MNA Scores Research Articles

Evaluation of five nutritional scores as predictors of postoperative outcome following pancreatic resection: A prospective, single-center study

Background and aimsPatients undergoing pancreatic resection are commonly malnourished. It is still unclear whether nutritional scores reliably predict postoperative outcomes after pancreatic resection. This study evaluated whether five commonly used preoperative nutritional screening scores predicted severe complications and length of stay. MethodsPatients scheduled for pancreatic resection (pancreatoduodenectomy, distal and total pancreatectomy) at a national referral center for pancreatic surgery from September 2022 to June 2023 were prospectively screened for malnutrition with MNA, MUST, SGA, SNAQ, and NRS2002 scores. Postoperative complications were classified using the Clavien-Dindo classification. #NCT05608538. ResultsThree hundred patients were enrolled, including 168 pancreatoduodenectomies (56%), 102 distal pancreatectomies (34%), and 30 total pancreatectomies (10%). Final pathology revealed malignancy in 203 cases (67.7%). When applying the scores, the proportion of patients malnourished or at risk of malnutrition ranged from 21.7% for SGA to 79.3% for NRS2002. After adjusting for selected confounders, only an MNA <17 was associated with severe postoperative complications (OR 8.39, 95%CI[1.95 – 32.31], p=0.01). MNA, SGA, and SNAQ predicted the length of stay (all p<0.01), while MNA and SGA also correlated with a higher probability of having a greater heterogeneity in the length of stay (p=0.04 and 0.002, respectively). DiscussionWe promote using MNA to detect malnourished patients at risk of severe postoperative complications and longer hospitalization after pancreatic surgery. SGA and SNAQ may also have value in predicting patients who will be hospitalized longer. More prospective studies will be needed to corroborate these findings.

Malnutrition among the older adult: an additional challenge for the rehabilitation team-insights of a small population of Switzerland.

Nutritional deficiency among the older adult is a widespread concern, significantly affecting their health. The prevalence of malnutrition increases with age, concurrent health conditions, and the level of care provided. Hospital stays can affect as 90% of the older adult. Malnutrition can hinder efforts to improve health and regain function in individuals undergoing rehabilitation. This study aims to assess the frequency of malnutrition among geriatric rehabilitation patients. A retrospective quantitative analysis was conducted on 357 patients admitted to the geriatric unit at Lucerne Cantonal Hospital Wolhusen in Switzerland. The patients' nutritional status was evaluated using the standardized Mini Nutritional Assessment Long Form questionnaire. The initial analysis indicated a considerable prevalence of malnutrition among the geriatric population: 31.1% were identified as malnourished (MNA < 17), while an additional 35.8% were at risk of malnutrition (MNA 17-23.5), totaling 66.9% of patients. The Kruskal-Wallis ANOVA test revealed a statistically significant difference in MNA scores among different age groups (p = 0.035). Statistical analysis also suggested a slightly higher prevalence of malnutrition among female patients. The duration of rehabilitation varied from 20.07 ± 6.93 to 22.20 ± 7.50 days, with longer durations associated with lower MNA scores. A correlation analysis between MNA values and body mass index (BMI) showed a positive correlation coefficient (r = 0.56), indicating that lower MNA scores were associated with lower BMI and vice versa. Malnutrition is prevalent among individuals over 65 years old, highlighting the importance of regular and timely nutritional assessments for geriatric patients to mitigate the complications and enhance prognoses in both acute care and rehabilitation settings. Such assessments can also improve the efficacy of rehabilitation programs and potentially reduce the duration of rehabilitation, thus carrying significant economic implications.

The Relationship between physical activity, nutritional status, and sarcopenia in community- dwelling older adults with type 2 diabetes: a cross-sectional study

