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Bernet NS, Everink IHJ, Hahn S, Müller M, Schols JMGA. Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study. BMJ Open 2024; 14:e082417. [PMID: 38754884 PMCID: PMC11097859 DOI: 10.1136/bmjopen-2023-082417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES This study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors. DESIGN A secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019. SETTING All Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included. PARTICIPANTS All inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included. OUTCOME MEASURE Whether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days? RESULTS Based on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level. CONCLUSIONS A significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.
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Affiliation(s)
- Niklaus S Bernet
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Sabine Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Marianne Müller
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
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Qing H, Zhang XD, Yang E, Li HX, Wei YL, Chen W, Guo SY, Tang SF. Nutritional status and nutritional intervention of older inpatients in China. J Nutr Health Aging 2024; 28:100169. [PMID: 38308922 DOI: 10.1016/j.jnha.2024.100169] [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: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Malnutrition is a critical issue among older inpatients, yet limited large-scale research related to this issue has been conducted in China. This study aimed to examine the nutritional status and support of older inpatients in China, assess the associations between disease categories and malnutrition on admission, and explore effective nutritional intervention. METHODS A total of 24,139 older participants from the China Nutrition Fundamental Data 2020 Project were included. Malnutrition was measured by the Global Leadership Initiative on Malnutrition criteria. Adjusted odds ratios (aORs) were calculated using logistic analysis. RESULTS The overall frequency of malnutrition on admission was 18.9%. Participants with infections were more likely to have malnutrition (aOR = 1.929, 95% CI 1.486-2.504). Risks that were also noted for malnutrition included neoplasms (aOR = 1.822, 95% CI 1.697-1.957), hemic and lymphatic diseases (aOR = 1.671, 95% CI 1.361-2.051), nervous system diseases (aOR = 1.222, 95% CI 1.126-1.326), respiratory diseases (aOR = 1.613, 95% CI 1.490-1.746), and digestive system diseases (aOR = 1.462, 95% CI 1.357-1.577). Further, 32.26% inpatients with malnutrition during hospitalization didn't receive nutritional support. Oral nutrition supplements, enteral tube feeding, and parenteral nutrition were associated with stable or improved nutritional status. CONCLUSIONS Older inpatients were at a high risk for malnutrition but did not receive adequate nutritional intervention. More resources and attention need to be devoted to the nutritional status of older inpatients and targeted nutritional support.
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Affiliation(s)
- Hua Qing
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xu-Dong Zhang
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China
| | - En Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui-Xin Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi-Lin Wei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yan Guo
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China.
| | - Shang-Feng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Tago M, Hirata R, Katsuki NE, Nakatani E, Tokushima M, Nishi T, Shimada H, Yaita S, Saito C, Amari K, Kurogi K, Oda Y, Shikino K, Ono M, Yoshimura M, Yamashita S, Tokushima Y, Aihara H, Fujiwara M, Yamashita SI. Validation and Improvement of the Saga Fall Risk Model: A Multicenter Retrospective Observational Study. Clin Interv Aging 2024; 19:175-188. [PMID: 38348445 PMCID: PMC10859763 DOI: 10.2147/cia.s441235] [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: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose We conducted a pilot study in an acute care hospital and developed the Saga Fall Risk Model 2 (SFRM2), a fall prediction model comprising eight items: Bedriddenness rank, age, sex, emergency admission, admission to the neurosurgery department, history of falls, independence of eating, and use of hypnotics. The external validation results from the two hospitals showed that the area under the curve (AUC) of SFRM2 may be lower in other facilities. This study aimed to validate the accuracy of SFRM2 using data from eight hospitals, including chronic care hospitals, and adjust the coefficients to improve the accuracy of SFRM2 and validate it. Patients and Methods This study included all patients aged ≥20 years admitted to eight hospitals, including chronic care, acute care, and tertiary hospitals, from April 1, 2018, to March 31, 2021. In-hospital falls were used as the outcome, and the AUC and shrinkage coefficient of SFRM2 were calculated. Additionally, SFRM2.1, which was modified from the coefficients of SFRM2 using logistic regression with the eight items comprising SFRM2, was developed using two-thirds of the data randomly selected from the entire population, and its accuracy was validated using the remaining one-third portion of the data. Results Of the 124,521 inpatients analyzed, 2,986 (2.4%) experienced falls during hospitalization. The median age of all inpatients was 71 years, and 53.2% were men. The AUC of SFRM2 was 0.687 (95% confidence interval [CI]:0.678-0.697), and the shrinkage coefficient was 0.996. SFRM2.1 was created using 81,790 patients, and its accuracy was validated using the remaining 42,731 patients. The AUC of SFRM2.1 was 0.745 (95% CI: 0.731-0.758). Conclusion SFRM2 showed good accuracy in predicting falls even on validating in diverse populations with significantly different backgrounds. Furthermore, the accuracy can be improved by adjusting the coefficients while keeping the model's parameters fixed.
