Nutritional Status In Geriatric Patients Research Articles

C-reactive protein/albumin ratio as a novel predictor for nutritional status of geriatric patients.

The C-reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients. A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross-sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p=.012). A significant negative correlation was also observed between the MNA score and the CAR (r=-0.196, p=.015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p=.012). The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.

The role of comprehensive geriatric assessment in the identification of different nutritional status in geriatric patients: a real-world, cross-sectional study.

Malnutrition is an often unrecognized problem, but it is common in older patients and leads to adverse outcomes. The purpose of this study is to analyze the prevalence of the risk of undernutrition in elderly patients and the correlation between CGA and nutritional status, and to determine the nutritional status of elderly patients. This is a real-world cross-sectional study of continuously enrolled elderly patients aged 65 years or older with a complete CGA database. CGA inventory was prepared by compiling and screening general information, body composition and blood biochemical results. MNA was also conducted for each elderly patient to screen for malnutrition. A multivariable logistic regression analysis was used to determine the association between the CGA and nutritional assessment. The average age of the 211 selected elderly patients (160 men and 51 women) was 79.60 ± 9.24 years, and their ages ranged from 65 to 96 years. After controlling for confounders, patients with a history of PUD (OR = 2.353, p = 0.044), increased ADLs & IADLs scores (OR = 1.051, p = 0.042) or GDS scores (OR = 6.078, p < 0.001) may increase the incidence of the risk of undernutrition respectively, while an increase in BMI (OR = 0.858, p = 0.032) may lower the incidence of malnutrition risk. In addition, increased ADLs & IADLs scores (OR = 1.096, p = 0.002) or GDS scores (OR = 11.228, p < 0.001) may increase the incidence of undernutrition. However, increased MMSE (OR = 0.705, p < 0.001), BMI (OR = 0.762, p = 0.034), UAC (OR = 0.765, p = 0.048) and CC (OR = 0.721, p = 0.003) may decrease the incidence of undernutrition, respectively. The study found that the prevalence of risk of undernutrition in elderly patients was the highest. Risk of undernutrition was independently associated with peptic ulcer disease, ADLs & IADLs, GDS and BMI. However, we found that when the nutritional status reached the level of undernutrition, it was related to more factors, including ADLs & IADLs, MMSE, GDS, BMI, UAC and CC. Determining the level of malnutrition through CGA may help to prevent and intervene malnutrition as early as possible.

Association between neutrophil to lymphocyte ratio, handgrip strength and nutritional status in geriatric patients

PurposeThis study aims to examine the relationship between neutrophil to lymphocyte ratio (NLR), handgrip strength (HGS) and nutritional status in non-critically ill patients and outpatients.Design/methodology/approachA cross-sectional study was conducted on 80 geriatric patients. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form, Geriatric Nutritional Risk Index, some anthropometric and biochemical parameters. NLR was calculated from the complete blood count results. Data were analyzed using SPSS 24.0.FindingsWhile 38.3% of patients were malnourished or at risk of malnutrition, 61.7% had normal nutritional status. Mini Nutritional Assessment Short Form was not correlated with NLR, whereas it showed a weak positive correlation with HGS. According to the logistic regression analysis, age, HGS, hemoglobin and platelet to lymphocyte ratio were significant independent factors for predicting malnutrition or risk of malnutrition. The receiver operator characteristic curve analysis showed that the optimum HGS cut-off point for patients with malnourished or at risk of malnutrition was 13.2. In conclusion, HGS was associated with the nutritional status. NLR was not associated with nutritional status but associated with nutritional risk.Originality/valueIt is well known that malnutrition is a serious health problem among older adults, and it is important to assess the nutritional status of older adults because of the adverse health effects. In addition, to the best of the authors’ knowledge, this is the first study to determine the relationship between NLR, HGS and nutritional status in non-critically ill patients and outpatients.

Influence of Malnutrition on Outcome after Hip Fractures in Older Patients.

