Nutritional Assessment Score Research Articles

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment.

Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0–86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.

Nutritional Risk Assessment Scores Effectively Predict Mortality in Critically Ill Patients with Severe COVID-19.

Background: Malnutrition predicts a worse outcome for critically ill patients. However, quick, easy-to-use nutritional risk assessment tools have not been adequately validated. Aims and Methods: The study aimed to evaluate the role of four biological nutritional risk assessment instruments (the Prognostic Nutritional Index—PNI, the Controlling Nutritional Status Score—CONUT, the Nutrition Risk in Critically Ill—NUTRIC, and the modified NUTRIC—mNUTRIC), along with CT-derived fat tissue and muscle mass measurements in predicting in-hospital mortality in a consecutive series of 90 patients hospitalized in the intensive care unit for COVID-19-associated ARDS. Results: In-hospital mortality was 46.7% (n = 42/90). Non-survivors had a significantly higher nutritional risk, as expressed by all four scores. All scores were independent predictors of mortality on the multivariate regression models. PNI had the best discriminative capabilities for mortality, with an area under the curve (AUC) of 0.77 for a cut-off value of 28.05. All scores had an AUC above 0.72. The volume of fat tissue and muscle mass were not associated with increased mortality risk. Conclusions: PNI, CONUT, NUTRIC, and mNUTRIC are valuable nutritional risk assessment tools that can accurately predict mortality in critically ill patients with COVID-19-associated ARDS.

Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study

BackgroundWith ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.MethodsThis intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.ResultsAfter the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.ConclusionAn individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.Trial registrationClinicalTrials.gov: NCT02214758. Date of trial registration: 12/08/2014.

MO854: Implementation of a Geriatric Assessment in Elderly Hemodialysis Patients

Abstract BACKGROUND AND AIMS Elderly patients who are on hemodialysis (HD) have a higher burden of multimorbidity and geriatric syndromes, that are underdiagnosed. These aspects affect quality of life and may lead to higher hospitalization rates and mortality rates. Despite guideline recommendations, geriatric assessment is not part of standard clinical care. The aim of this study was to assess the prevalence of geriatric impairments and frailty in patients ≥ 65 years old on maintenance HD by means of a geriatric assessment (GA). METHOD Cross-sectional study involving patients ≥ 65 years old on maintenance HD at a secondary Hospital in Ecuador between March and April 2021. Baseline demographic data, clinical and dialysis characteristics were collected from the medical charts and during the baseline assessment. All participants underwent a GA, including 5 domains: (1) comorbidity burden: Charlson comorbidity Index, (2) assessment of basic and instrumental activities of daily living (ADL: Barthel Index and iADL: Lawton and Brody index), (3) cognition: Pfeiffer Short Portable Mental Status Questionnaire, (4) mood: 5-item version of the Geriatric Depression Scale and (5) nutrition: Mini Nutritional Assessment (MNA) score. In addition, 3 frailty screening tools were applied: Frail-VIG Index (IF-VIG), Clinical Frailty Scale (CFS) and the clinical judgment of the nephrologist (surprise question). For the clinical judgment, the treating physician was asked to indicate if he would be surprised if the patient died in the next 6 months. Data were summarized using means with standard deviation or proportions when appropriate. Differences regarding baseline characteristics and outcomes between fit and frail patients stratified according to the Frail-VIG Index were assessed using Chi-squared tests and t-tests as appropriate. RESULTS Thirty-two patients were included, mean age 72.2 ± 5.83 years and 78.1% (n = 25) were men. Geriatric impairments were highly prevalent. Most frequently impaired geriatric domains were: functional performance (ADL 71.9% and iADL 75%), depression (40,6%), risk for malnutrition (68.8%), symptoms of cognitive decline (25%) and severe comorbidity (Charlson Index = 5.6 ± 2.3). The prevalence of frailty differed widely according to the different frailty screening tools. According to the IF-VIG, CFS and the clinical judgment, 56.2%, 37.7% and 35% of the patients were found frail, respectively. No differences between frail and fit patients were found in demographics nor in the prevalence of impairment in cognition, symptoms of depression, malnutrition, severe comorbidity or impairment in basic activities of daily living. Frail patients were more care dependent in their instrumental iADL compared with the fit group (P = 0.024) (Figure 1). CONCLUSION Geriatric impairments are highly prevalent in patients ≥ 65 years old on chronic HD. Since impairments can be missed when not searched for in regular dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.

