Nutritional Status In Elderly Patients Research Articles

The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population

Malnutrition is considered an important clinical problem in geriatric hospitalized patients, but no standard diagnostic criteria are available. The aim of this study was to investigate the effect of 7 different sets of diagnostic criteria (6 in hospitalized elderly and 1 in healthy elderly) from nutritional research studies on the prevalence of malnutrition in 151 elderly patients (49 men, 102 women, mean age 82.8 years) consecutively admitted to an acute geriatric ward. Nutritional status was assessed using anthropometric (body mass index, triceps skinfold thickness, mid arm circumference, arm muscle circumference), and laboratory (serum albumin) parameters, and 1 nutritional questionnaire (Mini Nutritional Assessment). The proportion of patients with malnutrition varied between 6.5 and 85%. It is important to assess the nutritional status in elderly patients because the prevalence of malnutrition in hospitalized elderly patients is substantial whatever criteria are used. However, the criteria for the diagnosis can differ by a factor of more than 10 in the number of patients classified as malnourished. A major goal for further research on malnutrition is to define more standardized and validated criteria in order to make comparisons of prevalence and outcome more meaningful, and ensure that all those who will benefit from a nutritional intervention are identified and treated.

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

Background and goal:Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. Methods:Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: ‘Anthropometric assessment’ based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 <- MNA ≤ 30), at risk of malnutrition (17 ≤ MNA ≤ 23.5), and undernutrition (MNA < 17). Also recorded were: age, gender, type of scheduled operation, and the American Society of Anesthesiologists (ASA) physical status score. Results are given as median (extremes). Results:Four hundred and nineteen patients (50.4% women) were seen between January and October1996. The mean age was 72 years (range, 60–98 years); BMI: 25.2 (12.8–40.4) kg m−2. The MNA score was recorded in 408 patients, ranging from 1.5 to 30 (median: 26). According to the score, the patients were stratified in: well-nourished, 276 patients (67.6%), at risk, 104 patients (25.5%) and suffering from overt malnutrition, 28 patients (6.9%). According to the ASA score, 290 patients were found to be at low or mild risk for anaesthesia and surgery (ASA 1 and 2), and 72 patients (24.8%) were stratified as being at least at risk of malnutrition. One hundred and eighteen other patients were found to be at a higher risk (ASA 3 and 4), and 58 (49.2%) were not well-nourished (MNA < 24). Conclusion:The MNA was found to be well-suited for the preoperative assessment during anaesthesia consultation because it required no biological marker. It showed that approximately one-third of all the examined patients, and half of the ASA 3–4 patients, were not well-nourished. The ASA score could not predict poor nutritional status. The results suggested that nutritional assessment should be routinely performed in ASA 3–4 patients over 60 years of age.

The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.

The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.

A Comparison of Nutritional Status in Elderly Patients with Diabetes Mellitus on Either a Calorie-Controlled or a no Concentrated Sweets Diet

LEARNING OUTCOME: The purpose of this study was to compare nutritional status in elderly patients with diabetes mellitus on either a calorie-controlled or a no concentrated sweets diet.Diabetes mellitus is one of the major diseases that affects the elderly population and diets that are used to treat this disease can affect nutritional status. The trend today is to liberalize the traditional calorie-controlled diet to a no concentrated sweets diet. This study compared the nutritional status of diabetic residents in long term care following restrictive calorie-controlled diets with diabetic residents following liberalized no concentrated sweets diets by using data from a retrospective audit of charts. Data from one hundred subjects were included; 50 elderly diabetic residents that followed a calorie-controlled diet, and 50 elderly diabetic residents that followed a no concentrated sweets diet. Comparisons were made on their blood glucose levels, cholesterol levels, body mass index, albumin levels, and their weight histories. Data were analyzed using t-tests and contingency tables with the SPSS computer system. Differences in nutritional status were few and not significant possibly making a no concentrated sweets diet an acceptable alternative to a calorie-controlled diet.

Assessing nutrition in elderly patients.

The nutritional status of elderly patients can have a significant bearing on their well-being. This article details how nurses can accurately assess the nutritional status and diet of elderly patients and plan appropriate care.