AimThis study was conducted in Urumqi, Xinjiang, to assess the prevalence of sarcopenia and to determine the relationship between physical activity, nutritional status, and sarcopenia among community-dwelling patients with type 2 diabetes mellitus.MethodsFour hundred eight cases of older people patients with type 2 diabetes mellitus in the community in Urumqi, Xinjiang, from May to August 2022 were selected for a cross-sectional on-site survey, and general information questionnaires, clinical information surveys, physical function measurements, and criteria developed by the Asian sarcopenia working group in 2019 were selected for diagnosis of sarcopenia, and unifactorial and multifactorial binary Logistic regression were applied to analyze the influencing factors of T2DM combined with sarcopenia in patients with sarcopenia.ResultsAmong the 408 patients, 84 (20.6%) had sarcopenia, with a prevalence of 12.6%, 32.1%, and 51.9% in those aged 60–70, 71– 80, and 81 or older respectively. The prevalence increased significantly with age. Adjusting for variables, the study found that FFM of the Left Leg (OR: 0.710, 95% CI: 0.612–0.804, P = 0.024), FFM of the Right Arm (OR: 0.710, 95% CI: 0.612–0.804, P < 0.001), Age (OR: 1.246, 95% CI: 1.031–1.505, P = 0.023), Fasting Blood Glucose (OR: 1.649, 95% CI: 1.066–2.550, P = 0.025), and Post-Prandial Blood Glucose (OR: 1.455, 95% CI: 0.999–2.118, P = 0.025) were independent associated factors. An increase in MNA score (OR: 0.398, 95% CI: 0.244–0.6500, P < 0.001), ASMI (OR: 0.000, 95% CI: 0.00–0.01, P < 0.001) walking energy expenditure (MET-min) (OR: 0.998, 95% CI: 0.996–0.999, P = 0.001) reduced the prevalence of sarcopenia.ConclusionThis study shows that increased age, increased skeletal muscle mass index, decreased right arm FFM, increased postprandial glucose, increased MNA scores, and increased walking energy expenditure (MET-min) were associated with type 2 diabetes with sarcopenia.

Vitamin D and Geriatric Assessment: A Cross-Sectional Study on the Cohort of Centenarians in the Central Region of Russian Federation

Background. The trend towards aging of the population is global, which makes the study of etiology, prevention and treatment of age-related disorders relevant. Increasing number of studies highlights the influence of 25-hydroxyvitamin D deficiency on health state in older people, as well as its correlation with geriatric syndromes prevalence. However, at the moment it is not known whether these patterns persist in patients older than 90 due to the limited number of studies on this population.Aim. To assess the prevalence of vitamin D deficiency in a cohort of centenarians in the central region of Russian Federation and to study its relationship with the presence of geriatric syndromes.Materials and methods. The study was carried out by Russian Gerontology Research and Clinical Centre of Pirogov Russian National Research Medical University and Center for Strategic Planning and Management of Medical and Biological Health Risks. It was a cross-sectional study on the cohort of centenarians (90 years and older). Complex geriatric assessment was performed. Complex geriatric assessment included past medical history, geriatric scales and questionnaires (MMSE, SARC-F, MNA scores). Blood samples were taken to assess the 25-OH vitamin D levels using chemiluminescence method. The study is reviewed by the ethics committee (№ 30 24.12.2019). The statistical analysis was performed using Python version 3.9 and R version 4.1.3.Results. The study included 3,235 people aged 90 to 107 years. Median level of 25-hydroxyvitamin D was 9 ng/ml, 86.7% of participants were found to be 25(OH)D deficient, and in 8.3% insufficiency 25(OH)D was detected. Using the intergroup analysis, the association between 25-OH vitamin D levels and some geriatric syndromes, such as malnutrition, sarcopenia and cognitive impairment was observed. However, after adjusting to physical activity and nutrition statistically significant association was demonstrated only for cognitive impairment.Conclusion. The results obtained on the association between low levels of 25-OH vitamin D and cognitive impairment among centenarians confirm the importance of vitamin D deficiency prevention and might be starting point for future studies.

Assessment of Nutritional Status among Elderly Hospitalized Patients in Enugu, Nigeria: A Hospital-based Study.

The ageing population worldwide presents a significant challenge for healthcare systems, with malnutrition being a common problem among elderly individuals, particularly those hospitalized. Assessing nutritional status is crucial for identifying and addressing malnutrition in this population. This study aimed to assess the prevalence of malnutrition among elderly hospitalized patients in a Nigerian tertiary healthcare setting. This was a hospital-based descriptive and cross-sectional study conducted from March to June 2023, involving 122 patients aged 60 years and above. Demographic data and anthropometric measurements were collected, and the Short-form Mini Nutritional Assessment (MNA-SF) tool was used to assess nutritional status. The reliability of the MNA-SF was assessed using Cronbach's α coefficient and item-to-total score correlations. The mean MNA score was 14.4 ± 5.3, with 71.3% of participants classified as malnourished, 22.1% at risk of malnutrition, and 6.6% well-nourished. Significant differences were observed in the body mass index (BMI) of nourished, at-risk, and malnourished individuals respectively (23.3 ± 3.6 kg/m2, 22.5 ± 3.8 kg/m2, and 19.6 ± 2.8 kg/m2, p < 0.001). The MNA-SF tool demonstrated acceptable reliability (Cronbach's α coefficient = 0.777), with significant correlations between total MNA scores and most MNA-SF questions. The high prevalence of malnutrition among elderly hospitalized patients in this Nigerian tertiary hospital emphasizes the importance of implementing routine nutritional screening protocols and targeted nutritional interventions for improved health outcomes among the elderly.

