1
|
Riddle E, Munoz N, Clark K, Collins N, Coltman A, Nasrallah L, Nishioka S, Scollard T, Simon JR, Moloney L. Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: an Evidence-based Nutrition Practice Guideline. J Acad Nutr Diet 2024:S2212-2672(24)00146-1. [PMID: 38583584 DOI: 10.1016/j.jand.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.
Collapse
Affiliation(s)
- Emily Riddle
- State University of New York at Oneonta, Oneonta, New York
| | - Nancy Munoz
- Veterans Affairs Southern Nevada Healthcare System, Las Vegas, Nevada
| | | | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
| | - Lamia Nasrallah
- Outpatient Nutrition Services, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | | | - Judy R Simon
- Nutrition and Health Promotion Consultant, Easton, Maryland
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, Illinois.
| |
Collapse
|
2
|
Murillo-Llorente MT, Lafuente-Sarabia B, Samper de la Paz J, Flores-Púa M, Tejeda-Adell M, Legidos-García ME, Perez-Bermejo M. Assessing Nutritional Status and Frailty among Poor Elderly Individuals in Requena del Tapiche, Peru. Nutrients 2023; 15:3840. [PMID: 37686872 PMCID: PMC10490412 DOI: 10.3390/nu15173840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Frailty is a biological syndrome that leads to a loss of physiological reserve, increasing susceptibility to adverse health events. In the Peruvian Amazon, the elderly live with hardly any economic resources, presenting a caloric deficit that is related to functional and cognitive deterioration. Our objective was to identify the health needs of elderly people living in extreme poverty in Requena (Peru) by means of a geriatric assessment of the nutritional and functional spheres to design, in the future, a cooperation project appropriate to the needs detected. This is an observational, descriptive, and cross-sectional study. Sixty participants were included, and sociodemographic and functional status variables were analyzed using the MNA and Barthel scales and the Get Up and Go test. The mean age of the participants was 79 ± 6.67 (women 55% and men 45%), where 60% had frailty. A statistically significant relationship was found between the MNA scores and Barthel test. Eighty-five percent were malnourished or at risk and thirteen percent had total or moderate dependence. We conclude that the nutritional status of the elderly was deficient. The high degree of living alone in which they live forces them to maintain their independence and their walking stability is normal. The situation of frailty exceeds the national average, a situation that has repercussions for their quality of life. We found a statistically significant association between nutritional status, dependence, and frailty. The better-nourished elderly are less frail and less dependent.
Collapse
Affiliation(s)
- María Teresa Murillo-Llorente
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (M.T.M.-L.); (M.E.L.-G.)
| | - Blanca Lafuente-Sarabia
- School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (B.L.-S.); (J.S.d.l.P.); (M.T.-A.)
| | - Jennifer Samper de la Paz
- School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (B.L.-S.); (J.S.d.l.P.); (M.T.-A.)
| | - Merita Flores-Púa
- Nurse Coordinator of the “Padre Nicolás Giner” Health Cente, Requena del Tapiche 16341, Peru;
| | - Manuel Tejeda-Adell
- School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (B.L.-S.); (J.S.d.l.P.); (M.T.-A.)
| | - María Ester Legidos-García
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (M.T.M.-L.); (M.E.L.-G.)
| | - Marcelino Perez-Bermejo
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain; (M.T.M.-L.); (M.E.L.-G.)
| |
Collapse
|
3
|
Perry E, Walton K, Lambert K. Prevalence of Malnutrition in People with Dementia in Long-Term Care: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2927. [PMID: 37447253 DOI: 10.3390/nu15132927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5-90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0-32.26, p < 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39-65.28, p < 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.