Ornithine oxoglutarate improved nutrition in elderly patients

LetterSeptember 1, 1995Ornithine oxoglutarate improved nutrition in elderly patientsMalayappa Jeevanandam, PhDMalayappa Jeevanandam, PhDSt. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA (M.J.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1995-123-2-056 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail To the EditorThe commentary by Saltzman (1) on the article by Brocker and colleagues (2) suggested unwarranted cautions on the clinical applications of the outcomes. Saltzman indicated that ornithine oxoglutarate (OGO), which is popularly known as OKG (ornithine-α-ketoglutarate), is not safe. Saltzman is correct in stating that OGO is not approved by the U.S. Food and Drug Administration (FDA), but this is only for parenteral use. FDA approval is not required for oral use, the form in this study, because the components of this compound are natural metabolites of the body and have no proven toxic or lethal side effects. ...References1 Saltzman JR. Commentary on “Ornithine oxoglutarate improved nutritional status in elderly patients after hospital discharge” ACP J Club. 1995 Jan-Feb;122:16. Comment on: Brocker P, Vallas B, Albarede Al, Poynard T. Age Ageing. 1994;23:303-6. Google Scholar2 Brocker P, Vellas B, Albarede JL, Poynard T. A two-centre, randomized double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age Ageing. 1994;23:303-6. Google Scholar3 Cynober L. Ornithine alpha-ketoglutarate in nutritional support. Nutrition. 1991;7:313-22. Google Scholar4 Jeevanandam M. Ornithine and ketoglutarate in trauma. Clinical Nutrition. 1993;12:61-2. Google Scholar1 Saltzman JR. Commentary on “Ornithine oxoglutarate improved nutrition in elderly patients.” ACP J Club. 1995 Jan-Feb;122:16. Comment on: Brocker P, Vallas B, Albarede Al, Poynard T. A two centre, randomized double-blind trial of ornithine oxoglutarate in 194 elderly ambulatory convalescent subjects. Age Ageing. 1994;23:303-6. Google Scholar2 Brocker P, Vellas B, Albarede JL, Poynard T. A two-centre, randomized double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age Ageing. 1994;23:303-6. Google Scholar3 Cynober L. Ornithine alphaketoglutarate in nutritional support. Nutrition. 1991; 7:313-22. Google Scholar Author, Article, and Disclosure InformationAffiliations: St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA (M.J.) Previousarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOrnithine oxoglutarate improved nutritional status in elderly patients after hospital discharge John R. Saltzman September 1, 1995Volume 123, Issue 2Page: 56KeywordsBody weightConvalescenceDiarrheaDrug administrationEatingElderlyExerciseFatsFoodGrowth hormoneHormone synthesisInsulin secretionInsulin-like growth factorsMeatMetabolitesMusclesNutritionOral healthProtein metabolismWeight gain ePublished: 9 March 2020 Issue Published: September 1, 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.Loading ...

Ornithine oxoglutarate improved nutritional status in elderly patients after hospital discharge

Source Citation Brocker P, Vellas B, Albarede AL, Poynard T. A two-centre, randomized double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age Ageing. 199...

Nutritional Status of Elderly Patients during Recovery from Chest Infection and the Role of Nutritional Supplementation Assessed by a Prospective Randomized Single-blind Trial

We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital, including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices. Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively, and randomized to receive supplement (500 ml of Ensure liquid daily) for 1 month, or no supplement, on discharge. Assessment at baseline, 1, 2 and 3 months included a questionnaire to determine health, mental and functional status, and anthropometric measurements. Biochemical nutritional status was assessed at baseline, 1 and 3 months, and dietary intake (24 h recall method) at 1 and 3 months. During recovery, both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status. In addition, the former group showed improvement in more anthropometric measurements, in thiamine and pyridoxine status, while the non-supplement group showed a lower level of functional ability after 3 months. Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups. We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections.

A study of the nutritional status of elderly patients with Parkinson's disease.

Patients with Parkinson's disease tend to lose weight although the reasons are uncertain. Fifteen patients with stable Parkinson's disease who had lost at least 5 kg in weight, and 15 age- and sex-matched control subjects were studied. All subjects underwent physical examination, anthropometric measurements, biochemical and haematological screening, measurement of tumour necrosis factor and full dietary assessment. The Parkinson's disease patients who had lost a mean of 6.2 kg had significantly less body fat and a lower total peripheral lymphocyte count than the control subjects. Dietary analysis showed a higher daily intake of calories in the patients which was derived from an increased carbohydrate intake. Tumour necrosis factor was not detected in either the patients or control subjects. Parkinson's disease patients lose weight in spite of an increased calorie intake. This may reflect an increased metabolic rate.

Nutritional status of elderly patients with venous ulceration of the leg–report of a pilot study

Twenty elderly patients who attended the wound‐healing research unit for treatment of a chronic leg ulcer took part in this pilot study. Nutritional analysis showed the diet to be poor generally, with mean energy, zinc and vitamin C intakes falling below the EAR and/or RNI for people of this age‐group. Iron intake and quality of protein in the diet also gave cause for concern. While no firm conclusions regarding the impact of nutrition on healing can be drawn from this study, these preliminary results suggest that this group of patients is at risk nutritionally.