Malnutrition might lead to a worse outcome in hip fractures of older patients. The purpose of this study is to analyze different indicators of malnutrition that lead to worse outcomes. 252 patients of a geriatric trauma unit were analyzed prospectively. Different demographic, as well as data on the trauma and whether osteoporosis prophylaxis or anticoagulation was present, were recorded. The nutritional status with respect to laboratory parameters as well as nutritional risk score was also analyzed. The main finding of this study is that a poor nutritional status is statistically significantly associated with higher mortality as well as worse independence (p &lt; 0.05). A postoperatively prescribed osteoporosis prophylaxis is protective of mortality and independence (p &lt; 0.05). Malnutrition of geriatric patients increases the risk for death, worse mobility, and independence after hip fractures. Osteoporosis prophylaxis prescribed during an inpatient stay enables patients to retain their independence. The nutritional status of geriatric patients with hip fractures should be obtained and provisions made.

The role of the nutritional status of geriatric patients with gastrointestinal cancer in developing postoperative complications

Background: Many studies have shown that geriatric patients with altered nutritional status are at higher risk of developing complications during medical treatment. Our study aimed to examine the role of preoperative nutritional status in developing postoperative complications and the length of hospital stay in geriatric patients who suffer from cancer and undergo major abdominal surgery. Methods: Prospective research was conducted at the Oncology Institute of Vojvodina from January 2020 until April 2021. This study included 82 patients over 65 years old, who were admitted to have radical surgery for gastrointestinal cancer performed. There were 6 patients excluded from the study. Nutritional status analysis was performed using BMI (Body mass index), preoperative serum albumin level, MNA-SF (Mini nutritional assessment- short form), and GNRI (Geriatric nutritional risk index). The classification of surgical complications was done using the Clavien-Dindo classification scale. Results: Of the total number of patients, 57 of them (75%) developed at least one surgical complication. Nonsurgical complications have been recognized in 28 patients (36.84%). Overweight patients, according to BMI, had a greater chance of developing grade I (p &lt; 0.01) and grade II (p &lt; 0.05) surgical complications of the Clavien-Dindo classification. Patients with normal serum albumin levels had a significantly lower chance of developing surgical complications of any grade (p = 0.00). BMI and MNA- SF were the most important predictors of delirium. Patients without GNRI risk (GNRI: &gt;98) had a significantly lower chance of developing nonsurgical complications regarding comorbidity exacerbation (p = 0.03), and delirium (p = 0.00). Conclusion: None of the nutritional assessment tools used in our study were better or more efficient than the others in our sample of patients. Precise nutritional status assessment is complex and we cannot use only one scoring system or scale to get accurate results.

Assessment of PUBMED Indexed Scientific Productions Related to Nutritional Status of Geriatric Patients: A Bibliometric Analysis

Geriatric patients (GP) have been on a rise in the past few decades. It is very essential to assess the nutritional status (NS) of such patients for constant care and support. So the aim of this bibliometric analysis was to provide a summary of countries, universities, authors, journals, and research data related to nutritional status in geriatric patients. Methodology: Many studies related to nutritional status (NS) in geriatric patients (GP) have been published in PubMed indexed journals from 2011 to 2021. Data was extracted from the Science Citation Index expanded core database. Publication of authors, journals, universities, and countries were retrieved and quantitatively analyzed using the R-Studio biblioshiny package.The core data set included a total of 43 Journals and books. 195 documents were recognized. Top 20 PubMed indexed journals were selected which published the data regarding NS. 20 universities were also analyzed for NS in GP. Average years from publication are 4.57 years. Results: A total of 195 documents were extracted. Documents were derived from 2011-2021. The number of documents/publications research steadily increased from 2011 to 2013. Then there was a fall in number of papers and research articles. Over the time, from 2015 till 2017, publications have steeply increased from all over the world. Again there was a gradual decrease in the articles from 2017-2021.

Is there a correlation between complete blood count parameters and nutritional risk score 2002, geriatric nutritional risk index and nutric score in geriatric patients admitted to intensive care unit

Aim: Malnutrition is a common condition especially in geriatric patients admitted to intensive care. There are various screening tools to be used in the evaluation of nutritional status in geriatric patients hospitalized in intensive care. However, a laboratory test has not been found yet for nutritional status assessment. With this study, we aimed to investigate whether there is a correlation between NLR, PLR, and complete blood count parameters at the time of admission to the intensive care unit and NRS-2002, GNRI, and mNutric Score measured in the intensive care unit.&#x0D; Material and Method: This retrospective study was performed in a tertiary intensive care unit of a Chest Diseases Hospital. Patients aged 65 and over were included in the study. Demographic data, length of stay in intensive care, complete blood count on the day of admission to the intensive care unit, albumin value, NLR, PLR, NRS-2002, GNRI, and mNutric Score values were recorded.&#x0D; Results: A total of 218 geriatric patients were analyzed. It was determined that 72.5% of the patients were at medium/high risk in terms of nutritional risk according to the GNRI classification, 76.6% were at high risk according to NRS-2002, and 84.9% were at high risk according to the mNutric score. According to the GNRI, the MPV values were statistically significantly higher (p