Collapse
Affiliation(s)
- Emma Perry
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Karen Walton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| |
Collapse
|
4
|
Totland TH, Krogh HW, Smedshaug GB, Tornes RA, Bye A, Paur I. Harmonization and standardization of malnutrition screening for all adults - A systematic review initiated by the Norwegian Directorate of Health. Clin Nutr ESPEN 2022; 52:32-49. [PMID: 36513471 DOI: 10.1016/j.clnesp.2022.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool. METHODS A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used. RESULTS The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited. CONCLUSIONS The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
Collapse
Affiliation(s)
- Torunn Holm Totland
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Henriette Walaas Krogh
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Guro Berge Smedshaug
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway; Dept. of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
5
|
Dawed A, Mekonnen TC, Genetu M, Tadesse SE, Dewau R, Muche A, Zerga AA, Ayele FY, Gill TK. Comparing the validity of anthropometric measurements in identifying malnutrition status of older age people in Borena district, North Central Ethiopia: a cross_sectional study. BMC Geriatr 2022; 22:776. [PMID: 36192694 PMCID: PMC9528122 DOI: 10.1186/s12877-022-03467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia. Methods A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach’s α coefficient and Pearson’s correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point. Results The reliability of BMI, MUAC and CC by Cronbach’s alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96–0.99, p < 0.001), 0.94(95% CI, 0.89–0.98, p < 0.001) and 0.96(95% CI, 0.94–0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex. Conclusions The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03467-9.
Collapse
Affiliation(s)
- Abdu Dawed
- Dessie Comprehensive Specialized Hospital, Dessie, North Eastern, Ethiopia
| | - Tefera Chane Mekonnen
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Muluken Genetu
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
6
|
Burman M, Hörnsten C, Gustafson Y, Olofsson B, Nordström P. Obesity may increase survival, regardless of nutritional status: a Swedish cohort study in nursing homes. BMC Geriatr 2022; 22:655. [PMID: 35948885 PMCID: PMC9364570 DOI: 10.1186/s12877-022-03356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment–Short Form (MNA-SF) scores, and 2-year mortality. Methods A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m2), normal-weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (class I, 30.0–34.9 kg/m2; class II, 35.0–39.9 kg/m2; class III, ≥ 40.0 kg/m2). Participants’ nutritional status were categorized as good (MNA-SF score 12–14), at risk of malnutrition (MNA-SF score 8–11), or malnutrition (MNA-SF score 0–7). Associations with mortality were analysed using Cox proportional-hazards models. Results At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55–1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60–0.66), class II (HR 0.62, 95% CI 0.56–0.68), and class III (HR 0.80, 95% CI 0.69–0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87–3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores. Conclusions Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03356-1.
Collapse
Affiliation(s)
- Maria Burman
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Carl Hörnsten
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | | | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| |
Collapse
|
7
|
Psihogios A, Madampage C, Faught BE. Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review. PLoS One 2022; 17:e0272513. [PMID: 35917358 PMCID: PMC9345473 DOI: 10.1371/journal.pone.0272513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Elderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures. Objective This scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation. Methods A database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs. Results The search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively. Conclusion The current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.
Collapse
Affiliation(s)
- Athanasios Psihogios
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Claudia Madampage
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Brent E. Faught
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- * E-mail:
| |
Collapse
|
8
|
Prospective validation of five malnutrition screening and assessment instruments among medical inpatients: Secondary analysis of a randomized clinical trial. Clin Nutr 2022; 41:1307-1315. [DOI: 10.1016/j.clnu.2022.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 01/04/2023]
|
9
|
Development of a protein energy malnutrition screening tool for older Thais in public residential homes. Public Health Nutr 2022; 25:565-577. [PMID: 34620259 PMCID: PMC9991796 DOI: 10.1017/s1368980021004250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and to test its practicality. DESIGN This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-h recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analysed by χ2 test, Fisher's exact test, t-test, Mann-Whitney U test and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model. SETTING Four public residential homes in central region, Thailand. PARTICIPANTS 249 older residents residing in public residential homes and eight intended users. RESULTS 26·9 % had PEM (serum albumin <3·5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥ 9 types of medicine daily. These predictors were included in PEM screening tool. Regarding the tool performance test, area under the ROC curve was 0·8 (P < 0·001) with sensitivity and specificity of 83·9 and 45·5 %, respectively. For its practicality, eight intended users reported that it was useful and easy to use. CONCLUSIONS New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.