Prognostic role of serum albumin and prealbumin levels in elderly patients at admission to a geriatric hospital

The incidence of biological malnutrition is very high in geriatric hospitalized patients. The aim of the present study was to investigate the nutritional status of elderly patients at the time of hospital admission in an effort to identify variables which influence the outcome of hospital stay. Forty-six percent ( 244 552 ) of the admitted patients had a serum albumin level less than 35 g/l. Cancer patients had a significantly ( p<0.0001) lower serum albumin and prealbumin values than other patients. The patients, who died, had even lower albumin values as compared to the cancer patients. None of the studied nutritional and social parameters showed correlation with the length of hospital stay in any group of patients. No significant correlation could be found between age and nutritional values. No significant correlation could be established between the social parameters and nutritional variables. By using variance analysis statistically significant association was found between cancer and serum albumin ( p<0.0001) as well as between the death occurring during the hospital stay and nutritional values ( p<0.0001). By the discriminant analysis model, the mortality during hospital stay could be predicted with 78.8% certainty when the presence of cancer, the albumin and prealbumin values were known. In addition, cancer status may be suspected in the case of low nutritional values at admission in these elderly patients. Our results indicate that by the measurement of these simple parameters an accurate prediction can be achieved in the prognosis of hospitalized geriatric patients already at the time of admission.

Total parenteral nutrition and tube feeding for elderly patients: findings of an OTA study.

A 1987 report by the US Office of Technology Assessment (OTA), Life-Sustaining Technologies and the Elderly discusses current utilization of tube feeding and total parenteral nutrition (TPN) for elderly people and the related issues of patient access to treatment, decision making practices, and quality of care. Factors that limit access for some elderly patients include negative attitudes of some health professionals about whether elderly people can benefit from tube feeding and TPN, lack of adequate nutritional standards for the elderly and lack of staff in some treatment settings who are trained and have enough time to assess nutritional status in elderly patients, and payment problems. Public controversy about life-sustaining technologies for elderly people now focuses on decisions about withholding or withdrawal of tube feeding, but debate about the legal and ethical issues involved in these decisions tends to obscure the relevant clinical considerations. Research issues and clinical practice concerns related to decision making and quality of care for elderly patients on tube feeding and TPN are discussed.

Discriminant biochemical markers for evaluating the nutritional status of elderly patients in long-term care

To determine the most discriminant serum markers of protein-energy status in elderly patients, we performed a discriminant analysis of 85 subjects grouped according to triceps skinfold and midarm circumference values as compared with reference percentiles. Results indicated that neither the classic serum indices of nutritional assessment nor retinol-binding protein can predict undernutrition. However, creatinine, urea, carotene, complement C3, and prealbumin included in a function enabled high discrimination between groups: 68% of subjects in 0–5th percentile for triceps skinfold and 75% of subjects in 0–5th percentile for midarm circumference are correctly predicted. Lower serum concentration was found in the lower anthropometric percentiles except for serum carotene, which showed an inverse relation not explained by diet. We found that nutritional alterations exist in hospitalized elderly patients. We emphasize the importance of considering several biochemical markers for detection of mal-nutrition and the pertinency of further exploration of serum carotene profiles in undernourished elderly patients.

Drugs and nutrition in old age

Drug effects are influenced by physiologic and pathologic changes that occur as a consequence of aging. The elderly may be more disposed to drug-induced nutrient depletion because of chronic illness, inadequate diet and long-term drug use. Digoxin, isoniazid, corticosteroids, diuretics and psychoactive agents pose special hazards to the nutritional status of elderly patients. On the other hand, dietary factors, such as protein levels or vitamin deficiencies, may be important determinants of age-related changes in drug disposition or toxicity.

The distribution of supposed indicators of nutritional status in elderly patients.

The results of a survey of indicators of nutritional status in patients on admission to wards in the Department of Health Care of the Elderly in Nottingham are reported. Results outside conventional limits of normality are common. Little or none of the observed variance in the biochemical indicators in this population is explained by age or sex. Weight, mid-arm circumference, triceps skinfold thickness, albumin, retinol binding protein and retinol tend to be lower in patients who subsequently die, in patients who are clinically classified as thin or wasted, in patients with poor appetites and in patients with a diagnosis of malignancy. Plasma vitamin C, erythrocyte glutathione reductase activation coefficient and erythrocyte transketolase activation coefficient do not show these trends and are likely to be determined by different factors.

Dietary intakes and nutritional status of elderly patients . Study in a private nursing home

Nutrient intake and several parameters of nutritional status were evaluated in patients sixty-three to ninety-three years of age. Although differences between men and women were observed, chronologic age did not exert a significant effect.