The Effect of Complete Denture Rehabilitation on Nutritional Status of Geriatric Patients

Background: Nutrition in elderly patients has been the topic of interest in field of geriatrics. Quality of life is directly correlated with nutritional status in geriatric patients. Aim of the Study: This study was undertaken to evaluate the nutritional status when completely edentulous patients were rehabilitated with conventional complete dentures. Materials and Methods: Hundred edentulous patients, in the age group of 45–65 years, were selected, and biochemical blood analysis was done at three different time periods (0, 3, and 6 months after delivery of complete dentures) for levels of calcium, protein, phosphorus, and hemoglobin in blood. The results at three different time periods were then compared to evaluate the change in the values of these nutrients in the body. Results: Loss of teeth was associated with lower than normal values for calcium, protein, phosphorus, and hemoglobin in blood. There was a significant improvement in the blood calcium and protein levels at the end of 3 months, whereas there was no significant improvement in the blood phosphorus and hemoglobin. Conclusion: Complete denture rehabilitation has a definite positive impact on nutritional status of geriatric patients.

Effect of serum vitamin D, calcium, and phosphorus on mandibular residual ridge resorption in completely edentulous participants: A clinical study

Statement of problemPublished data regarding association between edentulous mandibular residual ridge resorption and nutritional status of geriatric patients is limited. PurposeThe purpose of this clinical study was to evaluate the degree of mandibular residual ridge resorption in completely edentulous participants and to investigate the role of dietary nutrients in the resorption process. Material and methodsThree hundred (55% men and 45% women; aged between 35 and 85 years) completely edentulous participants with specific inclusion and exclusion criteria were enrolled for the study. A standardized panoramic radiograph was made, measurements were made digitally, and the amount of resorption was calculated using the Wical and Swoope method. The blood plasma levels of vitamin D3 were analyzed by using the direct competitive chemiluminescence immunoassay (CLIA) method, whereas the total calcium and phosphorus were determined by using spectrophotometer method. Statistical data of serum nutrient levels (calcium, phosphorus, and vitamin D3), age, sex, and residual ridge resorption were subjected to the Mann-Whitney U test, the Spearman correlation test, and a stepwise multiple linear regression analysis (α=.05). ResultsCalcium (P=.003) and phosphorus (P<.001) levels were significantly increased in the female participants as compared with the male participants. Vitamin D3 levels were similar in all the participants. Moreover, metabolic levels of calcium (rho=-0.09), phosphorus (rho=-0.10), and vitamin D3 (rho=-0.02) were found to be reduced with increasing age. However, male participants had increased mandibular residual ridge resorption (P<.001) with positive correlation (rho=0.06) when compared with female participants. Mandibular ridge resorption was increased with a decrease in levels of serum nutrients. ConclusionsIncreased levels of mandibular residual ridge resorption were observed in participants with decreased levels of systemic biochemical parameters, including calcium, phosphorus, and vitamin D3. Moreover, male participants showed increased residual ridge resorption when compared with female participants, who showed a significantly higher level of serum nutrient levels. Serum nutrient levels decreased, whereas mandibular residual ridge resorption increased with age.

Anticholinergic Load and Nutritional Status in Older Individuals.

The association between anticholinergic load-based Anticholinergic Risk Scale scores and nutritional status is unclear in Japanese patients. The aim of this study was to establish whether anticholinergic load affects the nutritional status of geriatric patients in convalescent stages. Retrospective longitudinal cohort study. Convalescent rehabilitation wards. Of the 1490 patients aged ≥65 years who were discharged from convalescent rehabilitation wards between July 2010 and October 2018, 908 patients met the eligibility criteria. They were categorized according to the presence or absence of increased anticholinergic load from admission to discharge. Demographic data, laboratory data, the Functional Independence Measure were analyzed between the groups. The primary outcome was Geriatric Nutritional Risk Index (GNRI) at discharge. Multiple linear regression analysis was performed to analyze the relationship between anticholinergic load and GNRI at discharge. Multiple linear regression analysis after adjusting for confounding factors revealed that anticholinergic load was independently and negatively correlated with GNRI at discharge. Particularly, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc. increased significantly from admission to discharge. Increased anticholinergic load during hospitalization may be a predictor of nutritional status in geriatric patients.

