Mini Nutritional Assessment Scale Research Articles

The role of malnutrition and dependence on outside help in hospitalized elderly patients with decompensated heart failure

Abstract Introduction Despite recent achievement in the diagnosis and treatment of heart failure, the prognosis for disease remains unfavorable especially in elderly patients. It has been recently actively proposed to introduce a comprehensive geriatric assessment to determine the group of adverse outcome and frailty, however the assessment of geriatric syndromes in acute decompensated heart failure (ADHF) among hospitalized patients is poor. Aim To assess the prognostic role of malnutrition and dependence on outside help in hospitalized elderly patients with ADHF. Materials and methods The study included 60 patients over 75 years old who were hospitalized for ADHF. The median [IQR] age was 83.0 [77.0-87.0] years, 41.7% (n=25) were men. The preserved left ventricular ejection fraction (LVEF) prevailed – 51.2% (n=22), moderately reduced and low LVEF – 23.3% (n=10) and 25.6% (n=11), respectively. Total/severe dependence on outside help was determined with Barthel Index of ≤60 points, malnutrition – with a Mini Nutritional Assessment Scale of <17 points, sarcopenia with SARC-F ≥4 points. At discharge, all patients underwent bioimpedance analysis of body composition (BIA). The primary endpoint was hospital mortality. Results 48.3% (n=29) of hospitalized elderly patients with ADHF had total/severe dependence on outside help. This group of patients had a higher risk of malnutrition (OP 2.01, 95% CI 1.49-2.83, p=0.04) and sarcopenia (OP 8.25, 95% CI 1.55-44.02, p=0.01). Elderly patients with ADHF and malnutrition had a more severe functional class (NYHA III-IV) than patients without malnutrition (97.1% vs. 66.7%, respectively, p=0.02). There were no differences in ADHF phenotypes depending on the presence of malnutrition. The ability to self-serve according to Barthel Index has positively correlated with the BIA Index (r=0.483, p=0.04). The risk of sarcopenia on the SARC-F scale has negatively correlated with fat, lean and active cell mass according to BIA (r=-0.538, r=-0.599 and r=-0.532, respectively, p<0.05). Elderly patients with ADHF and a combination of total/severe dependence on outside help and malnutrition (27.9%, n=12) had higher inflammation level (neutrophil-lymphocytic index 5.6 [2.6-7.7] vs. 3.9 [2.0-6.0], p=0.03, respectively) and the need for longer intravenous diuretic therapy (OP 4.38, 95% CI 1.21-15.81, p=0.03) compared with patients without these disorders (72.1%, n=31), The primary endpoint was reached by 4 patients, in 100% of cases there was a combination of total/severe dependence on outside help and malnutrition. Conclusion The combination of total/severe dependence on outside help and malnutrition is an unfavorable prognostic marker of hospital mortality in hospitalized elderly patients with ADHF. A comprehensive geriatric assessment and determination of body composition can identify a risk group for an adverse outcome.

Trajectories of perioperative nutritional status in patients with pancreatic tumor after surgery in six months

PurposeTo characterize subgroups with similar nutritional status trajectories during the 6-month period after pancreatectomy and to identify demographic and clinical characteristics influencing changes in nutritional status in each subgroup. MethodsThis longitudinal prospective study recruited 112 patients with newly diagnosed pancreatic tumor from an outpatient pancreatic surgical department of a medical center in northern Taiwan between September 2016 and April 2019. Patients completed a demographic and clinical characteristics form, the Mini Nutritional Assessment scale, and the Symptom Severity Scale prior to surgery (T0), 3 months after surgery (T1), and 6 months after surgery (T2). Latent class growth analysis was used to investigate the trajectories of nutritional status. Generalized estimating equations were used to identify significant factors influencing each trajectory. ResultsTwo latent groups of nutritional status trajectories were identified. Among 112 patients, 74.11% and 25.89% were classified as having high and low nutritional status trajectories, respectively. High nutritional status was significantly negatively correlated with changes in symptom severity. Low nutritional status was significantly negatively correlated with older age, surgical complications, and changes in symptom severity. ConclusionsSymptom severity has the most significant negative effect on perioperative nutritional status. Older age and surgical complications exert negative effects on perioperative nutritional status among patients with low nutritional status. These findings emphasize the need for nurses to identify at-risk individuals and provide individualized nutritional care to improve nutritional status in this population. Clinical trials registrationThis study was registered on ClinicalTrials.gov (trial registration number: NCT02900677; approved date: September 14th, 2016). Link: https://clinicaltrials.gov/ct2/show/NCT02900677.