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

Nutritional and physical improvements in older adults through the DOREMI remote coaching approach: a real-world study

BackgroundMalnutrition (excess or defect) and sedentariness act as an accelerator in the older people frailty process. A systemic solution has been developed to engage older people in a healthier lifestyle using serious games and food monitoring. The study aimed to evaluate protocol influence on variables related to unhealthy behaviors improving dietary habits through a remote nutritional coaching approach and stimulating the population to increase physical activity through Exergames. MethodsThirty-two subjects (25 Treatments and 7 Controls, aging 65–80 years), of which 15 (11 Treatments and 4 Controls) living in the UK (ACCORD and ExtraCare Villages placed in Shenley Wood (Milton Keynes), St. Crispin (Northampton), and Showell Court (Wolverhampton)) and 17 (14 Treatments and 3 Controls) in Italy (Genoa, Liguria), were recruited and characterized in terms of nutritional status, physical, somatometric, hemodynamic and biochemical measurements, and body composition. Participants were stimulated to adopt the Mediterranean dietary pattern, by a food diary diet-app, and perform regular physical activity, by the Exergame app, for three months. At the end of the trial, users underwent the same test battery. Data were tested for normality of distribution by the Shapiro-Wilk test. Comparisons between groups were performed at baseline by unpaired Student's t-test for continuous variables, chi-square test, or Fisher's exact test for categorical variables. Analysis of Variance (ANOVA) for repeated measures was used to analyze the significance of changes over time between groups. ResultsAt the end of the trial, significant reductions of systolic (15 mmHg, P = 0.001), diastolic (5 mmHg, P = 0.025), mean (10 mmHg, P = 0.001) blood pressure, and rate-pressure product (RPP) (1,105 mmHg*bpm, P = 0.017) values were observed in DOREMI users. A trend of improvement of physical performance by the short physical performance battery (SPPB) was observed for balance and walk subtests. A significant decrease (0.91 kg, P = 0.043) in Body Mass Index (BMI) was observed in overweight subjects (BMI >25 kg/m2) after DOREMI intervention in the entire population. The Mini Nutritional Assessment (MNA) score (1, P = 0.004) significantly increased after intervention, while waist measure (3 cm, P <0.001) significantly decreased in the DOREMI users. A reduction in glycated hemoglobin (Hb) was registered (0.20%, P = 0.018) in the DOREMI UK users. ConclusionsImprovement of healthy behavior by technological tools, providing feedback between user and remote coach and increasing user's motivation, appears potentially effective. This information and communication technologies (ICT) approach offers an innovative solution to stimulate healthy eating and lifestyle behaviors, supporting clinicians in patient management.

Relationship between Nutritional Status, Frailty, and Cognitive Function among Elderly at Dr. H. Moch. Ansari Saleh General Hospital Banjarmasin

The elderly often have nutritional problems. The risk of malnutrition can stimulate the prevalence of frailty and declining cognitive function in the elderly. The study aimed to analyze the relationship between nutritional status, frailty, and cognitive function in the elderly at Dr. H. Moch. Ansari Saleh Hospital Banjarmasin. This study was analytic observational using a cross-sectional method. A sample of 93 elderly was obtained using a total sampling technique according to the inclusion and exclusion criteria. The nutritional status assessment was done using the Mini Nutritional Assessment-Short Form (MNA-SF), the Edmonton Frailty Scale (EFS), and the Mini-Mental State Examination (MMSE). The results showed that the mean of Mini Nutritional Assessment score was 12.00±2.126, the average frailty score was 4.41±1.872, and the average value of cognitive function was 25.98±2.923. Data were analyzed using the Spearman's non-parametric correlation test with a 95% confidence level. The correlation test results between nutritional status and frailty obtained p=0.000 and r=-0.490. The correlation test results between nutritional status and cognitive function obtained p=0.000 and r=0.595. In short, there is a relationship between nutritional status on frailty and cognitive function in the elderly at Dr. H. Moch. Ansari Saleh General Hospital Banjarmasin, it means that the good nutritional status in the elderly, the risk of frailty syndrome will decrease and improve cognitive function.

Factors Contributing to Malnutrition in Parkinson's Disease Patients With Freezing of Gait.