The Effect of Comprehensive Tele-Education in Patients with Diabetes Mellitus: A Randomized Controlled Trial

Aim: This study aimed to investigate the effectiveness of remote education given via telehealth to individuals diagnosed with Type 2&#x0D; diabetes on exercise goals, physical activity, nutrition, medication habits and diabetes problems.&#x0D; Material and Methods: A randomized controlled trial was conducted with a total of 30 patients with diabetes mellitus (15 tele-education,&#x0D; 15 routine education). Individuals were educated about general information about diabetes, nutrition therapy, exercise, physical activity,&#x0D; drug therapy, and acute/chronic complications. Participants were evaluated with the Mini Nutritional Assessment, International Physical&#x0D; Activity Questionnaire, Goal Orientation in Exercise Measurement, Modified Morisky Medication Adherence Scale and Problem Areas&#x0D; in Diabetes Scale.&#x0D; Results: In terms of MNA scores, only the decrease in the score of routine rehabilitation was significant (p=0.041). The MNA score did&#x0D; not differ between the tele-education and routine rehabilitation groups (p&gt;0.05). Finally, the education program did not affect the other&#x0D; scores (p&gt;0.05).&#x0D; Conclusion: The study results showed that tele-education can only positively affect nutrition. However, both tele-education and routine&#x0D; training provided similar and ineffective results. Future studies could focus on remote education programs delivered through different&#x0D; educational methods.

The investigation of malnutrition and life quality’s relation with mortality in the patients who are 65 years old and above and are hospitilazed at the palliative care service

Aims: Our study aims to determine the impact of malnutrition on the quality of life of elderly patients receiving palliative care and identify the factors influencing quality of life. Methods: The study included patients aged 65 and older who were admitted to the Kırıkkale University Medical Faculty Hospital Palliative Care Service between November 2019 and February 2020. Patients with a history of active malignancy, hospitalization within the past 3 months, severe dementia precluding obtaining written consent, and patients under 65 years of age were excluded. Scores obtained from the Mini Nutritional Assessment-Short Form (MNA-SF) were recorded, with scores of 12 or higher considered as normal nutrition. Those with scores below 12 were reevaluated for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, and those meeting any of the phenotypic and etiological criteria were considered malnourished. Malnutrition severity was reclassified according to the GLIM criteria. The 13-item OPQOLbrief questionnaire was used to evaluate their quality of life. The questionnaire was published in Turkish by Çalışkan et al. Each question was rated on a scale of 1-5, with “Strongly Disagree” scored as 1, “Disagree” as 2, “Undecided” as 3, “Agree” as 4, and “Strongly Agree” as 5. Results: The mean total MNA score was found to be statistically lower in patients classified as mild and severe malnutrition according to the GLIM classification compared to those without malnutrition (p&lt;0.001). The rate of MNA scores between 12 and 14 in patients without malnutrition was higher than that of patients with mild and severe malnutrition, while the rate of scores between 8 and 11 was higher in patients with severe malnutrition. The rate of scores between 0 and 7 was higher in patients with mild and severe malnutrition (p&lt;0.001). The mean total MNA (p&lt;0.001) and QOL (p=0.021) scores were statistically lower in patients with malnutrition compared to those without malnutrition. The rate of MNA scores between 12 and 14 and between 8 and 11 was higher in patients without malnutrition, while the percentage of MNA scores between 0 and 7 was higher in patients with malnutrition. Conclusion: In the geriatric patient group, we believe that the GLIM criteria used in our study are more comprehensive and sensitive in detecting malnutrition in terms of phenotypic and etiological aspects through patient questioning.

Effects of oral function and depressive tendencies on nutritional status in older adults requiring support or low-level care: An investigation using path analysis.