Collapse
|
10
|
The Nutritional Status of Long-Term Institutionalized Older Adults Is Associated with Functional Status, Physical Performance and Activity, and Frailty. Nutrients 2021; 13:nu13113716. [PMID: 34835971 PMCID: PMC8619061 DOI: 10.3390/nu13113716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Among older adults living in long-term nursing homes (LTNHs), maintaining an adequate functional status and independence is a challenge. Whilst a poor nutritional status is a potential risk factor for a decreased function in this population, its role is not fully understood. Here, using a transversal multicenter study of 105 older adults living in 13 LTNHs, we analyzed the associations between nutritional status, as measured by the Mini Nutritional Assessment (MNA), and the parameters of functional status, physical performance, physical activity, and frailty as well as comorbidity and body composition. The MNA scores were positively correlated with the Barthel Index, handgrip strength, Short Physical Performance Battery (SPPB) scores, absolute muscle power, and Assessment of Physical Activity in Frail Older People (APAFOP) scores and were negatively correlated with dynamic balance and frailty. In a multiple linear regression model controlling for gender and age, the APAFOP score (β = 0.386), BMI (β = 0.301), and Barthel Index (β = 0.220) explained 31% of the variance in the MNA score. Given the observed close relationship between the MNA score and functional status, physical performance and activity, and frailty, interventions should jointly target improvements in both the nutritional status and functional status of LTNH residents. Strategies designed and implemented by interdisciplinary professional teams may be the most successful in improving these parameters to lead to better health and quality of life.
Collapse
|
11
|
Determination of the Personal Nutritional Status of Elderly Populations Based on Basic Foodomics Elements. Foods 2021; 10:foods10102391. [PMID: 34681440 PMCID: PMC8535163 DOI: 10.3390/foods10102391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
Nutritional status is a series of related parameters collected using different available methods. In order to determine the nutritional status of elderly populations and ensure nutritional support based on an individual approach, the implementation of the increasingly used foodomics approach is available; this approach plays a key role in personalized diets and in the optimization of diets for a population group, such as an elderly population. The Mini Nutritional Assessment (MNA) method and the Nottingham Screening Tool (NST) form were used on 50 users in a home for the elderly in northwest Croatia. A loss of body mass (BM) was statistically significantly higher for those who had the following: decreased food intake in the last week and users who had complete and partial feeding autonomy. Additionally, the obtained data on drug intake, fluid, individual nutrients, and physical activity are based on an individual approach. The available documentation provides insight into nutritional values and food preparation in an attempt to satisfy a holistic approach in the evaluation of exposure while trying to achieve as many elements of foodomics as possible.
Collapse
|
12
|
Moloney L, Jarrett B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2108-2140.e6. [PMID: 34581276 DOI: 10.1016/j.jand.2020.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.
Collapse
Affiliation(s)
- Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Brittany Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| |
Collapse
|
13
|
Mathewson SL, Azevedo PS, Gordon AL, Phillips BE, Greig CA. Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Res Rev 2021; 70:101401. [PMID: 34237434 DOI: 10.1016/j.arr.2021.101401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 01/06/2023]
Abstract
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.
Collapse
|
14
|
Malafarina V, Serra Rexach JA, Masanés F, Cervera-Díaz MC, Lample Lacasa L, Ollero Ortigas A, Cruz-Jentoft AJ. Results of High-Protein, High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational, Multicenter, Prospective, Pragmatic Study (PROT-e-GER). J Am Med Dir Assoc 2021; 22:1919-1926.e5. [PMID: 33819452 DOI: 10.1016/j.jamda.2021.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting. DESIGN Observational, multicenter, prospective, pragmatic study. SETTING AND PARTICIPANTS This study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions. INTERVENTION The participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months. MEASURES Primary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up. RESULTS A total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m2, interquartile range 18.3-21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m2) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found. CONCLUSIONS AND IMPLICATIONS Improvements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.