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Affiliation(s)
- Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Tomoyo Nishi
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hitomi Shimada
- Shimada Hospital of Medical Corporation Chouseikai, Saga, Japan
| | - Shizuka Yaita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Kaori Amari
- Department of Emergency Medicine, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kazuya Kurogi
- Department of General Medicine, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yoshimasa Oda
- Department of General Medicine, Yuai-Kai Foundation and Oda Hospital, Saga, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Maiko Ono
- Department of General Medicine, Karatsu Municipal Hospital, Saga, Japan
| | - Mariko Yoshimura
- Safety Management Section, Saga University Hospital, Saga, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, Japan
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López-Gómez JJ, Bachiller BR, de Luis Roman D. Management of disease-related malnutrition: a real-world experience with a novel concentrated high-protein energy-dense oral nutritional supplement. Postgrad Med 2024; 136:52-59. [PMID: 38251982 DOI: 10.1080/00325481.2024.2307869] [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: 11/23/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Despite the availability of a wide range of oral nutritional supplements (ONS) offerings, individuals with malnutrition are still struggling to meet their nutritional targets. A new concentrated and high-protein energy-dense ONS (≥2.1 kcal/mL;32 g protein/200 mL) with high-quality protein (60% whey protein) has emerged as a pivotal formula to reach the patient's energy-protein requirements, enhance compliance, and maximize stimulation of muscle protein synthesis, key factors driving better nutritional, functional, and clinical outcomes. The purpose of this article is to provide our clinical experience using this new nutritionally concentrated ONS as a therapeutic strategy for patients with DRM. METHODS Three clinical cases have been examined using new assessment procedures and a new form of nutritional therapy, and their impact on the nutritional and functional outcomes in patients with moderate-to-severe DRM. RESULTS A tailored individualized nutritional interventions improved anthropometric, biochemical, and functional outcomes (Case 1,2, and 3) assessed using hand grip strength, bioimpedance and muscle ultrasound, and as well as good gastrointestinal tolerance (Case 1) and compliance to the ONS in patients with DRM (Case 1,2,3). CONCLUSION The use of this novel high-protein energy-dense formula with high-quality protein source (≥2.1 kcal/mL; 32 g protein/200 mL; 60% whey protein) overcome common practical challenges in the medical nutrition therapy of patients with DRM, either because these patients require a highly concentrated formulation to meet nutritional requirements due to loss of appetite, lack of interest in food, and high caloric-protein needs due to disease, and a large quantity and quality of protein to optimize muscle recovery due to sarcopenia, common in patients with moderate-severe malnutrition.