This study investigated the effects of differences in oral function and depressive tendencies on nutritional status in older adults requiring support or low-level care. In 106 older adult participants residing in nursing/care homes or participating in community-level preventive care activities, the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutritional status and oral diadochokinesis (ODK), tongue pressure, and repetitive saliva swallowing test (RSST) for oral function, 15-item Geriatric Depression Scale (GDS), Diet-Related Quality of Life Scale-Short Form (DRQOL-SF), and Functional Independence Measure (FIM) were administered. Basic information, including cognitive function, was evaluated. Hierarchical MNA (dependent variable)-based multiple regression analysis was performed, followed by path analysis using factors with significant associations with MNA scores. RSST, ODK, tongue pressure, FIM, and DRQOL were positively correlated with MNA scores and GDS was negatively correlated. Hierarchical multiple regression demonstrated associations with tongue pressure, GDS, FIM, DRQOL scores, and gender. Path analysis confirmed significant paths from tongue pressure to MNA, tongue pressure to FIM, and FIM to MNA (P < .001). Significant paths were confirmed from GDS to MNA (P < .01), from DRQOL to MNA (P < .05), and from gender to MNA (P < .01). Tongue pressure, GDS, FIM, DRQOL scores, and gender were identified as factors that directly affect MNA. Tongue pressure showed the greatest effect and indirectly affected MNA via FIM. These findings emphasize the importance of early detection of low nutritional risk for preventing depression and oral function deterioration, and of evaluation of dietary satisfaction and improvement of quality of life in diets.

Physical function, nutritional status, and quality of life before and after chemotherapy in patients with malignant lymphoma.

This study investigates the efficacy of and gender differences in exercise therapy in patients with malignant lymphoma undergoing chemotherapy. Twenty-six patients (13 men, 13 women) received physical therapy (based on the Borg Scale 13) during hospitalization. Physical function was measured using grip and knee extension strength, 6-minute walking distance, and body composition; nutritional status assessed via Mini Nutritional Assessment (MNA®); and serum albumin levels analyzed. Fatigue was evaluated using the Brief Fatigue Inventory, and health-related quality of life was assessed with the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). The analysis of all patients indicated that the right grip strength, skeletal muscle mass, skeletal muscle index, and leg muscle mass significantly decreased, whereas the serum albumin level, MNA® score, and scores of many items of the SF-36v2 significantly increased after chemotherapy. In a gender-specific analysis, only men showed significant declines in the skeletal muscle mass and skeletal muscle index, and improvement in the MNA® score after chemotherapy. In the SF-36v2, there were significant improvements in general health and physical component summary scores among men, and general health and mental component summary scores among women. Exercise therapy at a Borg Scale intensity of 13 may not prevent muscle mass decline in patients with malignant lymphoma, especially male patients. In addition, this study revealed that there is a gender difference in the effect of exercise therapy on quality of life. Thus, gender should be considered in exercise therapy for patients with malignant lymphoma.

Seasonal differences in nutritional status of patients hospitalized with heart failure with reduced ejection fraction.

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Heart failure (HF) is increasing steadily while the prognosis still stays poor despite improvements in care and availability of new therapies. The nutritional status. is important in management of HF, as an part of multidisciplinary approach. It is known that the diet depends on the availability of nutritional products and therefore also on the season. The seasonal differences of the nutritional status in HF to our knowledge has not been studied before. Purpose The assessment of variability in nutritional status among patients with heart failure with reduced ejection fraction (HFrEF) in different seasons of the year. Methods We enrolled 240 consecutive patients hospitalized at the department of cardiology, due to HFrEF with left ventricular ejection fraction (LVEF) &amp;lt;=40%. Patients were interviewed with MNA form to assess their nutritional status. Detailed medical history was collected. Patients were divided according to the astronomical season of the year (spring summer fall winter), depending on the time of the admission to the hospital. We compared MNA scores between mentioned groups of patients using U Mann Whitney test. Due to the possible influence of HF exacerbations on nutritional status, the second analysis was done after exclusion of patients with HF decompensation. Results Mean age was 56.4±11.3 years, 15.8 % patients were women, mean BMI – 28.8±5.5 kg/m2, mean LVEF – 23.9±7.7%, mean MNA score – 23.0±2.9 points. MNA score was higher (the sign of better nutritional status) in patients interviewed during spring compared to those assessed in summer (p=0.0094) or fall (p=0.014). The same situation was observed after the exclusion of patients with decompensation of HF: MNA score measured in patients admitted in spring was better than those hospitalized in summer (p=0.042) or fall (p=0.0064). The difference between spring and winter lacked statistical significance (p=0.058). Mean MNA scores and more important data for every season are presented in Figure 1 and 2. Conclusion(s) The differences in nutrition state in stable patients with HFrEF suggest that the seasonality of the diet might result from veritable modification in nutrition associated with availability and price of fruit and vegetables or the respondents mood, unrelated to the real nutritional status, impacts the score in the MNA questionnaire. This requires further analyses.