Nutrition as a Health Determinant in Elderly Patients.

An adequate caloric intake is a major determinant for the health status especially when degenerative conditions become a predominant risk for difficult-to-treat diseases as in aging. A structured search of literature on the major databases was performed using terms as nutrition, elderly and malnutrition. According to most referenced articles, it appears to be unquestionable that both organic and social risk factors [economic hardship, loneliness, institutionalization] are important as determining causes of protein-caloric malnutrition. Some anthropometric, clinical and laboratory parameters can help to make diagnosis and quantify malnutrition. However, most of them are not cheap or are not simple to perform especially in the setting of General Practice. The application of a simple questionnaire [Mini Nutritional Assessment, MNA] allows to obtain in a fast, easy and non-invasive way a valid assessment of the nutritional status in geriatric patients. The maintenance of the nutritional status is the best measure to counteract the risk of proteincaloric malnutrition and its complications which often sneakily affects elderly population and in particular frail patients. This review, based on updated concepts, examines all the above mentioned points together with some aspects associated with malnutrition as an indicator of disease severity and health costs in the elderly population. Finally, the impact of nutritional intervention and nutrients supplementation on general indices of malnutrition are discussed as a promising strategy.

Wpływ żywienia klinicznego na wybrane parametry biochemiczne i ogólny stan odżywienia pacjentów geriatrycznych leczonych w warunkach domowych

ABSTRACTIntroduction: Eating disorders constitute one of the most serious health problems in older people.The objective of the thesis was to evaluate the impact of clinical nutrition on selected biochemical parameters and general nutritional status in geriatric patients undergoing home treatment.Material and methods: The study covered 65 people aged 65+ suffering from a chronic disease undergoing home therapy. The study was conducted based on the diagnostic survey method with the use of survey questionnaires.Results: The nutritional status of the studied patients was assessed against the NRS scale during the introductory assessment. The average result obtained by the subjects was 5.28 points ±0.84 points. The main reason for nutrition therapy in the case of 52 patients (80.0%) was dysphagia. In the remaining 20% of patients the causes for nutritional therapy stemmed from other clinical symptoms.Conclusions: 1. Nutritional therapy improves nutritional status in chronically ill patients treated at home. 2. Dysphagia in the course of oncological and neurological diseases is the most frequent indication for home nutritional treatment. 3. To a substantial extent, nutritional therapy improves albumin and haemoglobin levels in chronically ill patients. Meanwhile, no statistically significant differences were reported in terms of improved total cholesterol, triglycerides or electrolytes among patients.

Change in number of potentially inappropriate medications impacts on the nutritional status in a convalescent rehabilitation setting.

The association between potentially inappropriate medications (PIM) use and nutritional status is unclear in Japan. The aim of the present study was to establish whether PIM use during hospitalization affects the nutritional status among geriatric patients in the convalescing stage. This retrospective longitudinal cohort study included consecutive geriatric patients admitted and discharged from convalescent rehabilitation wards between 2010 and 2016. Participants were divided based on the presence or absence of increased PIM from admission to discharge. Demographic data, laboratory data and the Functional Independence Measure were analyzed between groups. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIM, and the primary outcome was the Geriatric Nutritional Risk Index at discharge. A multiple linear regression analysis was used to examine whether Geriatric Nutritional Risk Index at discharge was independently associated with increased PIM. In total, 643 participants (220 men, 423 women; interquartile range 73-85 years) were included in the present study. Multiple linear regression analysis for increased PIM, adjusting for confounding factors, showed that PIM use was independently and negatively correlated with Geriatric Nutritional Risk Index at discharge. In particular, first-generation antihistamine, antipsychotic, benzodiazepine, proton pump inhibitor and non-steroidal anti- inflammatory drug use increased significantly from admission to discharge. Increased PIM might be a predictor of nutritional status in geriatric patients. Geriatr Gerontol Int 2019; 19: 44-50.

Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients.