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Affiliation(s)
- Juan J López-Gómez
- Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Servicio Endocrinología y Nutrición Hospital Clínico Universitario, Valladolid, Spain
| | - Beatriz Ramos Bachiller
- Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Servicio Endocrinología y Nutrición Hospital Clínico Universitario, Valladolid, Spain
| | - Daniel de Luis Roman
- Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Servicio Endocrinología y Nutrición Hospital Clínico Universitario, Valladolid, Spain
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Lee SW, Werner B, Holt J, Lohia A, Ayutyanont N, York H. Clinical characteristics, hospital course, and disposition of patients with nontraumatic spinal cord injury in a large private health care system in the United States. J Spinal Cord Med 2023; 46:900-909. [PMID: 35532310 PMCID: PMC10653757 DOI: 10.1080/10790268.2022.2069533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, hospital courses, outcomes after hospitalization, and factors associated with outcomes in patients with nontraumatic spinal cord injuries (NTSCI). DESIGN Retrospective analysis. SETTING A large for-profit United States health care system. PARTICIPANTS 2807 inpatients with NTSCI between 2014 and 2020 were identified using International Classification of Disease codes. MAIN OUTCOME MEASURE Demographic, clinical characteristics, hospital course, and disposition data collected from electronic health record. RESULTS The mean age was 57.91 ± 16.41 years with 69.83% being male. Incomplete cervical level injury was the most common injury type, spinal stenosis was the most common diagnostic etiology and central cord syndrome was the most common clinical syndrome. The average length of stay was 9.52 ± 15.8 days, with the subgroup of 1308 (46.6%) patients who were discharged home demonstrating a shorter length of stay (6.42 ± 10.24 days). Falls were the most common hospital-acquired complication (n = 424, 15.11%) and 83 patients deceased. There were increased odds of non-home discharge among patients with the following characteristics: older age, Medicare insurance, non-black racial minority, increased Charlson Comorbidity Index (CCI), intensive care unit (ICU) stay, use of steroid or anticoagulant medications, and hospital-acquired pulmonary complications. Increased in-hospital mortality was observed in those with Medicaid insurance, ICU stay, increased CCI, diagnosis of degenerative spine disease, other unspecified level of injury, and hospital-acquired pulmonary complications. CONCLUSIONS NTSCI in this sample were predominantly incomplete cervical central SCIs. Increased CCI, ICU stay, and hospital-acquired pulmonary complications were associated with poorer outcomes after acute care hospitalization among patients with NTSCI.
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Affiliation(s)
- Se Won Lee
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Bryan Werner
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Jonathan Holt
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Akash Lohia
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Napatkamon Ayutyanont
- Clinical Research Department, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Henry York
- Department of Physical Medicine and Rehabilitation, VA San Diego Healthcare System, San Diego, California, USA
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Kang MG, Ji S, Park YK, Baek JY, Kwon YH, Seo YM, Lee SH, Lee E, Jang IY, Jung HW. The Clinical Frailty Scale as a Risk Assessment Tool for Dysphagia in Older Inpatients: A Cross-Sectional Study. Ann Geriatr Med Res 2023; 27:204-211. [PMID: 37429593 PMCID: PMC10556717 DOI: 10.4235/agmr.23.0053] [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: 04/17/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Dysphagia is a common problem with potentially serious consequences including malnutrition, dehydration, pneumonia, and death. However, there are challenges in screening for dysphagia in older adults. We assessed the feasibility of using the Clinical Frailty Scale (CFS) as a risk assessment tool for dysphagia. METHODS This cross-sectional study was conducted at a tertiary teaching hospital from November 2021 to May 2022 and included 131 older patients (age ≥65 years) admitted to acute wards. We used the Eating Assessment Tool-10 (EAT-10), which is a simple measure for identifying individuals at risk of dysphagia, to assess the relationship between EAT-10 score and frailty status as measured using the CFS. RESULTS The mean age of the participants was 74.3±6.7 years, and 44.3% were male. Twenty-nine (22.1%) participants had an EAT-10 score ≥3. The CFS was significantly associated with an EAT-10 score ≥3 after adjusting for age and sex (odds ratio=1.48; 95% confidence interval [CI], 1.09-2.02). The CFS was able to classify the presence of an EAT-10 score ≥3 (area under the receiver operating characteristic [ROC] curve=0.650; 95% CI, 0. 544-0.756). The cutoff point for predicting an EAT-10 score ≥3 was a CFS of 5 according to the highest Youden index, with a sensitivity of 82.8% and a specificity of 46.1%. The positive and negative predictive values were 30.4% and 90.4%, respectively. CONCLUSION The CFS can be used as a tool to screen for the risk of swallowing difficulty in older inpatients to determine clinical management encompassing drug administration routes, nutritional support, prevention of dehydration, and further evaluation of dysphagia.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Sunghwan Ji