Collapse
Affiliation(s)
- Vincenzo Malafarina
- Department of Nutrition, Food Science, and Physiology, School of Pharmacy and Nutrition, Universidad de Navarra, Pamplona, Spain; Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José A Serra Rexach
- Departamento de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense, CIBERFES, Madrid, Spain
| | - Ferrán Masanés
- Departamento de Medicina Interna, Hospital Clinic, Barcelona, Spain
| | - Ma Carmen Cervera-Díaz
- Unidad de Geriatría, Hospital Clínico Universitario, Valladolid, Spain; Asociación Casa de Beneficencia, Valladolid, Spain
| | | | | | | |
Collapse
|
15
|
Pakai A, Havasi-Sántha E, Mák E, Máté O, Pusztai D, Fullér N, Zrínyi M, Oláh A. Influence of cognitive function and nurse support on malnutrition risk in nursing home residents. Nurs Open 2021; 8:1805-1811. [PMID: 33635604 PMCID: PMC8186720 DOI: 10.1002/nop2.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Aim To predict malnutrition risk of older residents by cognitive function, nurse support and self‐care capacity as primary measures of interest. Design Cross‐sectional, correlation design with linear regression analysis. Methods Older residents over 60 years of age were randomly selected from nursing homes. Mini Mental State Exam and the Mini Nutritional Assessment were used were as main measures. Results Lower malnutrition risk was associated with better cognitive functioning. Improved independence of self‐feeding was also linked to reduced nutritional risk. Nurse support was positively related to BMI and cognitive impairment. General self‐care capacity and ‘appetite the week before’ were key predictors of malnutrition risk; 1‐point increase in both variables caused nutritional risk to decrease by 1.73 and 1.38 points, respectively. That is, a 1‐point increase in self‐care capacity and appetite would decrease malnutrition risk by 5.76% and 4.6%. The regression model explained significant amount (65.6%) of variance in malnutrition risk.
Collapse
Affiliation(s)
| | | | - Erzsébet Mák
- Department of Dietetics, Faculty of Health, Semmelweis University, Budapest, Hungary
| | - Orsolya Máté
- Faculty of Health, University of Pécs, Pécs, Hungary
| | | | - Noémi Fullér
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - Miklós Zrínyi
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - András Oláh
- Faculty of Health, University of Pécs, Pécs, Hungary
| |
Collapse
|
16
|
Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
Collapse
Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
| | | |
Collapse
|
17
|
Fashho E, Ahmed T, Garden G, Readman D, Storey L, Wilkinson L, Wilson G, Slee A. Investigating the prevalence of malnutrition, frailty and physical disability and the association between them amongst older care home residents. Clin Nutr ESPEN 2020; 40:231-236. [PMID: 33183542 DOI: 10.1016/j.clnesp.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition, frailty and physical disability are inter-related, more prevalent in the older population and increase the risk of adverse health outcomes. Thus, screening is essential, especially in the understudied care home setting where the population is vulnerable and at higher risk of malnutrition. Furthermore, prevalence may vary depending upon screening tools used. The aims of this study were to: 1) investigate the prevalence of 1) malnutrition risk using Mini Nutritional Assessment - Short Form (MNA-SF) and Malnutrition Universal Screening Tool (MUST), 2) frailty using the Edmonton Frailty Scale (EFS), 3) physical disability using the Barthel Index (BI) and (4) examine the association between variables and coexistence of states. METHODS Screening for malnutrition (MNA-SF and MUST) and frailty (EFS) was performed as part of a comprehensive geriatric assessment (CGA) in 527 residents from 17 care homes in Lincoln, UK. Mean age of the group was 85.6 ± 7.6 years and body mass index, BMI 23.0 ± 5.1 kg/m2. RESULTS A high prevalence of malnutrition risk was detected: 41.4% by MNA-SF and 25.5% by MUST (high risk/malnourished). Furthermore, there was a clear discordance between MNA-SF and MUST scoring of malnutrition; for example, the percentage of those identified as being at low risk was 18.8% using the MNA-SF and 57.0% using the MUST. In addition, there was a high prevalence of severe frailty by EFS (69.6%) and functional impairment by BI (62.0%). There was good association between some variables (P < 0.001) and 33.4% of residents had coexistence of all three states of malnutrition, frailty and physical disability. CONCLUSIONS Malnutrition risk, frailty and physical disability are highly prevalent in care home residents and interrelated. However, prevalence varies depending on the screening tool used. More research should be conducted in the care home setting to improve daily clinical practice as screening may impact upon subsequent treatment and care modalities and clinical outcomes.
