNA-SF). Variables on sociodemographic, health status, and dietary practices were also obtained. The complex sampling analysis was used to determine the prevalence and associated factors of at-risk or malnutrition among the elderly. Result A total of 3,977 elderly completed the MNA-SF. The prevalence of malnutrition and at-risk of malnutrition was 7.3% and 23.5%, respectively. Complex sample multiple logistic regression found that the elderly who lived in a rural area, with no formal or primary level of education, had depression, Instrumental Activity of Daily Living (IADL) dependency, and low quality of life (QoL), were underweight, and had food insecurity and inadequate plain water intake were at a significant risk of malnutrition (malnutrition and at-risk), while Chinese, Bumiputra Sarawak, and BMI more than 25 kgm-2 were found to be protective. Conclusions Currently, three out of ten elderly in Malaysia were at-risk or malnutrition. The elderly in a rural area, low education level, depression, IADL dependency, low QoL, underweight, food insecurity, and inadequate plain water intake were at risk of malnutrition in Malaysia. The multiagency approach is needed to tackle the issue of malnutrition among the elderly by considering all predictors identified from this study.
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Moradell A, Fernández-García ÁI, Navarrete-Villanueva D, Sagarra-Romero L, Gesteiro E, Pérez-Gómez J, Rodríguez-Gómez I, Ara I, Casajús JA, Vicente-Rodríguez G, Gómez-Cabello A. Functional Frailty, Dietary Intake, and Risk of Malnutrition. Are Nutrients Involved in Muscle Synthesis the Key for Frailty Prevention? Nutrients 2021; 13:nu13041231. [PMID: 33917848 PMCID: PMC8068284 DOI: 10.3390/nu13041231] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Frailty is a reversible condition, which is strongly related to physical function and nutritional status. Different scales are used to screened older adults and their risk of being frail, however, Short Physical Performance Battery (SPPB) may be more adequate than others to measure physical function in exercise interventions and has been less studied. Thus, the main aims of our study were: (1) to describe differences in nutritional intakes by SPPB groups (robust, pre-frail and frail); (2) to study the relationship between being at risk of malnourishment and frailty; and (3) to describe differences in nutrient intake between those at risk of malnourishment and those without risk in the no-frail individuals. One hundred one participants (80.4 ± 6.0 year old) were included in this cross-sectional study. A validated semi-quantitative food frequency questionnaire was used to determine food intake and Mini Nutritional Assessment to determine malnutrition. Results revealed differences for the intake of carbohydrates, n-3 fatty acids (n3), and saturated fatty acids for frail, pre-frail, and robust individuals and differences in vitamin D intake between frail and robust (all p < 0.05). Those at risk of malnutrition were approximately 8 times more likely to be frail than those with no risk. Significant differences in nutrient intake were found between those at risk of malnourishment and those without risk, specifically in: protein, PUFA n-3, retinol, ascorbic acid, niacin equivalents, folic acid, magnesium, and potassium, respectively. Moreover, differences in alcohol were also observed showing higher intake for those at risk of malnourishment (all p < 0.05). In conclusion, nutrients related to muscle metabolism showed to have different intakes across SPPB physical function groups. The intake of these specific nutrients related with risk of malnourishment need to be promoted in order to prevent frailty.
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Affiliation(s)
- Ana Moradell
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain
| | - Ángel Iván Fernández-García
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain
| | - David Navarrete-Villanueva
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Department of Physiatry and Nursing, Faculty of Health, University of Zaragoza, 50009 Zaragoza, Spain
| | - Lucía Sagarra-Romero
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, 50830 Zaragoza, Spain;
| | - Eva Gesteiro
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Polytechnic University of Madrid, 28040 Madrid, Spain
| | - Jorge Pérez-Gómez
- HEME (Health, Economy, Motricity and Education) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain;
| | - Irene Rodríguez-Gómez
- GENUD Toledo Research Group, University of Castilla-La Mancha, 45071 Toledo, Spain; (I.R.-G.); (I.A.)
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, University of Castilla-La Mancha, 45071 Toledo, Spain; (I.R.-G.); (I.A.)
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Jose A. Casajús
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Department of Physiatry and Nursing, Faculty of Health, University of Zaragoza, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 28029 Madrid, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 28029 Madrid, Spain
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.M.); (Á.I.F.-G.); (D.N.-V.); (J.A.C.); (G.V.-R.)