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ki Park
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Yeon mi Seo
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Siegwart J, Spennato U, Lerjen N, Mueller B, Schuetz P, Koch D, Struja T. Prediction of In-Hospital Falls Using NRS, PACD Score and FallRS: A Retrospective Cohort Study. Geriatrics (Basel) 2023; 8:60. [PMID: 37367092 DOI: 10.3390/geriatrics8030060] [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: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Harmful in-hospital falls with subsequent injuries often cause longer stays and subsequently higher costs. Early identification of fall risk may help in establishing preventive strategies. OBJECTIVE To assess the predictive ability of different clinical scores including the Post-acute care discharge (PACD) score and nutritional risk screening score (NRS), and to develop a new fall risk score (FallRS). METHODS A retrospective cohort study of medical in-patients of a Swiss tertiary care hospital from January 2016 to March 2022. We tested the ability of the PACD score, NRS and FallRS to predict a fall by using the area under curve (AUC). Adult patients with a length of stay of ≥ 2 days were eligible. RESULTS We included 19,270 admissions (43% females; median age, 71) of which 528 admissions (2.74%) had at least one fall during the hospital stay. The AUC varied between 0.61 (95% confidence interval (CI), 0.55-0.66) for the NRS and 0.69 (95% CI, 0.64-0.75) for the PACD score. The combined FallRS score had a slightly better AUC of 0.70 (95% CI, 0.65-0.75) but was more laborious to compute than the two other scores. At a cutoff of 13 points, the FallRS had a specificity of 77% and a sensitivity of 49% in predicting falls. CONCLUSIONS We found that the scores focusing on different aspects of clinical care predicted the risk of falls with fair accuracy. A reliable score with which to predict falls could help in establishing preventive strategies for reducing in-hospital falls. Whether or not the scores presented have better predictive ability than more specific fall scores do will need to be validated in a prospective study.
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Affiliation(s)
- Jennifer Siegwart
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Umberto Spennato
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Nathalie Lerjen
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Beat Mueller
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Daniel Koch
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Tristan Struja
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Kato R, Miyamoto Y, Ouchi M, Ogawa K, Yoshida N, Baba H. The Geriatric Nutritional Risk Index is a prognostic marker in patients with metastatic colorectal cancer. Int J Clin Oncol 2023:10.1007/s10147-023-02338-6. [PMID: 37072628 DOI: 10.1007/s10147-023-02338-6] [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: 11/13/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The Geriatric Nutritional Risk Index (GNRI) is a nutritional index for elderly patients that is associated with prognosis in cancer patients. We investigated using the GNRI in patients with metastatic colorectal cancer to predict prognosis. METHODS This study included 419 metastatic colorectal cancer patients who received first-line chemotherapy between February 2005 and December 2020. First, we calculated pre-treatment GNRI and divided the patients into four groups according to the values (G1-G4). We evaluated patient characteristics and overall survival in the four groups. RESULTS Overall, 419 patients were included. The median follow-up was 34.4 months. Lower GNRI was positively associated with a lower grade Eastern Cooperative Oncology Group Performance Status (p = 0.009), synchronous metastases (p < 0.001), primary tumor resection prior to chemotherapy (p = 0.006), and did not undergo resection after chemotherapy (p < 0.001). Patients with low GNRI had significantly shorter overall survival than the group with high GNRI (median OS: G1 = 19.3 months [M], G2 = 30.8 M, G3 = 38 M, G4 = 39.7 M; log-rank test, p < 0.001). Multivariate Cox regression analysis showed that GNRI was an independent prognostic factor (G3: HR = 0.49, 95% CI = 0.35-0.69; G4: HR = 0.67, 95% CI = 0.48-0.93). In the subgroup analysis of overall survival, we found no interaction between clinicopathological factors and the prognostic value of GNRI. Interestingly, younger patients (< 70 years) but not older patients showed a significant difference in overall survival according to GNRI, despite being the metric being designed for elderly patients. CONCLUSION Pretreatment GNRI can be a prognostic marker for patients with mCRC who received systemic chemotherapy.