Collapse
Affiliation(s)
- Evate Fashho
- Division of Medicine, University College London, London, UK
| | - Tanweer Ahmed
- Research and Development Department, Lincoln County Hospital, Lincoln, UK
| | - Gill Garden
- Lincoln Medical School, University of Lincoln, Lincoln, UK
| | | | | | | | | | - Adrian Slee
- Division of Medicine, University College London, London, UK.
| |
Collapse
|
18
|
Bellanti F, Lo Buglio A, Quiete S, Pellegrino G, Dobrakowski M, Kasperczyk A, Kasperczyk S, Vendemiale G. Comparison of Three Nutritional Screening Tools with the New Glim Criteria for Malnutrition and Association with Sarcopenia in Hospitalized Older Patients. J Clin Med 2020; 9:jcm9061898. [PMID: 32560480 PMCID: PMC7356988 DOI: 10.3390/jcm9061898] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.
Collapse
Affiliation(s)
- Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
- Correspondence:
| | - Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Stefano Quiete
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Giuseppe Pellegrino
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Michał Dobrakowski
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Sławomir Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| |
Collapse
|
19
|
Bobčíková K, Lukšová H. Nutritional status of hospitalized elderly with coronary heart disease. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2020. [DOI: 10.15452/cejnm.2020.11.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
20
|
Effect of Preoperative Nutritional Risk Screening on Postoperative Recovery in Patients with Laparoscopic-Assisted Radical Resection for Colorectal Cancer. Gastroenterol Res Pract 2020; 2020:2046253. [PMID: 32382262 PMCID: PMC7199584 DOI: 10.1155/2020/2046253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Results There were statistically significant differences in BMI, albumin, total cholesterol, and lymphocyte count between patients from the two groups (all P < 0.05). There was no difference in the incidence rate of postoperative complications between the two groups, but there was a statistically significant difference in the total number of complications (P < 0.05). There were no significant differences between the two groups regarding abdominal drainage volume, exhaust (flatus) time, hospitalization cost, morbidity, or 60 d readmission rate (all P > 0.05). However, patients with nutritional risk had higher postoperative blood transfusion volumes, albumin infusions, weight difference before and after surgery, and postoperative hospital stays than the nonnutritional risk group (all P < 0.05). Smoking, diabetes, and preoperative nutritional risk were the risk factors by the univariate and multivariate logistic regression analyses. Conclusions The postoperative complication rate was increased, and the short-term efficacy was decreased in the preoperative nutritional risk group compared with those without nutritional risk.
Collapse
|
21
|
Zhang XL, Zhang Z, Zhu YX, Tao J, Zhang Y, Wang YY, Ke YY, Ren CX, Xu J, Zhang XY. Comparison of the efficacy of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in recognizing sarcopenia and predicting its mortality. Eur J Clin Nutr 2020; 74:1029-1037. [DOI: 10.1038/s41430-020-0621-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
|
22
|
Ge L, Yap CW, Heng BH. Association of Nutritional Status with Physical Function and Disability in Community-Dwelling Older Adults: A Longitudinal Data Analysis. J Nutr Gerontol Geriatr 2020; 39:131-142. [PMID: 32048552 DOI: 10.1080/21551197.2020.1725711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To investigate how change in nutritional status is associated with physical function and disability among community-dwelling older adults. Methods: Baseline and 1-year follow-up data of 593 community-dwelling older adults were obtained from the Population Health Index survey in Singapore. The Mini Nutritional Assessment was used to assess nutritional status; the Late-Life Function and Disability Instrument was used to measure physical function and disability. Multivariate linear regression was applied to examine the association of change in nutritional status with physical function and disability. Results: Compared to older adults with normal nutritional status at both baseline and 1-year follow-up, those who became undernourished or remained undernourished reported poorer physical function (B = -6.36 and -5.96, respectively; both P < 0.01), and had less frequent involvement (B = -3.95 and -2.84, respectively; both P < 0.01) and more limitation in performing life tasks (B = -13.24 and -16.02, respectively; both P < 0.01) at 1-year follow-up. However, older adults with improved nutritional status did not differ in physical function and frequency of involvement in life tasks compared to those with normal nutrition. Conclusion: Undernutrition is associated with poorer physical function and disability in community-dwelling older adults regardless of whether it developed or was persistent over one year. Improving nutritional status could be an effective strategy to improve physical function in older adults.
