The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly

Abstract

Background: Sarcopenia, frailty, malnutrition, and cachexia are overlapping conditions in hospitalized older adults; they are characterized by altered body composition and are associated with poor outcomes. Aim: to quantify the effect of this overlap on other geriatric giants e.g., delirium, cognitive impairment, and functional disability in hospitalized older adults. Methods: A cross sectional observational study involving 206 hospitalized older adults was conducted. Each patient was assessed using Arabic validated versions of mini mental state examination, geriatric depression scale-15, the mini nutritional assessment, activities of daily living and instrumental activities of daily living. Furthermore, Johns Hopkins fall risk assessment tool, bioelectrical impedance analysis, handgrip strength, and timed up and go test were performed. Comorbidities were measured using the age adjusted Charlson Comorbidity Index. Results: 21.4% of the participants had only one syndrome, 13.1%, 14.1%, and 3.4% had two, three, and four coexisting syndromes, respectively. In the adjusted model for age, gender, and comorbidities, the combined effect of overlapping syndromes was significantly higher than the isolated presence of a single syndrome on the risk of delirium, cognitive impairment, community acquired infections, severe functional disability, high risk of falls, and pressure ulcers. Conclusions: The overlap between frailty, sarcopenia, malnutrition, and cachexia, increases the risk of many other geriatric giants. The application of the comprehensive geriatric assessment at hospital admission would help clinicians identify this overlap. Moreover, the existing screening protocols for older adults should include these four conditions.