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Affiliation(s)
- Rikako Kato
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Mayuko Ouchi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Hiraike T, Momoki C, Habu D. Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study. BMC Geriatr 2023; 23:35. [PMID: 36670357 PMCID: PMC9854135 DOI: 10.1186/s12877-023-03740-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The global leadership initiative on malnutrition (GLIM) proposed the first international standards (GLIM criteria) for malnutrition diagnosis. Early screening using nutritional tools is recommended to improve the prognosis of older patients. The association between Mini Nutritional Assessment-Short Form (MNAⓇ-SF) and Geriatric Nutritional Risk Index (GNRI) and prognosis has been reported, but there is insufficient evidence to develop the GLIM criteria for older inpatients. We aimed to evaluate the MNAⓇ-SF, GNRI, and GLIM criteria to determine their contribution to the prognosis prediction of hospitalized older patients at 1 year after discharge. METHODS This study included 386 patients hospitalized between September 2014 and October 2015, and May and December 2019. After excluding 17 patients who died at the time of initial hospitalization, 23 who were lost to follow-up after 1 year, and 28 who had missing data on admission, only 318 were included in the final analysis. The primary outcome was death within 1 year after discharge, assessed using the MNA®-SF, GNRI, and GLIM criteria, and survival analysis was conducted. Multivariate Cox proportional hazards analysis was performed to identify the nutritional assessment tools that contributed to the prognosis prediction. RESULTS A total of 43 patients died within 1 year. Of them, 58.1% had malnutrition and 37.2% were at risk of malnutrition, assessed using the MNAⓇ-SF; 27.9% had severely malnourished assessed using the GNRI; and 58.1% had severely malnourished assessed using the GLIM criteria. The proportions of malnourished and severely malnourished patients were significantly higher in the mortality group than in the survival group. Multivariate Cox proportional hazards analysis showed hazard ratios of 1.06 (95% confidence interval [CI]: 0.24-4.71) for at risk and 2.17 (95% CI: 0.48-9.84) for malnutrition (MNAⓇ-SF); 5.68 (95% CI: 2.74-11.80) for moderately malnourished and 7.69 (95% CI: 3.13-18.91) for severely malnourished (GNRI); and 1.47 (95% CI: 0.48-4.50) for moderately malnourished and 2.45 (95% CI: 1.22-4.93) for severely malnourished (GLIM criteria); GNRI had the most significant contribution to prognosis prediction. CONCLUSIONS GNRI significantly contributed to the prognosis prediction 1 year after hospital discharge of older patients.
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Affiliation(s)
- Taeko Hiraike
- grid.261445.00000 0001 1009 6411Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
| | - Chika Momoki
- Department of Food Science and Human Nutrition, Faculty of Agriculture, Setsunan University, 45-1, Nagaotoge-Cho, Hirakata-Shi, Osaka, 573-0101, Japan.