Background and PurposeLittle is known about the nutritional status and clinical characteristics of patients with Parkinson's disease with freezing of gait (PDFOG). The purpose of this study was to describe the relationship between nutritional status and characteristics of patients with PDFOG.MethodsIn this cross-sectional study, 178 PDFOG patients were recruited and classified as nutritionally normal or at risk of malnutrition/already malnourished based on their Mini Nutritional Assessment (MNA) scores. Each participant underwent a structured questionnaire, physical examination and routine serum biochemical tests.ResultsWe found that 44.4 and 37.1% of PDFOG patients were malnourished [mini nutritional assessment (MNA) score <17] and at risk of malnutrition (17 ≤ MNA score ≤ 23.5), respectively. Compared to patients with normal nutrition, PDFOG patients with malnutrition and at risk of malnutrition had longer duration of Parkinson's disease (PD) and freezing of gait (FOG), more levodopa equivalent daily doses (LEDD), lower body mass index (BMI), more motor symptoms according to the Unified PD Rating Scale-III (UPDRS-III) and non-motor symptoms according to the PD Non-motor Symptoms Questionnaire (PD-NMS) (P < 0.05). Uric acid, albumin, prealbumin, and total cholesterol (TC) differed between the two groups (P < 0.05). High Hoehn and Yahr (H-Y) stage, high Freezing of Gait Questionnaire (FOGQ) scores, low TC and low uric acid were risk factors for malnutrition in patients with PDFOG.ConclusionOur results showed disease severity, motor symptoms, TC levels and uric acid levels were all associated with nutritional status in patients with PDFOG. This study suggest early discovery of the nutritional status of PDFOG patients is important.

Denutrition in Cirrhosis: Prevalence and Risk Factors among a Moroccan Center

Background: Denutrition is common in patients with liver cirrhosis and is recognized as an independent prognostic factor. Its prevalence is correlated with the severity of cirrhosis. Its evaluation is difficult to quantify, due to the presence of many confounding factors, interfering with the usual nutritional parameters. The aim of this work is to evaluate the prevalence of undernutrition among cirrhotic patients using different methods and to identify the risk factors. Methods: we conducted a prospective descriptive and analytical study of cirrhotic patients, nutritional status was assessed by body mass index (BMI), brachial circumference (BC), nutritional index, mini nutritional assessment (MNA) score, and by the results of the biological assessment. Results: 135 patients were included, the average age was 50 years the sex ratio was M/F=1/2. The etiology of cirrhosis was essentially viral. The severity of cirrhosis was estimated according to the Child score which B in 59.25% and C in 18.55% of cases. All patients were on a low-salt diet, 55.55% of them had anorexia. The mean body mass index was 20.7 kg/m2. The brachial circumference was in favor of undernutrition in 50 patients. After analytical study, the risk factors significantly associated with anthropometric values in favor of undernutrition were: poor socioeconomic conditions, digestive disorders, low-salt diet, existence of hepatic encephalopathy. Conclusion: Denutrition in cirrhotic patients constitutes a prognostic factor of mortality independent of cirrhosis, and its evaluation is therefore of increasing interest in the management of cirrhotic patients. In our population, nutritional indexes and BC were the most sensitive methods for the detection of undernutrition. In our population, nutritional indexes and BC were the most sensitive methods to detect undernutrition. The risk factors were related to circumstances inducing a decrease in food intake and hypermetabolism.

Pacientes com Síndrome Pós-Covid-19 apresentam risco de desnutrição e obesidade: achados de um ambulatório de seguimento

ABSTRACT Objective To evaluate the nutritional and functional status, swallowing disorders, and musculoskeletal manifestations of patients with Post-Covid-19 Syndrome, stratified by the Appendicular Skeletal Muscle Mass Index. Methods This is a cross-sectional study with patients diagnosed with Post-Covid-19 Syndrome after discharge from the intensive care unit of a university hospital. The evaluated outcomes were: nutritional status (Mini Nutritional Assessment, bioimpedance and anthropometry), swallowing disorders (Dysphagia Risk Evaluation Protocol), functional status (Post-Covid-19 Functional Status Scale), and musculoskeletal manifestations. According to the Appendicular Skeletal Muscle Mass Index, patients were stratified in terms of loss or not loss of muscle mass. Results Thirty-eight patients were included in the study, 20 stratified into the no loss of muscle mass group (17 females; 49.45±12.67 years) and 18 into the loss of muscle mass group (18 males; 61.89±12.49 years). Both groups were at risk of malnutrition (Mini Nutritional Assessment scores between 17–23.5 points; No Loss of Muscle Mass Group: 21.82±3.93; Loss of Muscle Mass Group: 23.33±3.41) and obesity (No Loss of Muscle Mass Group: 33.76±6.34; Loss of Muscle Mass Group: 30.23±3.66). The groups differed in terms of bioimpedance parameters (except fat mass) and age. However, there were no differences in swallowing alterations, functional status, and musculoskeletal manifestations. Conclusion Patients with Post-Covid-19 Syndrome, stratified according to the Appendicular Skeletal Muscle Mass Index, were at risk of malnutrition and obesity. The persistence of fatigue, weakness, myalgia and arthralgia at 6 months after hospital discharge is noteworthy. These findings emphasize the importance of comprehensive care for patients with Post-Covid-19 Syndrome.