Collapse
Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Chun Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| |
Collapse
|
23
|
Zhang X, Zhang X, Zhu Y, Tao J, Zhang Z, Zhang Y, Wang Y, Ke Y, Ren C, Xu J. Predictive Value of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in Mortality in Chinese Hospitalized Geriatric Patients. Clin Interv Aging 2020; 15:441-449. [PMID: 32256059 PMCID: PMC7093094 DOI: 10.2147/cia.s244910] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Aim The presence of malnutrition in hospitalized geriatric patients is associated with an increased risk of mortality. This study aimed to examine the performance of Nutritional Risk Screening 2002 (NRS2002) and Mini Nutritional Assessment Short Form (MNA-SF) in predicting mortality for hospitalized geriatric patients in China. Methods A prospective analysis was performed in 536 hospitalized geriatric patients aged ≥65 years. Nutrition status was assessed using the MNA-SF and NRS2002 scales within 24 hrs of admission. Anthropometric measures and biochemical parameters were carried out for each patient. Patients were follow-up for up to 2.5 years. Results At baseline, 161 (30.04%) patients had malnutrition/nutritional risk according to NRS2002 assessment. According to MNA-SF, 284 (52.99%) patients had malnutrition/nutritional risk. Malnutrition/nutritional risk patients had lower anthropometric and biochemical parameters (P<0.05). NRS2002 and MNA-SF had a strong correlation with classical nutritional markers (P<0.05). NRS2002 versus MNA-SF showed moderate agreement (kappa=0.493, P<0.001). During a median follow-up time of 795 days (range 10-947 days), 118 (22%) participants died. The Kaplan-Meier curve demonstrated that malnutrition/nutritional risk patients according to NRS2002 or MNA-SF assessment had a higher risk of mortality than the normal nutrition patients (χ 2=17.67, P<0.001; χ 2=28.999, P<0.001, respectively). From the components of the Cox regression multivariate models, only the NRS2002 score was an independent risk factor influencing the mortality. Conclusion Both NRS2002 and MNA-SF scores could predict mortality in Chinese hospitalized geriatric patients. But only NRS2002 score was the independent predictor for mortality.
Collapse
Affiliation(s)
- Xiaoyan Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Xingliang Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Yunxia Zhu
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Jun Tao
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Zhen Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Yue Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Yanyan Wang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - YingYing Ke
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - ChenXi Ren
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Jun Xu
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| |
Collapse
|
24
|
Motokawa K, Yasuda J, Mikami Y, Edahiro A, Morishita S, Shirobe M, Ohara Y, Nohara K, Hirano H, Watanabe Y. The Mini Nutritional Assessment-Short Form as a predictor of nursing home mortality in Japan: A 30-month longitudinal study. Arch Gerontol Geriatr 2020; 86:103954. [DOI: 10.1016/j.archger.2019.103954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022]
|
25
|
Keller H, Vucea V, Slaughter SE, Jager-Wittenaar H, Lengyel C, Ottery FD, Carrier N. Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools. J Nutr Gerontol Geriatr 2019; 38:329-344. [PMID: 31335280 DOI: 10.1080/21551197.2019.1640165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.
Collapse
Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo , Waterloo , Canada
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Vanessa Vucea
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Susan E Slaughter
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta , Edmonton , Canada
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba , Winnipeg , Canada
| | - Faith D Ottery
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Ottery and Associates , Vernon Hills , IL , USA
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton , Moncton , Canada
| |
Collapse
|
26
|
Hoskin K, Müller B, Schütz P. [Nutritional Therapy in the Elderly - What Do We Know Today?]. PRAXIS 2019; 108:863-868. [PMID: 31571539 DOI: 10.1024/1661-8157/a003307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nutritional Therapy in the Elderly - What Do We Know Today? Abstract. Malnutrition in the elderly has a high prevalence and is a strong and independent risk factor for complications and high mortality. Early diagnosis and therapeutic intervention have demonstrated positive effects on the risk for complications and morbidity/mortality. The nutritional therapy should be individually tailored to meet patients' needs and nutritional goals. Associated factors and diseases need to be taken into account while deciding on the nutritional therapy and nutritional targets. A big interprofessional effort is needed to address this specific problem. However, the latest EFFORT study showed: The expenditure is worthwhile!