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
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Kang MG, Choi JY, Yoo HJ, Park SY, Kim Y, Kim JY, Kim SW, Kim CH, Kim KI. Impact of malnutrition evaluated by the mini nutritional assessment on the prognosis of acute hospitalized older adults. Front Nutr 2023; 9:1046985. [PMID: 36687683 PMCID: PMC9849807 DOI: 10.3389/fnut.2022.1046985] [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: 09/17/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Background Malnutrition is prevalent among hospitalized older patients. Therefore, this study aimed to investigate the association between nutritional status [assessed using the Mini Nutritional Assessment (MNA) and serum albumin levels] and adverse outcomes in hospitalized older patients. We also aimed to compare the predictive utility of our findings. Methods This retrospective cohort study was conducted between January 2016 and June 2020. In total, 808 older patients (aged ≥ 65 years, mean age 82.8 ± 6.70 years, 45.9% male) admitted to the acute geriatric unit were included in our sample. Comprehensive geriatric assessments, including the MNA, were performed. Malnutrition and risk of malnutrition were defined as MNA < 17, albumin < 3.5 g/dL and 17 ≤ MNA ≤ 24, 3.5 g/dL ≤ albumin < 3.9 g/dL, respectively. The primary outcome was that patients could not be discharged to their own homes. The secondary outcomes were overall all-cause mortality, 3-month all-cause mortality, and incidence of geriatric syndrome, including delirium, falls, and newly developed or worsening pressure sores during hospitalization. Results Poor nutritional status was associated with older age; female sex; admission from the emergency room; high risk of pressure sores and falls; lower physical and cognitive function; higher depressive score; and lower serum albumin, protein, cholesterol, and hemoglobin levels. In the fully adjusted model, malnutrition assessed using the MNA predicted discharge to nursing homes or long-term care hospitals [odds ratio (OR) 5.822, 95% confidence interval (CI): 2.092-16.199, P = 0.001], geriatric syndrome (OR 2.069, 95% CI: 1.007-4.249, P = 0.048), and 3-month mortality (OR 3.519, 95% CI: 1.254-9.872, P = 0.017). However, malnutrition assessed using albumin levels could only predict 3-month mortality (OR 3.848, 95% CI: 1.465-10.105, P = 0.006). The MNA predicted 3-month mortality with higher precision than serum albumin levels (P = 0.034) when comparing the areas under the receiver operating characteristic curve. Conclusion Nutritional risk measured by the MNA was an independent predictor of various negative outcomes in hospitalized older patients. Poor nutritional status assessed by serum albumin levels, the most widely used biochemical marker, could predict mortality, but not the development of geriatric syndrome or discharge location reflecting functional status.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyun-Jung Yoo
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Si-Young Park
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yoonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji Yoon Kim
- Department of Nutrition Care Service, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sun-wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea,*Correspondence: Kwang-il Kim,
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Kawase F, Masaki Y, Ozawa H, Imanaka M, Sugiyama A, Wada H, Goto R, Kobayashi S, Tsukahara T. Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements. Nutrients 2022; 14:nu14245210. [PMID: 36558367 PMCID: PMC9784286 DOI: 10.3390/nu14245210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70−89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.
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Affiliation(s)
- Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, 57, Iwasaki-cho, Nisshin 470-0196, Aichi, Japan
- Correspondence:
| | - Yoshiyuki Masaki
- Department of Internal Medicine, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
- Department of Community-Based Medical Education, Graduate School of Medical Sciences, Nagoya City University, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Hiroko Ozawa
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Manami Imanaka
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Aoi Sugiyama
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Hironari Wada
- Department of Rehabilitation Therapy, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Ryokichi Goto
- Department of Rehabilitation Therapy, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Shinya Kobayashi
- Department of Internal Medicine, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Takayoshi Tsukahara
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, 57, Iwasaki-cho, Nisshin 470-0196, Aichi, Japan
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12
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Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health 2022; 10:902599. [PMID: 36324472 PMCID: PMC9618649 DOI: 10.3389/fpubh.2022.902599] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/20/2022] [Indexed: 01/22/2023] Open
Abstract
Aim This study aims to clarify the risk factors for falls to prevent severe consequences in older adults. Methods We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared. Results We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls. Conclusion Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.
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Affiliation(s)
| | | | - Jinfeng Li
- Department of Geriatrics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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13
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Kupisz-Urbanska M, Marcinowska-Suchowierska E. Malnutrition in Older Adults—Effect on Falls and Fractures: A Narrative Review. Nutrients 2022; 14:nu14153123. [PMID: 35956299 PMCID: PMC9370498 DOI: 10.3390/nu14153123] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute to a higher prevalence of falls and osteoporotic fractures that lead to loss of independence and an increased rate of institutionalization. The role of malnutrition in the pathogenesis of other geriatric syndromes seems to be well established. However, the data concerning nutritional interventions are confounding. Moreover, long-term undernutrition seems to be one of the factors that strongly influences the efficacy of interventions. This review outlines the current literature on this topic, and aims to guide physicians to make proper decisions to prevent the vicious cycle of falls, fractures, and their negative outcomes in patients with malnutrition.