Body Mass Index Affect Extracellular Mass/Body Cell Mass Ratio The Most

ABSTRACT&#x0D; Background: Extracellular mass/body cell mass (ECM/BCM) ratio is a independent predictor mortality in nutritional status and certain chronic disease. ECM/BCM ratio is influenced by various factors such as muscle mass, blood cells, bone mass, tendons, total body water, and certain chronic diseases.&#x0D; Objective: Determine factors associated with elderly ECM/BCM ratio in Jakarta nursing home.&#x0D; Methods: This observational cross-sectional study was conducted in four nursing home in Jakarta. Nutritional status measured with Mini Nutritional Assessment (MNA) score, Body Mass Index (BMI), Waist Circumference (WC), Mid-Arm Circumference (MAC), and calf circumference (CC) using measurement. ECM/BCM ratio is measured using Maltron Bioscan 916, Pearson correlation and Kendall's Tau B were used for bivariate analysis. Simple linear regression was used for multivariate analysis.&#x0D; Results: A total of 74 subjects were recruited (mean age 72.12 years, 71.6% women). Body mass index (p&lt;0.05), WC (p&lt;0.05), and CC (p&lt;0.05) were negatively associated with ECM/BCM ratio, while MNA score (p&lt;0.05) and age (p&lt;0.05) were positively associated with ECM/BCM ratio. There wasn't any significant difference in TBW between male and female elderly. In the multivariate linear regression analysis, BMI was negatively associated with ECM/BCM ratio (p&lt;0.05).&#x0D; Conclusions: Significant relationship were found independently between MNA score, BMI, WC,MAC, and age with ECM/BCM ratio. Body mass index is the main factor associated with ECM/BCM ratio in the elderly in Jakarta nursing homes. Our findings suggest that elderly with lower BMI have higher ECM/BCM ratio.

Malnutrition in patients admitted to in-hospital cardiac rehabilitation: Clinical correlates and association with mortality.

Malnutrition is highly prevalent among hospitalized patients; thus, an accurate identification of malnutrition could improve the outcome of these patients. The aim of the present paper was to apply multiple methods to evaluate the prevalence of malnutrition and clinical correlates in patients admitted to in-hospital cardiac rehabilitation. We performed a prospective study of 426 patients admitted to in-hospital cardiac rehabilitation: 282 (66.2%) had undergone a major cardiac surgery and 144 (34.8%) had experienced heart failure. The albumin level and Mini Nutritional Assessment (MNA) scores were applied to evaluate the nutritional status of these patients. Serum albumin levels were < 3.5 g/dl in 147 (34.5%) patients, and MNA scores were < 24 in 179 (42.0%) patients. Patients with malnutrition or a risk of malnutrition had lower haemoglobin values, lower EuroQol scores and poorer functional status. Female gender, age, functional status and Cumulative Illness Rating Scale severity were predictors of malnutrition. Over a median follow-up of 47 months, MNA scores <24 were associated with higher mortality, even after correction for confounding variables. In conclusion, in patients admitted to in-hospital cardiac rehabilitation, malnutrition and risk of malnutrition frequently occur and are associated with poor functional status, higher clinical complication rates and long-term mortality.