Translation and validation of a French version of the Xerostomia Inventory.

This study aimed to assess the transcultural adaptation and psychometric properties of the French-language version of the Xerostomia Inventory (XI-Fr). In total, 65 patients aged 65years or older were recruited from three departments of a single French hospital. Patients had to have a Mini Mental State Examination score of 10 or more and be able to read and write French. The XI-Fr was administered to all patients after transcultural adaptation, at the start of the study, and again at 7days after inclusion. We assessed reliability, acceptability, validity, internal consistency and reproducibility of the instrument in its French-language version. The XI-Fr showed good internal consistency (Cronbach's alpha 0.79) and good reliability (intra-class correlation 0.83) at 7days. Convergent validity showed no relation between salivary flow and XI-Fr score, as with the original instrument. Discriminant validity showed a positive correlation between the XI-Fr and the GOHAI, but no difference for the MNA or miniGDS scores. The XI-Fr is a valid and reliable measure of xerostomia in French, with psychometric properties comparable to those of the original English-language version.

Prevalence of Malnutrition among Elderly in Rural Field Practice area of Chengalpattu Medical College

Background: People of elderly age group were more vulnerable in terms of health compared to younger age group and nutrition plays an important role in determination of health. Malnutrition including both under nutrition and obesity has major impact on health status of elderly population. Hence measures to prevent malnutrition in elderly was of utmost importance in present situation. Objectives: 1. To estimate the prevalence of malnutrition among people of age ≥ 60 years in rural field practice area of Chengalpattu Medical College. 2. To explore the factors contributing to malnutrition among the study population. Methodology: The study was a community based cross sectional study among 115 study participants in rural field practice area of Chengalpattu Medical College. The study population was arrived by Multistage sampling method and data was collected after obtaining permission from Institutional Ethical Committee and after getting informed consent from study participants. The study was conducted using a pre-tested semi-structured questionnaire which consists of sociodemographic details, personal habits, comorbidities and ailments, general examination, Anthropometry and nutrition assessment using Mini Nutrition Assessment tool. Data collected was entered in MS excel and data analysis done using SPSS version 20. Chisquare test and Pearson correlation was applied to analyze the data and p value &lt;0.05 was taken as significant. Results: Among the study population 35(30.43%) were males and 80(69.57%) were females. The mean age of entire study population was 68.11±5.561 years. Mean weight of the study participants was 54.65±10.04 kg. About 71(61.74%) participants had comorbidities and 49(42.61%) had addiction habits. The prevalence of malnutrition among the study participants was 12.17% and those at risk of malnutrition was about 49.56% according to Mini Nutrition Assessment and the prevalence of obesity was 6.09%, overweight was 18.26%, normal weight was 61.74% and underweight was 13.91%, based on Body Mass Index in the study area. There was a statistically significant (p-value &lt;0.05) association between malnutrition (based on Mini Nutrition Assessment) in elderly and increasing age; illiteracy; those who were financially dependent population; those with psychological stress; people with reduced food intake and those taking &lt; 3 meals per day. Female gender and presence of comorbidities had statistically significant association (p value &lt;0.05) with obesity based on BMI. There was a Significant positive correlation between anthropometric measurements like weight, BMI, mid arm circumference and calf circumference and MNA scores both short form and full form except for height. Conclusion: The prevalence of Malnutrition among elderly in present study was 12.17% and more of concern was those at risk of Malnutrition contributed by 49.56%. Establishing Nutrition Centres for older people especially in rural areas emphasizing on healthy eating and promoting healthy lifestyle would be of immense help to achieve healthy and graceful aging.

Combined Impact of Positive Screen for Sarcopenia and Frailty on Physical Function, Cognition and Nutrition in the Community Dwelling Older Adult.