Unveiling the impact: Exploring malnutrition rates in patients with cancer and its association with anticancer treatments.

189 Background: Malnutrition is a common cause of morbidity and mortality in patients with cancer. Malnutrition is seen in 40 to 80% of patients with cancer. Recent literature has shown loss of lean body mass in cancer population can be an independent factor for poorer outcomes. Anorexia, the loss of appetite has been either secondary to the disease itself or as a side effect of treatment. The mechanism of anorexia development is due to physiologic alteration in metabolism during carcinogenesis. Hence, it becomes important to screen for malnutrition in all patients with diagnosis of cancer. Methods: This single-center cohort study, conducted between January 15, 2024, and February 9, 2024, involved 106 patients receiving outpatient oncology care. Patients aged 18 to 90 years who consented to participate were administered the Mini Nutritional Assessment (MNA) questionnaire at the oncology registration desk. Exclusion criteria included patients with a dietician and those with pure nonmalignant hematological diagnoses. Data analysis comprised identifying patients at risk of malnutrition (8-11 points) or malnourished (0-7 points) using the MNA scale, followed by retrospective chart review. Primary outcomes focused on identifying prevalent cancer types among malnourished or at-risk patients, while secondary outcomes included comparing malnutrition proportions among different treatment groups and assessing gastrointestinal tract metastases and common causes of malnutrition. Results: The data encompassed 106 patients, among whom 29 (27.3%) were identified as at risk of malnutrition, while 9 (8.4%) were malnourished. Notably, a majority of at-risk or malnourished patients (60.5%) were classified as overweight or obese. The most prevalent cancers among these patients were breast cancer (26.3%), genitourinary cancer (23.6%), and gastrointestinal cancer (18.4%). Chemotherapy use was noted in 16 (42.1%) patients, immune checkpoint inhibitor treatment in 12 (31.5%), and a combination of both in 7 (18.4%). Gastrointestinal metastasis was observed in 5 (13.1%) patients. Among those at risk of malnutrition, the primary contributing factors identified were tumor impact and location (63.1%), diarrhea (18.4%), and fatigue (18.4%). Conclusions: The study underscores the significant prevalence of malnutrition risk among cancer patients, emphasizing the importance of systematic screening during outpatient oncology follow-ups.

Relationship between Nutritional Status and Activities of Daily Living on Geriatric Depression among the Elderly Attending Primary Health Centers in Southern Karnataka

Abstract Introduction: The population of the planet is aging quickly. According to the World Health Organization, the percentage of elderly individuals above 60 years of age worldwide is predicted to be doubled, from 12% in 2015 to 22% by 2050. Depression is the most common psychiatric disorder among the elderly which has a larger influence on their physical and emotional well-being. It is important to recognize the unique physical and mental health issues experienced by older adults. Materials and Methods: A community-based analytical cross-sectional study was conducted among elderly above 60 years of age attending two Primary Health Centres in the field practice areas of JSS Medical College, Mysuru. Based on inclusion and exclusion criteria, 130 elderly people were selected. Pretested semi-structured questionnaire on sociodemographic characteristics was administered, and a Geriatric Depression Scale (short form), Mini Nutritional Assessment Scale of the elderly, and Katz scale of independence were used. Statistical tests such as the Chi-square test and Spearman’s correlation test were used. Results: The prevalence of geriatric depression was 34.6%. Along with that, 5% were malnourished and 60% were at risk of malnutrition. The prevalence of physical dependency was 10%. Malnutrition and daily living activities were significantly associated with depression. Nutritional status and daily living activities show a negative correlation with geriatric depression and among them, nutritional status shows significant negative correlation with geriatric depression. Conclusion: Most of the elderly with poor nutritional status were depressed. Proper nutrition and adequate physical activity can cause a reduction in depression among the elderly.

Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study.

With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ± standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ± 6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ± 1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ± 2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.