S1352 Changes in Mini Nutritional Assessment Scores and BMI in Geriatric Oncology Patients at Days 0, 30, 90 and 180 Post Cancer Treatment

S1352 Changes in Mini Nutritional Assessment Scores and BMI in Geriatric Oncology Patients at Days 0, 30, 90 and 180 Post Cancer Treatment

Impact of quality of life on nutritional risk and malnutrition: a cross-sectional study in elderly patients

Objectives: To investigate prevalence of malnutrition and nutritional risk, related factors, and the association between nutritional status and quality of life in the elderly.&#x0D; Material and Method: Cross-sectional study. Participants; elderly (≥65 years) patients without severe hearing and vision impairment and dependency on a bed or wheel chair who admitted internal medicine outpatient clinics. Measurements; the mini nutritional assessment questionnaire, Charlson comorbidity index, the World Health Organization quality of life (WHOQOL-OLD) questionnaire. Intervention; none.&#x0D; Results: The study included 532 patients with a mean age of 70.8±5.4 years. The median Mini Nutritional Assessment score was 26, and the total prevalence of nutritional risk and malnutrition was 26.7%. There were significant differences between the nutritional groups regarding the educational, living, and marital status, smoking history, presence of any systemic disease, Charlson Comorbidity Index, and polypharmacy (p

Mini Nutritional Assessment and physical function of older people in residential aged care facility, Bangladesh.

Malnutrition may decrease physical function and exacerbate health conditions and thus have a negative effect on health-related quality of life of older people. The study was aimed at evaluating the extent of malnutrition, physical function and other associated risk factors for the older persons (>65 years) living in the residential aged care facilities in Bangladesh. A cross-sectional study was performed with a sample of 200 older people in various residential aged care facilities in Dhaka, Bangladesh. Nutritional status was evaluated using the Mini Nutritional Assessment. A structured questionnaire was used to assess the socioeconomic condition, dietary diversity, functional ability and other related risk factors for malnutrition. According to the Mini Nutritional Assessment, 33.5% of participants living in residential aged care facilities were malnourished and 52.5% were at risk of malnutrition. Dietary diversity score differs significantly (p<0.001) among malnourished (3.78 ± 0.45), at risk of malnutrition (4.46 ± 0.98) and well-nourished (4.75 ± 1.11) groups. Twenty-five percent of the study participants reported limitations in mobility and 26.5% reported limitations in activities of daily living. Females were more vulnerable in terms of malnutrition and physical function than males. Mini Nutritional Assessment score is significantly correlated (p<0.05) with several risk factors for malnutrition such as body mass index, education level, meal, protein consumption, dietary diversity score, weight loss, reduced food intake, mobility and activities of daily living of the older people. The study reaffirms that a high rate of malnutrition and risk of malnutrition is prevalent among aged care residents, who need special attention and may benefit from individualized nutrition interventions.

Epidemiology of geriatric syndromes among older people residing in six old-age homes of Delhi-NCR.

The frequency of geriatric syndromes (GSs) such as cognitive impairment (CI), depression, and malnutrition among older people residing in old-age homes (OAHs) of Delhi-National Capital Territory Region (NCR) has not been reported. The availability of such data determines the quality of health care. The present study aims to assess the frequency of GS among residents of six OAHs in Delhi-NCR. The study was carried out after obtaining informed written consent from all participants. The team comprising doctors, physiotherapists, and nurses visited the OAHs and assessed GSs using a psychometrically validated screening tool ICT-BRIEF 30. Other standard tools such as Snellen's chart, whisper voice test, mini nutritional assessment, time up and go test score, Mini-Cog, and geriatric depression scale 5 were used to assess vision, hearing, nutrition, mobility, cognition, and mood, respectively. Out of 131 participants, low vision was observed in 69.47%, hearing impairment in 20.61%, malnutrition in 12.9%, risk of fall in 18.32%, CI in 46.56%, and depression in 62.59% of the participants. Hearing impairment was found to be significantly associated with quality of life and cognition. The present study from Delhi showed high frequency of vision impairment, CI, frailty, depression, and malnutrition in older people residing in OAHs. 20% of the participants had functional loss due to various reasons. Hence, the owner/caretaker of OAHs of Delhi/NCR needs to be proactive in screening the residents for various GSs to provide quality care to the residents.

Excessive Daytime Sleepiness is Associated With Malnutrition, Dysphagia, and Vitamin D Deficiency in Older Adults

ObjectivesBoth excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia. DesignCross-sectional study. Setting and ParticipantsA total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included. MethodsAll patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS. ResultsThe mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted. Conclusions and ImplicationsThere is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.