BackgroundWhile sarcopenia and frailty independently contribute to functional impairment and disability, the combined impact resulting from their interplay is unclear. We investigated if functional, physical, cognitive, and nutritional measures were more adversely affected in community-dwelling older adults who were screened positive for both frailty and sarcopenia.MethodsUsing the FRAIL (≥1) and SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls) (≥1) scales for screening, we categorized 200 participants (age, 67.9±7.9 years) as combined (both positive, 12.5%), intermediate (either positive, 25.5%), or robust (both negative, 62%). ResultsComparisons of the three groups showed that the combined group had significantly worse functional ability (Frenchay Activities Index and Modified Barthel Index), physical performance (knee extension, gait speed, and Short Physical Performance Battery score), cognition/mood (Chinese Mini-Mental State Examination [CMMSE] score and Geriatric Depression Scale), and nutrition (Mini Nutritional Assessment [MNA] score) (p<0.05, one-way analysis of variance). Post-hoc comparisons revealed similar findings between the combined and robust groups, except for knee extension and CMMSE scores. Only MNA scores were significantly lower between the intermediate and robust groups. ConclusionFunctional ability, physical performance, and nutrition were more adversely affected in our study population of community-dwelling older adults who screened positive for both frailty and sarcopenia than in those who screened positive for either or neither, supporting the use of community screening for early detection and intervention for both frailty and sarcopenia as opposed to either alone.

Geriatrik Erkeklerde Nokturi ve Ayrıntılı Geriatrik Değerlendirme Parametreleri

Aim: The aim of this study was to demonstrate the relationship between nocturia and geriatric syndromes, and comprehensive geriatric assessment parameters (CGA) in older men.Material and Methods: A total of 397 older outpatient men who had undergone CGA were included in this cross-sectional study. For the nocturia variable, the question, ‘Generally, during the past 30 days, how many times did you usually urinate after you have gone to sleep at night until the time you got up in the morning?’’ was used.Results: The mean age of patients was 75.6 ± 8.1. There was a significant positive correlation between the frequency of nocturia and number of drugs, Timed-up Go, and Insomnia severity score (p&amp;lt;0.05), while there was a significant negative correlation between Mini Nutritional Assessment, Basic activities of daily living (BADL) and Tinetti total score, and hand grip strength (p&amp;lt;0.05). The prevalence of patients with 0, ≥1, ≥2, ≥3, and ≥4 nocturnal episodes was 11.6%, 88.4%, 70.5%, 47.3% and 25.4%, respectively. Patients with nocturia ≥2 had lower MNA scores and had a higher fall risk, depression, and dynapenia compared to patients with nocturia ≤1. There were higher rates of insomnia, depression, frailty, dynapenia, lower BADL and nutritional status with ≥3 nocturia episodes compared to ≤ 2 nocturia episodes (p&amp;lt;0.05).Conclusions: Nocturia is common and associated with dynapenia, insomnia, frailty, polypharmacy, incontinence, increased fall risk and depression in older men. Therefore, nocturia is important for geriatric practice and ≥3 nocturia episodes may be used as a marker of poor health status in older men.

The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults

BackgroundThe type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D.MethodsWe included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles.ResultsMean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures.ConclusionThe DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.

Nutrition assessment and geriatric associated conditions among community dwelling Iranian elderly people

BackgroundAlthough malnutrition risk is well documented in elderly care institutions, few studies have been conducted to address concerns regarding community-dwelling elderly people. This study has been aimed to describe the nutritional status and its related socioeconomic and geriatric factors in community-dwelling elders with malnutrition.MethodFor this study, a randomized sampling among people aged 60 has been done (n = 326). Information on nutrition status (full MNA) and health information, like cognitive status (MMSE), daily functional status (ADL and IADL scales) and frailty was obtained. Multiple logistic regression analyses have been carried out, in order to identify the association of demographical and clinical factors with malnutrition.Results28.1% of the participants suffered from poor nutrition. In the binary analysis, low MNA scores were associated with increasing age, female gender, lower education level, financial dependence, solitary life, poor self-rated health, multiple physical disabilities and chronic disease, polypharmacy, smoking, functional and cognitive decrease and frailty. In the final model of the multivariate analysis, living alone (OR:1.249,CI:1.105–2.620), multiple physical disabilities (OR:2.183,CI:1.246 ± 3..250) and chronic disease (OR: 2.148,CI:1.167–2.879) were independently associated with malnutrition. Also financial independency (OR:0.625,CI:0.233–0.938), functional ability on ADL (OR:0.536,CI:0.327–0.976) and IADL (OR:0.319,CI:0.194–0.856), normal cognitive (OR:0.456,CI:0.293–0.934) and no frailty (OR:0.253,CI:0.117–0.729) independently were inversely associated with malnutrition. The model was adjusted for all socio- demographic and health variables that were significantly related in the previous models.ConclusionsOur results indicated a strong correlation between malnutrition and health status. Identifying predictive factors can potentially improve prevention and management strategies used for malnutrition in elderly.