An analysis of influencing factors of oral frailty in the elderly in the community

ObjectiveThis study aimed to investigate the current situation of oral frailty (OF) in the elderly in the community in China and analyse its influencing factors.MethodsUsing convenience sampling, 380 elderly people from three communities in our city were selected as participants in the study. The Oral Frailty Index-8, the Frailty Scale, the Oral Health Assessment Tool, the Mini-nutritional Assessment Scale and the Pittsburgh Sleep Quality Index were used to investigate and analyse OF influencing factors.ResultsIn this study, the 380 elderly participants were categorized into three groups: frailty, pre-frailty, and non-physical frailty, based on their responses to the questionnaires.The influencing factor analysis showed that age, gender, education level, frailty score, frailty stage, number of dentures, dry mouth, subjective chewing difficulty, oral health score and sleep quality were the influencing factors of OF in the elderly in the community (R2 = 0.712, F = 434.73, P < 0.05). The evaluation of the prediction results showed that the frailty score (area under the curve [AUC]: 0.751, 95% confidence interval [CI]: 0.683–0.862), subjective chewing difficulty (AUC: 0.765, 95% CI: 0.655–0.831) and sleep quality (AUC: 0.736, 95% CI: 0.652–0.781) had a higher predictive value for OF.ConclusionThe main OF influencing factors in the elderly in the community are age, gender, education level, physical frailty (PF) score, PF stage, number of dentures, dry mouth, subjective chewing difficulties, oral health score and sleep quality. Nursing staff should pay attention to the OF of the elderly in the community and take targeted intervention measures in time to reduce and control OF occurrence and progression.

TRIBES OF TELANGANA: NUTRITIONAL STATUS, HEALTH CONDITIONS AND QUALITY OF LIFE - A STUDY OF ADILABAD DISTRICT

Introduction: Indias agricultural output has recently been self-sufficient; the issue of malnutrition still exists and is still regarded as one of the most important problems. The quality-of-life index is a composite criterion used in public health management and policy analysis to assess the well-being of communities or groups of people based on a variety of social, physical, psychological, and economic characteristics. Methodology: The study was conducted in Adilabad district of Telangana state with an aim of assessing nutritional level and its influence on tribal quality of life. The study adopted a cross-sectional descriptive research design with cluster sampling technique of probability sampling method and the sample size of the current study is 379. The tools including Sociodemographic data sheet, Mini Nutritional Assessment scale and WHO Quality of life. Results: The study findings show the statistically positive correlation between nutritional level and quality of life domains such as physical, psychological, environmental quality of life and social relationships. Conclusion: The study findings indicating the influence of nutritional level on tribal quality of life. It is important to addressing nutritional deficits among the tribal and it is evidence to understand how the quality of life has been increasing in tribal who has good nutritional levels. KEYWORDS: Tribal, Nutrition, quality of life

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. To assess nutritional status and its associated factors among the elderly population. This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults.

Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults. This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression. The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance. RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

Examining the Nutrition, Oral Mucositis, and Gastrointestinal System Symptoms of Intensive Care Units Patients Receiving Enteral and Parenteral Nutrition.

This descriptive study aims to examine the complications that might develop in patients who receive enteral or parenteral nutrition treatment in intensive care unit in this process and to examine the nutritional status, oral mucositis, and gastrointestinal system symptoms among patients who receive enteral or parenteral nutrition treatment in intensive care unit. A sample of this study consists of 104 patients who received enteral or parenteral nutrition treatment in intensive care units between January and June 2019. The data were collected face to face by using Sociodemographic Form, constipation severity scale, Mini Nutritional Assessment Scale, Mucositis Assessment Scale, visual analog scale, and gastrointestinal system Symptoms Scale. The results were calculated as numbers, percentage, SD, and mean values. Among the participating patients, 67.4% were older than 65 years, 55.8% were female, 42.3% were receiving treatment in internal medicine intensive care units, and 43.4% had severe mucositis. It was determined that 31.7% of the patients receiving treatment in intensive care units required nutrition treatment. It was determined that patients receiving parenteral nutrition had more symptoms such as gastrointestinal system symptoms, mucositis, constipation, and colonic inertia. It was determined that when compared to the patients receiving enteral nutrition, the patients receiving parenteral nutrition had higher scores in mucositis, visual analog scale pain, Mini Nutritional Assessment Test, constipation, obstructive defecation, colonic inertia, and gastrointestinal symptom total scores.

Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka.

Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka. A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis. The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults. Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.

Dynamic alterations of immunosenescence-related genes in older women with breast cancer receiving chemotherapy: A prospective study

BackgroundThe exact impact of chemotherapy on the immune system of older patients with breast cancer is not well known. A longitudinal study was performed investigating the evolution of the blood immune profile during and after chemotherapy in this population. Patients and MethodsThe study included 39 patients receiving adjuvant chemotherapy (chemotherapy group, CTG) and 32 patients receiving only hormone therapy (control group, CG). A 10-gene panel associated with immunosenescence was measured in peripheral blood mononuclear cells (PBMC) before (T1), at 3 months (T2) and at 12 months (T3) after initiation of adjuvant therapy. Nutrition status was assessed by using a mini nutritional assessment scale. Linear mixed model analyses were performed for trajectory evolution, with or without adjusting for age, tumor stage, breast cancer phenotype, and/or corresponding baseline gene levels. ResultsSix genes relating to T cell activation (CD28, CD27, CD86, LCK, GRAP, LRRN3), and two genes relating to oxidative stress (PRDX6, HMOX1) exhibited a significant group-by-time effect, even after adjusting covariates(p≤ 0.01). In CTG, the T cell activation genes substantially declined from T1 to T2 and bounced back to a level higher than baseline at T3 (p<0.03), which was not observed in CG (p>0.26). Patients with malnutrition detected at T1 experienced more pronounced perturbation regarding CD27, LCK, CD69, VAMP5, and LRRN3 (p<0.05). ConclusionChemotherapy leads to transient perturbation of immune-related gene expression and potentially stimulates immunity in the long term. Well-nourished patients experience less impact of chemotherapy on immune-related gene expression profiles.

Cut-off of Anthropometric Measurements and Nutritional Status among Elderly Outpatients in a Tertiary Health Care Center in Telangana.

Introduction:Geriatric population is most vulnerable to various emerging communicable and noncommunicable diseases due to various socio-economic, physiological, psychological and nutritional risk factors. Adequate nutritional status is utmost important in older age as it helps in maintaining the immune response and preventing the morbidities and mortalities in this age. Thus, the opportunistic screening of malnutrition among geriatric population gives an extra edge for achievement of healthy ageing in the elderly. The objective of the present study was to assess the nutritional status among the elderly population and provide cut-off values of various anthropometric measurements for detecting the risk of malnutrition among old age people. Materials and methods:The present cross-sectional study was carried out among people aged . 60 years who visited the geriatric clinic of a tertiary health care center between May and December 2021. The nutritional status of the 468 selected elderly was assessed using the Mini Nutritional Assessment (MNA) tool and various anthropometric measurements. Receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off values of anthropometric measurements. Correlation between various anthropometric parameters was studied. Data was analyzed using SPSS vs. 20 software. Results:Out of the 468 subjects, around one third had a risk of malnutrition and 7% malnutrition as per the MNA scale. Cut-off values of triceps skinfold thickness, neck circumference and arm muscle circumference were 12.5 cm, 32.5 cm, 18.3 cm and 11.5 cm, 35.5 cm, 21.2 cm for detecting malnutrition and risk of malnutrition, respectively. Neck circumference was found to be the most suitable measurement, with a cut-off value of 32.5 cm and 35.5 cm for detecting malnutrition and risk of malnutrition, respectively, as it possessed the highest Youden index and AUC. Conclusion:The prevalence of malnutrition was found to be low in the present study setting. Our findings firmly established that the neck circumference could be used as a simple, rapid, non-invasive and valid screening tool, with high sensitivity and specificity for detecting the risk of malnutrition in geriatric clinics or primary health care settings.