Neutrophil-to-lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients. This cross-sectional study included 95 geriatric (age≥65years) patients from general internal medicine outpatient clinic of a university hospital. Nutritional status of the patients was evaluated using Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index, albumin, total cholesterol, body mass index, mid-arm circumference, and calf circumference. NLR was calculated from the complete blood count results. A total of 59 patients were female, and the mean age was 73±9.8years. According to the MNA, 51.6% of patients had a normal nutritional status, and 48.4% were malnourished or at risk of malnutrition. The mean NLR of patients with malnourished or at risk of malnutrition was significantly higher than that of patients with normal nutritional status (P=0.004). There was a negative correlation between NLRs and the MNA scores (r=-0.276, P=0.007). Optimal NLR cutoff point for patients with malnourished or at risk of malnutrition was 1.81 with 71.7% sensitivity and 63.3% specificity [95% confidence interval (CI): 0.562-0.780, P=0.004]. Logistic regression analysis revealed that elevated NLR was an independent factor in prediction of malnutrition or risk of malnutrition in geriatric patients. These results demonstrated that NLR was associated with the nutritional status of geriatric patients. NLR may be a useful nutritional marker for evaluating the nutritional status of geriatric outpatients.

A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk—a randomized controlled trial

Objectives: To investigate the effect of a nutrition intervention program for geriatric nutritional at-risk patients. Design: A randomized controlled trial. Setting: Department of geriatric medicine in a university hospital and in the primary healthcare sector, Copenhagen. Subjects: Geriatric patients (N = 144) at nutritional risk. Intervention: The intervention consisted of an individual dietary plan for home, including pre-discharge advice on nutritional intake, combined with three follow-up visits after discharge (one, four, and eight weeks). Main measures: Change in body weight, Barthel Index, hand-grip strength and self-rated health from baseline (discharge) to three months after discharge, readmission, and mortality (90 and 120 days). Results: The mean (SD) age in total sample was 87.2 (6.2) years. Sample size in the intervention group (IG) was N = 72, and in the control group (CG), N = 72. IG had a mean (SD) weight gain of 0.9 (4.2) kg compared to a weight loss of 0.8 (3.6) kg in the CG (P = 0.032). In addition, an improvement in self-rated health was seen in the IG compared to CG (IG: 23 (47%) vs. CG: 12 (24%); P = 0.021). No significant difference between groups was found in functional status, mortality, or readmission rates. Conclusion: An individual dietary plan based on everyday food, combined with three follow-up visits (one, four, and eight weeks) after discharge, led to an improvement in nutritional status and self-rated health in geriatric patients.

Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It?

To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. The study was performed in an Italian geriatric research hospital (INRCA, Ancona). Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses-linear and logistic regression-were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04-5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21-0.95). A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.

Nutritional assessment using stable isotope ratios of carbon and nitrogen in the scalp hair of geriatric patients who received enteral and parenteral nutrition formulas.

The δ13C and δ15N values in the scalp hair of geriatric patients in Japan who received the enteral or parenteral nutrition formula were measured to assess nutritional status. The relations among δ13C, δ15N, calorie intake, BMI, albumin concentration, total cholesterol (T-CHO) and geriatric nutritional risk index (GNRI) in the patients were investigated. Furthermore, the enrichment of δ13C and δ15N from the nutrients to the hair was investigated. The δ13C values in the hair of patients who received enteral nutrition decreased with decreases in the calories received, while the δ15N values increased, suggesting malnutrition in some patients with a low calorie intake due to a negative nitrogen balance. The distribution of patients with a low calorie intake (below 20kcal/kg/day) when δ13C was plotted against δ15N differed from that of control subjects, but the distribution of patients with a high calorie intake (above 20kcal/kg/day) was similar to that of control subjects. No significant differences were observed in BMI, albumin concentration, T-CHO or GNRI between the low and high calorie groups. The enrichment of δ13C and δ15N from the enteral nutrients to the hair were inversely correlated with the δ13C and δ15N in the enteral nutrients. The enrichment levels of δ13C and δ15N tended to be higher and lower, respectively, in the high calorie group. On the other hand, the δ13C and δ15N values in the hair of patients who received parenteral nutrition were higher and lower than those in the control subjects and in the patients who received enteral nutrition, respectively, reflecting the higher δ13C and lower δ15N contents of the parenteral nutrients. The δ13C and δ15N values in the hair of patients who received enteral nutrition may be effective indicators for evaluating the long-term nutritional status of geriatric patients. A calorie intake of 20kcal/kg/day may be a cut-off value for malnutrition in Japanese geriatric patients receiving enteral nutrition. However, caution is necessary when dealing with patients switching from parental nutrition as parenteral nutrition resulted in different changes in δ13C and δ15N. The enrichment levels of δ13C and δ15N from the enteral nutrients to the hair may be inversely correlated with the δ13C and δ15N values of enteral nutrients and vary according to the calorie intake.

Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture

ObjectivesHip fractures (HFs) in old age frequently cause severe functional impairment and deteriorating autonomy in everyday life. Many older patients with HFs are malnourished or at risk of malnutrition. In this study, we examined the relationship between nutritional status of geriatric patients before HF and their functional and clinical course up to 6 months after hospital discharge. DesignObservational study with follow-up after 6 months. SettingFour wards of the department of trauma and orthopedic surgery of a large urban maximum care hospital (Klinikum Nürnberg, Nuremberg, Germany). ParticipantsGeriatric patients aged ≥75 years with surgically repaired proximal femoral fracture. MeasurementsPrefracture nutritional status was determined by Mini Nutritional Assessment (MNA). Comorbidities and complications during hospital stay were obtained from medical documentation. Functional status before HF, postoperatively, at hospital discharge, and 6 months later was assessed by Barthel Index for activities of daily living (ADL) and patients' mobility level and related to MNA categories. Associations were evaluated using χ2, Fisher exact, Kruskal-Wallis, Mann-Whitney-U, Jonckheere-Terpstra, and Cochrane-Armitage tests as appropriate, as well as analysis of covariance with repeated measures. ResultsOf 97 included patients, 17% were malnourished and 38% at risk of malnutrition before HF. Participants with (risk of) malnutrition were equally mobile but more dependent in ADL prior to HF than well-nourished patients (P < .001). Independent of nutritional status, after 6 months 68% of participants had not regained their prefracture level of independence in ADL. According to analysis of covariance, the ADL development over time until follow-up 6 months after hospital discharge did not depend on nutritional status. However, at follow-up malnourished patients more often suffered from remaining losses in ADL ≥25% of initial Barthel Index points (P = .033) and less often had regained their prefracture mobility level (P = .020) than well-nourished patients. Clinical course did not differ significantly between the groups with different nutritional status. ConclusionsIn this study with geriatric HF patients from all functional and cognitive levels, worse prefracture nutritional status was associated with worse functional status and more frequent remaining functional loss, whereas the trajectory of ADL recovery and clinical course did not differ significantly. Further studies with sufficient statistical power are needed to substantiate these inconclusive results. In order to clarify the association of nutritional status with functional and clinical course in geriatric patients after HF, they should preferably focus on the role of nutritional management during the hospital stay.

The evolution of nutritional status of geriatric patients without cachexia is associated with food intake in sub-acute care.

To determine if changes in patients' nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for. Prospective study. A total of 32 non-cachectic patients (21 women; 65-92 y). Nutritional status was evaluated at admission and discharge using the Protein-Energy Malnutrition Index which includes BMI, %IBW, TS, MAC, albumin, hemoglobin and lymphocyte count. Food intake was assessed 3 meals/day every other day for an average of 46.2 +/- 14.6 meals/participant. In all, 47% of the study sample was malnourished at admission. Nutritional status improved in 73% of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission. Total energy intake correlated with improvements in BMI, %IBW and total lymphocyte count (all p < 0.04). Improvement in PEMI score for the whole group was associated with functional status (p < 0.05). Controlling for this variable, energy (kj/kg body weight) and protein (g/kg body weight) intakes correlated positively with improvements in BMI, %IBW and MAC (Energy: partial r = 0.644, 0.624, 0.466 respectively; Protein: partial r = 0.582, 0.554, 0.433 respectively; all p < 0.05). Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for, standard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay.

Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients.

To evaluate the clinical assessment of nutritional status and mortality in geriatric patients. Prospective follow-up study. Acute geriatric inpatient ward. Eighty-three consecutive acute geriatric patients (mean age +/- standard deviation = 83 +/- 7; 68% women). Patients were classified as (1) having protein-energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x-ray absorption and bioelectrical impedance. Three-year mortality data were obtained from the Swedish population records. Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well-nourished subjects (P <.05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P =.03-0.17) and 50% after 3 years (P <.01) in patients classified as being well nourished. Fewer than one-third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1-, 2-, and 3-year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.