- Agrifood Research and Technology Centre of Aragón -IA2-, CITA-Universidad de Zaragoza, 50009 Zaragoza, Spain
- Exercise and Health in Special Population Spanish Research Net (EXERNET), 50009 Zaragoza, Spain;
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), 28029 Madrid, Spain
- Centro Universitario de la Defensa, 50090 Zaragoza, Spain
- Correspondence: ; Tel.: +34-876-553-756
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Kocyigit SE, Ates Bulut E, Aydin AE, Isik AT. Improvement of nutritional status enhances cognitive and physical functions in older adults with orthostatic hypotension. Nutrition 2021; 90:111261. [PMID: 33975062 DOI: 10.1016/j.nut.2021.111261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/23/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Malnutrition may be an important risk factor for orthostatic hypotension (OH). The aim of this study was to investigate the relationship between malnutrition and OH, and the effect of nutritional improvement on cognitive functions and gait-balance parameters in patients with OH. METHODS A total of 692 patients were included in the study. The Head-up Tilt Table Test and Mini Nutritional Assessment (MNA) were implemented for participants. Patients underwent a comprehensive geriatric assessment, including a neurocognitive evaluation and physical performance. After 6 mo, the participants who had OH were reevaluated. RESULTS Women comprised 64.8% of the patients and the mean age was 74.98 ± 7.68 y. The frequencies of OH, malnutrition, and risk of malnutrition were 31.9%, 7.4%, and 13.3%, respectively. The rates of dementia, hypertension, sarcopenia, frailty, and a history of falls in the past year were higher in the OH-positive group. OH was associated with malnutrition (odds ratio: 2.48; confidence interval, 1.35‒4.54; P = 0.003) and risk of malnutrition (odds ratio: 1.64; CI, 1.03‒2.62; P = 0.035) in contrast with normal nutritional status. A higher MNA score during the follow-up period resulted in improved cognitive and gait-balance scores when confounding factors were adjusted (P < 0.05). Patients with OH whose MNA score improved during the follow up also had a significant decrease in the number of falls (P = 0.034). CONCLUSIONS Optimization of nutritional status may improve global cognition and gait-balance functions, and prevent falls in older people with OH.
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Affiliation(s)
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali Ekrem Aydin
- Department of Geriatric Medicine, Sivas Numune State Hospital, Sivas, Turkey
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Zhang XM, Jiao J, Zhu C, Guo N, Liu Y, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu XJ, Xu T. Cognitive Frailty and 30-Day Mortality in a National Cohort of Older Chinese Inpatients. Clin Interv Aging 2021; 16:389-401. [PMID: 33692618 PMCID: PMC7939486 DOI: 10.2147/cia.s294106] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients. Patients and Methods A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality. Results Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80-6.55) for cognitive frailty, 1.85 (95% CI: 1.01-3.41) for frailty only, and 1.43 (95% CI: 0.77-2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621-0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594-0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556-0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender. Conclusion Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Na Guo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People's Republic of China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, People's Republic of China
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Seo AR, Kim MJ, Kim B, Seo YM, Lee GY, Park KS, Yoo JI. Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia. Yonsei Med J 2021; 62:249-254. [PMID: 33635015 PMCID: PMC7934103 DOI: 10.3349/ymj.2021.62.3.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression. MATERIALS AND METHODS This research used baseline data from the Namgaram-2 study. Frailty was evaluated using the Kaigo-Yobo checklist in an older Korean population. The nutritional statuses of older people were measured using the Korean version of the mini nutritional assessment (MNA). The recent criteria of the Asian Working Group for Sarcopenia were applied for diagnosis of sarcopenia, and depression was assessed using the Geriatric Depression Scale-Short Form. RESULTS The prevalence of frailty was 18.8% (male: 9.6%; female: 23.4%) and was significantly higher in individuals in their 80s [male, 35.3% (p<0.001); female, 42.3% (p<0.001)], those of poor economic status [male, 18.2% (p=0.012); female, 34.9% (p<0.001)], those with hypertension [female, 27.7% (p=0.008)], those with sarcopenia [male, 34.1% (p<0.001); female, 37.2% (p<0.001)], those with depression [male, 46.4% (p<0.001); female, 51.7% (p<0.001)], and those at high risk of malnutrition [male, 44.4% (p<0.001); female, 51.7% (p<0.001)]. After adjusting for demographic variables, including hypertension, diabetes, sarcopenia and depression, frailty was significantly associated with nutritional status [male: odds ratio (OR)=6.73, 95% confidence interval (CI), 1.84-24.65; female: OR=4.83, 95% CI, 2.88-8.11]. CONCLUSION For older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.