Nutritional Status and Severity Correlation Of COPD Patients Admitted in Tertiary Care Hospital

Background: Malnourishment is highly prevalent among COPD patients. The study was carried out to assess the nutritional status of hospital admitted COPD patients to evaluate the relationships between the nutritional indices and the pulmonary function parameters with severity correlation. Methods: A cross-sectional observational study was done constituting 50 spirometryproven COPD patients admitted at Dhaka Medical College Hospital. Lung function was measured by routine spirometry. Anthropometric measures, biochemical parameters, and Mini Nutritional Assessment (MNA) score were used for nutritional assessment. Results: Mean age of study population was 64.31 years.22% (n = 11), 42% (n = 21) 32% (n = 16) &amp; 4% (n = 2) of the patients were of stage I, II, III and IV of COPD respectively.According to MNA scalethe study population were malnourished 46% (n = 23), at risk of malnutrition 40% (n = 20) and normal nutritional status 14% (n = 7).13 patients were found malnourished according to BMI scale and were in stage I COPD 15.38% (n = 2), stage II 38.46% (n = 5), stage III 38.46% (n = 5) and stage IV 7.69% (n = 1). Mid arm circumference (MAC), mid-calf circumference (MCC), MNA scale score and BMI score showed a significant decline of mean value with increasing severity of stages of COPD. The correlation between BMI and FEV1 (R2 = 0.087 and p value= 0.038), body weight and FEV1 (R2 = 0.173 and p value= 0.003), MUAC and FEV1 (R2: 0.202, p value = 0.001) and MNA scale and FEV1 (R2 = 0.144 and p value= 0.007). All correlations were statistically significant. Conclusion: The high prevalence of malnutrition among hospitalized COPD patients is related to their lung function. Weight, mean MNA, and BMI score decrease with increasing severity of COPD. Bangladesh J Medicine 2022; 33: 186-192

Geriatric Depression and Its Association with Geriatric Malnutrition: A Cross-Sectional Study in Hubballi, North Karnataka

Background: The world's elderly population is increasing rapidly. According to the 2011 census elderly population contributes to 7.4% of the total population. Both physical and mental disorders are prevalent among the elderly. Symptoms of depression in older people are often overlooked and untreated. Depression leads to loss of appetite, diminution of food intake, and weight loss consequently leading to malnutrition. Methodology: A community-based cross-sectional study was conducted among the geriatric population of urban field practice area using a predesigned, semi-structured questionnaire. Geriatric Depression was assessed using Geriatric Depression Scale and Nutritional Status using the Mini Nutritional Assessment Scale. House to house survey of the Geriatric population was conducted after obtaining written consent. Results: Out of 260 participants, 51.5% of the population were males, 49.2% of the population belonged to 60-69 years age group and 16.9% of them were more than 80 years of age. The prevalence of geriatric depression was 68.5 %,). The majority (64%) of the elderly population were at risk of malnutrition. Depression scores were negatively correlated with nutritional scores. Conclusion: The prevalence of depression and malnutrition was considerably high among the elderly population. Malnutrition among the elderly is a significant determinant of malnutrition.

Elderly People from Old Age Homes have Higher Risk of Malnutrition and Depression as Compared to Family Setup

With increase in average age of population and increasing trend of nuclear families, old age homes are fast becoming a norm in India. The COVID-19 pandemic has made nutritionists revisit the health status of our elderly living in different family set ups. The present study was carried out with the objective to compare the health and risk of malnutrition among elderly (? 60 yrs in age) living in three different residential set ups i.e. old age homes, urban family or rural family. The study was carried out in Hisar district of Haryana state in Northern India. In this cross-sectional study, sixty subjects each (N=180) from the three residential set ups were selected randomly and assessed for depression, level of independence in daily activities and risk for malnutrition. Standard scales viz. Geriatric Depression Scale, Barthel Index and Mini Nutritional Assessment Scale were used. The PAR (Physical Activity Ratio) values for activities performed in a day were aggregated over the period i.e. 24 hours to yield physical activity level. It was observed that respondents from rural family set up were more active as compared to their counterparts in urban family set up or old age homes. Osteoporosis (94.44%), joint pain (87.78%), loss of appetite (85.56%) and anemia (80.56%) were the most commonly reported problems. Per cent prevalence of most problems was higher in old age home respondents. The level of independence for most activities was lowest in old age home respondents as compared to other two residential set ups. Depression was evident in 36.67 per cent of total respondents with higher per cent prevalence in residents of old age home. It may be concluded that elderly people from old age homes have higher risk of malnutrition and depression as compared to urban or rural family setup. Interventions are highly recommended for mental and nutritional well-being of elderly specially those living in old age homes. Considering the increasing trend of old age homes, deeper studies are required on their living conditions. There should be stringent SOP’s for all old age homes and elderly care.