Prospective trial to evaluate the prognostic value of different nutritional assessment scores for survival in pancreatic cancer surgery

Abstract Objective Malnutrition is associated with poor survival in pancreatic cancer patients. Nutritional scores show great heterogeneity diagnosing malnutrition. The aim of this study was to find the score best suitable to identify patients with malnutrition related to worse survival after surgery for PDAC. Methods Risk of malnutrition was evaluated preoperatively using twelve nutritional assessment scores. Patients were followed-up prospectively for at least 3 years. Patients at risk for malnutrition were compared to those not at risk according to each score using Kaplan Meier survival statistics. Results A total of 116 Patients receiving a PDAC resection in curative intent were included. Malnutrition according to the Subjective Global Assessment score (SGA), the Short Nutritional Assessment Questionnaire (SNAQ) and the INSYST2 score was associated with worse overall survival (SGA: at-risk: 392 days; not at-risk: 942 days; p = 0.001; SNAQ: at-risk: 508 days; not at-risk: 971 days; p = 0.027; INSYST2: at-risk: 538 days; not at risk: 1068; p = 0.049). In the multivariate analysis SGA (HR of death 2.22, 95% CI 1.37-3.6, p = 0.002) was associated with worse overall survival. Conclusion Malnutrition as defined by the Subjective Global Assessment is independently associated with worse survival in resected PDAC patients. The SGA should be used to stratify PDAC patients in clinical studies. If severely malnourished patients according to the SGA profit from intensified nutritional therapy should be evaluated in a randomized controlled trial.

Are Nutritional Screening Scores Associated with the Serum Albumin Levels and the Presence of Bedsores in Bedridden and Chairbound Home Care Patients?

Based on the fact that immobile bedridden patients have a high risk of developing bedsores and infection, we evaluated whether the presence of bedsores and low serum albumin levels significantly alter the scores of long and short forms of Mini Nutritional Assessment and body mass index. From January to July 2016, 143 bedridden/chairbound home care patients were visited with the Karaman State Hospital home healthcare team. The Mini Nutritional Assessment and Mini Nutritional Assessment-short form were used for nutritional evaluation. The retrospective serum albumin levels that had been analysed in the last 30 days, were recorded from the patients’ files. Also, the skin integrity was evaluated by the home care physician to detect the presence of bedsores. The mean Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores of the patients were 13.2±7.0 and 6.4±3.8, respectively. The mean serum albumin level was 3.2±0.6 g/dL, and 33 patients had bedsores. The Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores, and body mass index values in patients with normal serum albumin levels were significantly higher than those in patients with low serum albumin levels. Moreover, these nutritional parameters in patients with bedsores were significantly lower than those in patients without bedsores. Lastly, the serum albumin levels were found to be significantly positively correlated with all these nutritional parameters. (r=0.477 for Mini Nutritional Assessment; r=0.456 for Mini Nutritional Assessment-short form; r=0.451 for body mass index). Low Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores were significantly related to the presence of bedsores, providing strong evidence that malnutrition may be a major risk factor for bedsore formation. An effective, comprehensive, and holistic treatment protocol and care plan, including nutritional intervention, is important and necessary for immobile home care patients.

Influence of Conventional Complete Dentures and Different Attachment Types in Implant-Supported Overdentures on Quality of Life and Nutritional Status in Edentulous Geriatric Patients.

To determine whether the use of implant-supported overdentures (IODs) with different attachments influences the Mini Nutritional Assessment (MNA) and Geriatric Oral Health Assessment Index (GOHAI) scores in edentulous patients > 65 years of age. The MNA and GOHAI were administered to 54 edentulous patients > 65 years of age (mean age = 68.35 ± 4.1 years) before treatment (A) and 6 months after treatment (B): 10 with maxillary + mandibular conventional complete dentures (CDs); 10 with a maxillary conventional CD + mandibular magnetic-retained IOD; 12 with a maxillary conventional CD + mandibular ball-retained IOD; 12 with a maxillary conventional CD + mandibular Locator-retained IOD; and 10 with a maxillary conventional CD + mandibular bar-retained IOD. Statistical differences between treatment types were evaluated using one-way analysis of variance and paired-sample t tests. The correlation between MNA and GOHAI scores was determined using Pearson correlation analysis (α = .05). The difference between mean GOHAI-A and GOHAI-B scores was statistically significant for each type of denture (P < .005). The difference between the mean MNA-A and MNA-B scores was statistically significant for all types of denture except for conventional CDs (P < .05). There was a statistically significant positive correlation between MNA and GOHAI scores (P < .01). Regardless of the type of denture used, treatment of edentulous geriatric patients is important for improving nutritional status and self-rated oral health.