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Affiliation(s)
- Ae Rim Seo
- Department of Preventive Medicine and Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
- Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Ji Kim
- Department of Preventive Medicine and Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Bokyoung Kim
- Department of Preventive Medicine and Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
- Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Mi Seo
- Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Korea
| | - Gyeong Ye Lee
- Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine and Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
- Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Korea
- Department of Bio & Medical Big Data, Gyeongsang National University, Jinju, Korea.
| | - Jun Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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Evaluation of pro-inflammatory cytokines in frail Tunisian older adults. PLoS One 2020; 15:e0242152. [PMID: 33166358 PMCID: PMC7652286 DOI: 10.1371/journal.pone.0242152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022] Open
Abstract
The present study was undertaken to evaluate serum levels of pro-inflammatory cytokines in Tunisian older adults and to examine the relationships between inflammatory marker levels, geriatric, and biochemical parameters. A cross-sectional study was conducted in a population of Tunisian older adults (N = 141, aged 65 and over). Patients were recruited from the Department of Internal Medicine, Fattouma Bourguiba University Hospital (Monastir, Tunisia) and from a nursing home (Sousse, Tunisia). Comprehensive geriatric assessment, history taking and examination including functional and nutritional assessment were done for each participant. Enzyme-linked immunosorbent assay (ELISA) test was used to measure serum cytokine (TNF-α, IL-8, IL-6) levels. The modified Short Emergency Geriatric Assessment score (SEGAm) were used to classify patients as 51 very-frail, 40 frail, and 50 non-frail. The age of the participants (80 men, 61 women) ranged from 65 to 97 years. Serum levels of TNF-α, IL-8 and C-reactive protein (CRP) were significantly higher in very-frail participants compared to frail and non-frail ones. However, no significant differences in IL-6 levels were detected among frailty groups. After adjustment for age, CRP and IL-8 levels remained significantly associated with frailty. Analysis of the receiver operating characteristic (ROC) curve corresponding to IL-8 showed an area under the curve of 0.7 (p = 0.003; 95% CI [0.58-0.81]) and a predictive threshold of 5.27 pg/ml. Positive correlations were found between frailty score, IL-6, and IL-8 levels. In addition, a significant positive correlation was observed between IL-8 levels and Timed Up and Go test results. However, a negative correlation was observed between Mini Nutritional Assessment Short-Form score, IL-6 and CRP levels, as well as between Activities of Daily Living score and serum levels of TNF-α, IL-6, and CRP. In conclusion, the key findings of this study collectively support a role of pro-inflammatory cytokines, TNF-α, CRP, and especially IL-8 in the development of frailty in older adults.
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Hironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, Kera T, Kojima M, Fujiwara Y, Ihara K, Kim H, Obuchi S, Kakinoki Y. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr 2020; 89:104105. [PMID: 32480111 DOI: 10.1016/j.archger.2020.104105] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty. METHODS Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty. RESULTS Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF. CONCLUSIONS These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.
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Affiliation(s)
- Sanae Hironaka
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan; Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshihiro Kugimiya
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan.
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Oral Surgery and Dentistry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hisashi Kawai
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeshi Kera
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan
| | - Motonaga Kojima
- Department of Physical Therapy, University of Tokyo Health Sciences, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Obuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yasuaki Kakinoki
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan
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Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study. Nutrients 2020; 12:nu12041041. [PMID: 32290060 PMCID: PMC7231056 DOI: 10.3390/nu12041041] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aims to assess the relationship that frailty has with nutritional status and functional risk factors in community-dwelling older adults. METHODS Cross-sectional study in community-dwelling older people, independent for walking and without impaired cognition. Frailty was assessed by Fried criteria. Nutritional status was analyzed by the Mini Nutritional Assessment Short Form (MNA-SF), biochemical markers (albumin, total proteins, cholesterol, lymphocytes, and hemoglobin); and anthropometric parameters (body mass index [BMI], body fat percentage, handgrip, and perimeters). A comprehensive geriatric assessment analyzed other risk factors: functionality, cognition, falls, comorbidity, polypharmacy, physical activity, and quality of life (QoL). RESULTS We included 564 elderly people with a mean age of 76.05 (standard deviation 3.97) years; 63.1% (n = 356) were women, and 83.9% (n = 473) were prefrail, and frail. The sample presented high functionality and a nutritional status with a predominance of overweight and obesity. Factors associated with frailty (R2 = 0.43) were age over 75 years (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.76, 6.21; p < 0.001), female gender (OR 2.37, 95% CI 1.24, 4.52; p = 0.009), anemia (OR 2.45, 95% CI 1.19, 5.02; p = 0.015), falls (OR 1.94, 95% CI 1.12, 3.25; p = 0.016) and the fear of falling (OR 4.01: 95% CI 1.76, 9.16; p = 0.001). Performing more than 3 weekly hours of physical activity was found to be a protective factor (OR 0.23, 95% CI 0.15, 0.35; p < 0.001). CONCLUSIONS The relationship between frailty and malnutrition in functionally independent community-dwelling older people is unclear. More studies are needed to know what nutritional markers are related to frailty, cognition, and functionality in order to discriminate the risk factors for community-dwelling older people at risk of malnutrition and dependency.
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50
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Soysal P, Isik AT. Comment on "nutritional status and all-cause mortality in older adults with acute coronary syndrome". Clin Nutr 2019; 38:2958-2959. [PMID: 31542244 DOI: 10.1016/j.clnu.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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