The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT

A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available. To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years. 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level. The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times. EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

Determination of malnutrition and nutritional risks in aged individuals between 65 and 84 years in Turkey

BACKGROUND: Nutritional inadequacy, physical impairments, and degenerative diseases are the main causes of a general deterioration in health and quality of life in aged individuals. OBJECTIVE: The to determine malnutrition and nutritional risks in Turkish aged individuals by evaluating nutritional status and recording anthropometric measurements. MATERIALS AND METHODS: Eight hundred and eighty-seven Turkish aged individuals aged between 64 and 85 years participated in the study. Nutritional habits were interrogated by face to face interview method. Anthropometric measurements (body mass index [BMI], waist, hip, and upper-middle arm circumference), nutritional screening index (NSI), and mini nutritional assessment scale (MNA) were used to evaluate nutritional status and malnutrition risk among the participants. RESULTS: As per MNA, 29.8% of females, 22.1% of males were at malnutrition risk whereas 4.5% of females and 4.3% of males were malnourished. In NSI evaluations, 23.3% of females and 17.1% of males were at medium risk whereas, 12.6% of females and 6.5% of males were in high-risk category. A moderate positive correlation was found between the BMIs of the individuals and upper-middle arm circumferences (P &lt; 0.05). Furthermore, a moderate positive correlation was found between MNA and NSI scores (P &lt; 0.05). CONCLUSION: It is necessary to evaluate the nutritional and health status of elderly people at a regular basis. Further studies are required for suitable nutritional intervention or recommendations for the aged group.

Relationship between Frailty, Glycemic Control, and Nutritional Status among the Elderly with Diabetes Mellitus Residing in an Urban Community of Mysuru.

In India, the elderly (aged 60 and above) constitute 8.2% of the total population and are expected to increase to 10% by the year 2020. Globally, around 450 million people are suffering from diabetes mellitus. Frailty is regarded as a predisability state and, therefore, if identified early, may avert many adverse health outcomes in the elderly. Diabetes and frailty are found to be close associates. This community-based cross-sectional study was conducted among 104 elderlies with diabetes mellitus residing in an urban slum situated in Mysuru for a period of 6 months. Pretested structured questionnaire was used to collect the information on sociodemographic characteristics and details of diabetes. The Tilburg's Frailty Scale was used to assess frailty, and the Mini Nutritional Assessment Scale was used to assess the nutritional status. The prevalence of frailty among the study population was 53.8%. 51% of the subjects were found to have their glycemic status under control, 16.3% were malnourished, and 70.2% were at risk of malnutrition (RMN). The majority of the subjects with malnourishment were frail (76.5%) followed by those at RMN, 36 (49.3%). Gender, marital status, engaging in occupation, socio economic status, poor glycemic control were found to be significantly associated with frailty. The prevalence of frailty is significantly higher among elderly diabetics. The poorer glycemic control is a significant factor associated with frailty, and malnourished elderlies are more at risk of developing frailty.

Outcomes of a Telephone-Based Frailty and Functional Assessment

With the goal of increasing the clinical use of frailty, we piloted a quality improvement project to determine the feasibility and utility of a telephone-based frailty and functional assessment. We identified 122 established patients with serious medical illness from an academic geriatrics clinic. A geriatric fellow assessed the functional status and conducted the Mini Nutritional Assessment, telephone-MoCA, and Geriatric Depression Scale to generate a deficit-accumulation frailty index (FI) score which was automatically calculated through the electronic medical record. A note was then generated to inform the providers of the details of the assessment and to provide recommendations based on the findings. From November 2020 to March 2021, 104 out of 122 (85.2%) established patients (mean [SD]: 83.4 [7.1], 66% female, 81% White, and mean [SD] FI: 0.32 [0.17]) agreed and proceeded with the assessment. One month after the call, we found that the assessment was included in the clinical decision-making of 55 out of 100 patients seen by their primary care provider. The top 3 incorporated recommendations were chronic disease management based on frailty status (n=56), lifestyle change and counseling to prevent frailty progression (n=44), and management of cognition and mood (n=18). Management of physical status including referral to PT and OT were incorporated in 15 encounters. Our results suggest that a telephone-based frailty and functional assessment is feasible and has value-added contributions in improving the care of older adults through providing a holistic view of their health status.