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Affiliation(s)
- Malgorzata Kupisz-Urbanska
- Department of Geriatrics, Centre of Postgraduate Medical Education, 02-673 Warsaw, Poland
- Correspondence:
| | - Ewa Marcinowska-Suchowierska
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 02-673 Warsaw, Poland;
- Department of Geriatrics and Gerontology, School of Public Health, Medical Centre of Postgraduate Education, 02-673 Warsaw, Poland
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14
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Bellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients 2022; 14:nu14040910. [PMID: 35215559 PMCID: PMC8880030 DOI: 10.3390/nu14040910] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
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15
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Ishida Y, Maeda K, Ueshima J, Shimizu A, Nonogaki T, Kato R, Matsuyama R, Yamanaka Y, Mori N. The SARC-F Score on Admission Predicts Falls during Hospitalization in Older Adults. J Nutr Health Aging 2021; 25:399-404. [PMID: 33575734 DOI: 10.1007/s12603-021-1597-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Community-dwelling older adults with sarcopenia are likely to fall. However, few studies have investigated whether sarcopenia is associated with falls during hospitalization in older adults. The purpose of this study was to determine whether the SARC-F when used as a simple screening tool for sarcopenia at the time of admission, predicts in-hospital falls. DESIGN A retrospective, observational study. SETTING A 900-bed university hospital. PARTICIPANTS A total of 9,927 patients aged 65 years and older were hospitalized at the hospital between April 2019 and March 2020. MEASUREMENTS The SARC-F contains five items: strength, assistance in walking, rise from a chair, climb stairs, and falls were evaluated at hospital admission. To investigate the relationship between the SARC-F score and falls, a ROC curve analysis was performed. Multivariate analysis adjusted for fall-related confounding factors such as age, gender, ADL, and disease were performed. RESULTS Mean age: 75.9±6.7 years; male: 56.2% were analyzed, and 159 patients (1.6%) fell during hospitalization. SARC-F scores at admission were significantly higher in the fall group than in the control group (3 [1-6] points vs. 0 [¬0-2] point, p<0.001). Statistical association was observed between the SARC-F and in-hospital fall (area under the curve = 0.721 [0.678-0.764], p < 0.001). The cut-off value for the highest sensitivity and specificity of the SARC-F score for in-hospital falls was two (sensitivity = 0.679, specificity = 0.715). Among the subitem of the SARC-F, the hazard ratios for climbing stairs were significantly higher (HR = 1.52 [1.10-2.09], p = 0.011) and for a history of fall was significantly higher (HR = 1.41 [1.02-1.95], p = 0.036). A SARC-F score ≥ 2 had a significantly higher incidence of in-hospital falls compared to a SARC-F score <2 (3.7% vs. 0.7%, p < 0.001). Also, a SARC-F score ≥ 2 had a significantly higher hazard ratio for falls (2.11 [1.37-3.26], p < 0.001). CONCLUSION SARC-F can help predict falls among hospitalized older adults.
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Affiliation(s)
- Y Ishida
- Keisuke Maeda, M.D., Ph.D., Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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16
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Ueshima J, Mori N. Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan. Geriatr Gerontol Int 2020; 20:811-816. [PMID: 33058420 DOI: 10.1111/ggi.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
AIM The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut-off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. METHODS This retrospective cross-sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut-off value of GNRI, and the results were compared against the Mini Nutritional Assessment - Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut-off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. RESULTS The mean age of the patients was 76.0 ± 7.0 years. The optimal cut-off value of GNRI for Mini Nutritional Assessment - Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817-0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776-0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut-off in the European Society of Clinical Nutrition and Metabolism-defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment - Short Form-based and MUST-based diagnosis, respectively. CONCLUSIONS The study showed GNRI <96 points as the optimal cut-off value for nutritional screening. GNRI might be one of the easy-to-use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811-816.