P0806RESIDUAL RENAL FUNCTION IS COMPLEMENTARY TO GERIATRIC ASSESSMENT SCORE IN ASSESSING CLINICAL RISK OF ELDERLY PATIENTS

Abstract Background and Aims Renal function impairment is highly pervasive in the elderly and triggers increased morbidity and mortality. Comprehensive geriatric assessment (CGA) is a validated multidisciplinary instrument to assess medical, psychosocial and functional limitations of old patients with diagnostic and risk-stratification purposes. In a focused cohort of frail individuals, we aimed at evaluating possible relationships between single CGA items and renal function. Method 254 consecutive elderly subjects (mean age 79.9±6.6 years, female 65.8%) from the geriatric division of a large Italian community hospital were studied. We collected clinical data including CGA and renal function (CKD-EPI formula). CGA single items included the Cumulative Illness Rating Scale (CIRS), the Exton Smith Scale (ESS), the Mini Nutritional Assessment Short Form (MNA-SF), the Katz‘s Activities of Daily Living (ADL), the Lawton’s Instrumental Activities of Daily Living (IADL), the Short Portable Mental Status Questionnaire (SPMSQ) and the amount of drugs administered (AD). Results Mean eGFR was 66.37±30.94 mL/min/1.73 m2. Overall, the reported CIRS, ESS, MNA, ADL and AD scores were low (7.6±3.3) while IADL and SPMQ were on a mild range, denoting a potential alarm signal for poor prognosis and the risk for adverse outcomes. At univariate analyses, eGFR was significantly associated with CIRS (R=-0.389, p&amp;lt;0.0001), ESS (R=0.355, p&amp;lt;0.0001), MNA (R=0.394, p&amp;lt;0.0001), ADL (R=0.394, p&amp;lt;0.0001), AD (R=-0.374, p&amp;lt;0.0001. while a weak, although significant correlation was found with IADL (R=0.131, p=0.038) and SPMSQ (R=-0.141, p=0.038). In a fully adjusted multivariate analyses only SPMSQ (ß=-0.174, p=0.04), ADL (ß=0.182, p=0.012), IADL (ß =0.209, p=0.003) and AD (ß=-0.354, p&amp;lt;0.0001) remained significant predictors of residual renal function. Conclusion In elderly frail subjects, residual renal function may influence daily life and cognitive activities, the perceived quality of living and the entity of drug assumption. Inclusion of renal function within a comprehensive geriatric assessment could help improving risk stratification in the elderly

Effects of Polypharmacy on Appetite and Malnutrition Risk Among Institutionalized Lebanese Older Adults - Preliminary Results

Abstract Objectives We aimed to assess the polypharmacy effect on appetite and malnutrition risk among Lebanese nursing home residents. We hypothesized that polypharmacy will be associated to lower appetite and increased of malnutrition. Methods A cross-sectional pilot study was carried out in two nursing homes in the North-Lebanon region. Fifty-three older adults (OA) aged 60 and above were recruited and were interviewed face-to-face. A general questionnaire was administered to gather information about their socio-demographics, dietary habits and physical activity routine. Appetite was evaluated by the Simplified Nutritional Appetite Questionnaire (SNAQ) validated for use with nursing homes residents. The participants' nutritional status was assessed using the Short Form of the Mini-Nutritional Assessment (MNA-SF). Polypharmacy was determined if OA were taking 5 or more medications. Information about attitudes towards the use, the number and the cost of medications was also collected. Differences in SNAQ and MNA scores based on polypharmacy were tested using Independent t-tests. Logistic regression was performed to assess the association between polypharmacy and nutritional status after adjusting for several factors. Results Our sample constituted of 49.1% females with an average age of 67.6 ± 3.8 and BMI of 22.3 ± 1.7 kg/m2. The majority were widowed (79.2%) and had a low level of education (85% elementary education). Regarding the MNA scores, 33% had a normal nutritional status while 59% were at risk of malnutrition and 8% were malnourished, with an average MNA score of 10.1 ± 2.2. The average SNAQ score was 11.0 ± 3.3, with 85% scoring ≤14, indicating an significant risk of at least 5% weight loss withing 6 months. Regarding medication use, 50.9% of OA take at least 5 drugs/d with an average of 4.3 ± 2 drugs. Independent t-tests showed that MNA scores were significantly lower in those taking 5 drugs/d vs those taking less (9.4 ± 2.5 vs 10.8 ± 1.6, P = .024) while no significant difference was observed for SNAQ scores (10.3 ± 2.9 vs 11.6 ± 3.6, P = .13). Logistic regressions did not show any significant association between polypharmacy and MNA or SNAQ categories. Conclusions Lower MNA scores were observed in OA taking ≥5 drugs/d indicating a higher risk of malnutrition with polypharmacy. This is significant since malnutrition can further worsen the aging process. Funding Sources N/A.