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Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Ryoko Kato
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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17
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Urquiza M, Fernandez N, Arrinda I, Sierra I, Irazusta J, Rodriguez Larrad A. Nutritional Status Is Associated with Function, Physical Performance and Falls in Older Adults Admitted to Geriatric Rehabilitation: A Retrospective Cohort Study. Nutrients 2020; 12:E2855. [PMID: 32961884 PMCID: PMC7550987 DOI: 10.3390/nu12092855] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Nutritional status is relevant to functional recovery in patients after an acute process requiring rehabilitation. Nevertheless, little is known about the impact of malnutrition on geriatric rehabilitation. This study aimed to determine the association between nutritional status at admission and the evolution of functional and physical outcomes, as well as the capability of nutritional status to identify fallers among patients admitted to geriatric rehabilitation for different reasons. This was a retrospective cohort study of 375 patients. Data collected included age, gender, diagnosis at admission, comorbidities, cognitive and nutritional status, functional and physical measurements, length of stay, mortality and falls. Orthogeriatric patients with worse nutritional status according to the Mini Nutritional Assessment-Short Form (MNA-SF) had a significantly lower Barthel Index at admission and discharge with worse functional gain and poorer outcomes in the Short Physical Performance Battery (SPPB). However, in hospital-deconditioned patients, the MNA-SF score was not significantly associated with functional and physical recovery. Poor nutritional status at admission increased the risk of experiencing at least one fall during rehabilitation in orthogeriatric patients. However, hospital-deconditioned patients who fell had better SPPB scores than those who did not fall. Our results demonstrate the importance of nutritional status in the clinical evolution of orthogeriatric patients throughout the rehabilitation process.
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Affiliation(s)
- Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (J.I.); (A.R.L.)
| | - Naiara Fernandez
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, 48011 Bilbao, Spain; (N.F.); (I.A.); (I.S.)
| | - Ismene Arrinda
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, 48011 Bilbao, Spain; (N.F.); (I.A.); (I.S.)
| | - Irati Sierra
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, 48011 Bilbao, Spain; (N.F.); (I.A.); (I.S.)
| | - Jon Irazusta
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (J.I.); (A.R.L.)
| | - Ana Rodriguez Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (J.I.); (A.R.L.)
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18
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Fukami Y, Saito T, Arikawa T, Osawa T, Komatsu S, Kaneko K, Ishida Y, Maeda K, Mori N, Sano T. European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy. World J Surg 2020; 45:243-251. [PMID: 32880680 DOI: 10.1007/s00268-020-05767-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, diagnostic criteria for malnutrition have been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the utility of the ESPEN malnutrition criteria as a predictor for major complications following hepatectomy and pancreatectomy. METHODS Data were reviewed from 176 consecutive patients who underwent hepatectomy (n = 103) or pancreatectomy (n = 73) between November 2017 and December 2019. Patients were divided into two groups according to the ESPEN malnutrition criteria using a prospectively collected database. The clinical data and the surgical outcomes of patients in the malnourished and normal groups were retrospectively analyzed. RESULTS Thirty-five (20%) patients were diagnosed with malnourishment according to ESPEN criteria. The malnourished group had a significantly low preoperative albumin concentration (p = 0.001). After hepatectomy, major complications (Clavien grade ≥ 3a) occurred significantly more frequently in the malnourished group than in the normal group (p = 0.013). Multivariate analysis indicated that operative duration ≥ 300 min (hazard ratio: 22.47, 95% CI: 2.17 to 232.73, p = 0.009) and malnourishment (hazard ratio: 14.56, 95% CI: 2.58 to 82.17, p = 0.002) were independently associated with major complications after hepatectomy. On the other hand, malnutrition was not associated with major complications after pancreatectomy. CONCLUSIONS The ESPEN malnutrition criteria are a valuable predictor for major complications following hepatectomy.
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Affiliation(s)
- Yasuyuki Fukami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
| | - Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Takashi Arikawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Takaaki Osawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keisuke Maeda
- Department of Nutrition, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoharu Mori
- Department of Nutrition, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
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