The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study

BackgroundWorldwide, 1.3 million patients sustain a hip fracture every year. In Canada, 23 621 patients over 60 have been admitted with a hip fracture in 2003. Few authors have yet investigated the full postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. HypothesisMost geriatric patients undergoing surgery for a hip fracture will not be able to return to their original residence at one-year of follow-up. ObjectiveTo characterize the full one-year postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. Patients and methodsThis is a prospective observational cohort study of geriatric patients undergoing surgery for a hip fracture from 2011 to 2017 in an academic center. A total of 254 patients were enrolled in this cohort. Demographic data and scores were collected throughout the hospitalisation. Patients’ residences were assessed pre-fracture and at 1, 3, 6 and 12-month post-hospitalisation. ResultsMost patients evolved in one of the following trajectories at one-year; (1) 30% (n=63) went back at home, (2) 11% (n=22) went back to a senior residence, (3) 16% (n=36) needed rehabillitation, (4) 13% (n=28) were discharged to a different location than prior to admission and (5) 18% (n=37) were deceased. Patients evolving in trajectory 1 were younger (mean, 80.8±11.1, p<0.0001). Patients evolving in trajectory 5 had lower MNA11Mini Nutritional Assessment scores (mean, 19.9±5.2, p.<0.0001) and lower MMSE22Mini-Mental State Examination scores (mean, 16.0±10.9, p<0.0001). The delay between discharge from the attending staff and real departure from the hospital was correlated to low MNA scores (−0.35627, p<0.0001), low MMSE scores (−0.35910, p=0.0004) and associated with the need for a rehabilitation center (trajectory 3) (mean, 2.67±4.36 days, p=0.0002). DiscussionThe postoperative evolution of geriatric patients with a hip fracture will continue to worsen due to the aging of the population. However, this study highlights important issues such as nutritional assessment, cognitive disorders and access to rehabilitation centers. Level of evidenceII, prospective cohort study.

Effect of individualized diet nursing intervention on prognosis, MNA and MNA-SF scores of elderly patients with chronic heart failure

Objective To explore and analyze the effects of individualized dietary nursing intervention on prognosis and MNA (Mini Nutritional Score) and MNA-SF (Modified Mini Nutritional Score) score in elderly patients with chronic heart failure. Methods A total of 100 elderly patients with chronic heart failure admitted to our hospital from February 2016 to February 2017 were selected and divided into observation group and control group according to random number table, 50 cases in each group. Patients in the control group were given routine nursing intervention, patients in the observation group were given personalized diet nursing intervention on the basis of patients in the control group.Serum albumin and prealbumin, MNA-SF and MNA scores, hospitalization indexes and efficacy were observed and recorded in the two groups before and after intervention. Results There was no significant difference in serum albumin between the two groups before intervention (P>0.05). Serum albumin of the two groups was significantly higher after intervention than before intervention (P 0.05). Serum prealbumin was significantly higher in the two groups after intervention than before intervention (P 0.05). MNA-SF was significantly higher in the two groups after intervention than before intervention (P 0.05). MNA of the two groups was significantly higher after intervention than before intervention (P<0.05). However, MNA in the observation group was significantly higher than that in the control group (P<0.05). The length of stay, readmission rate and mortality in observation group were significantly lower than those in control group (P<0.05), while the readmission time was significantly higher than the control group (P<0.05). After rank-sum test, the difference between the two groups was statistically significant (U=9.438, P=0.000). The total effective rate of the observation group was significantly higher than that of the control group, and the difference was statistically significant (χ2=5.761, P=0.007). Conclusion Individualized dietary nursing intervention can effectively improve nutritional status, prognosis, MNA and MNA-SF scores of elderly patients with chronic heart failure. Key words: Personalized care; Old age; Chronic heart failure; Nutrition