Collapse
Affiliation(s)
- Katja Hoskin
- Abteilung für Endokrinologie, Diabetologie und Metabolismus, Medizinische Universitätsklinik, Kantonsspital Aarau
| | - Beat Müller
- Abteilung für Endokrinologie, Diabetologie und Metabolismus, Medizinische Universitätsklinik, Kantonsspital Aarau
| | - Philipp Schütz
- Abteilung für Endokrinologie, Diabetologie und Metabolismus, Medizinische Universitätsklinik, Kantonsspital Aarau
| |
Collapse
|
27
|
Leij-Halfwerk S, Verwijs MH, van Houdt S, Borkent JW, Guaitoli P, Pelgrim T, Heymans MW, Power L, Visser M, Corish CA, de van der Schueren MA. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years. Maturitas 2019; 126:80-89. [DOI: 10.1016/j.maturitas.2019.05.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
|
28
|
Effects of high-protein, high-calorie oral nutritional supplementation in malnourished older people in nursing homes: An observational, multi-center, prospective study (PROT-e-GER). Protocol and baseline population characteristics. Maturitas 2019; 126:73-79. [DOI: 10.1016/j.maturitas.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 01/06/2023]
|
29
|
Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
Collapse
Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | | |
Collapse
|
30
|
Becker L, Volkert D, Christian Sieber C, Gaßmann KG, Ritt M. Predictability of a modified Mini- Nutritional- Assessment version on six-month and one-year mortality in hospitalized geriatric patients: a comparative analysis. Sci Rep 2019; 9:9064. [PMID: 31227778 PMCID: PMC6588546 DOI: 10.1038/s41598-019-45452-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/04/2019] [Indexed: 01/04/2023] Open
Abstract
Recently we introduced a modified Mini Nutritional Assessment (MNA) Short Form (MNA-SF) and Long Form (MNA-SF) with operationalization of the ‘mobility’ and ‘neuropsychological problems’ items of the MNA using scores on Barthel Index mobility item and Mini Mental State Examination and Geriatric Depression Scale scores. We have now evaluated the abilities of this modified MNA-SF and MNA-LF to predict mortality in comparison with the standard MNA-SF and MNA-LF and the Nutritional Risk Screening 2002 (NRS 2002) and the Malnutrition Universal Screening Tool (MUST). A prospective analysis was performed in 240 hospitalised geriatric patients aged ≥ 65 years. Malnutrition and/or malnutrition risk were assessed using the modified MNA-SF and MNA-LF, the standard MNA-SF and MNA-LF, and the NRS 2002 and MUST. The modified MNA-SF and MNA-LF and the standard MNA-SF and MNA-LF assessments (all p < 0.05), but not NRS 2002 or MUST (all p ≥ 0.05), predicted six-month and/or one-year mortality. Prediction of six-month and/or one-year mortality by the modified MNA-SF was comparable with predictions by the standard MNA-SF and MNA-LF (all p ≥ 0.05). The modified MNA-LF showed better prediction of six-month and one-year mortality than the standard MNA-SF and MNA-LF (all p < 0.05). The modified MNA-LF (all adjusted p < 0.05), but none of the other instruments (all adjusted p ≥ 0.05), predicted six-month and one-year mortality independently of age, sex, frailty, comorbidity and ADL disability burden. The modified MNA-SF and MNA-LF emerged as potentially valuable tools for predicting mortality in patients hospitalised on geriatric wards.
Collapse
Affiliation(s)
- Lea Becker
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, D-91054, Erlangen, Germany
| | - Dorothee Volkert
- Institute of Biomedicine of Ageing (IBA), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kobergerstraße 60, D-90408, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute of Biomedicine of Ageing (IBA), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kobergerstraße 60, D-90408, Nürnberg, Germany.,Department of Internal Medicine and Geriatrics, Hospital of the Order of St. John of God, Prüfeninger Straße 86, D-93049, Regensburg, Germany
| | - Karl-Günter Gaßmann
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, D-91054, Erlangen, Germany.,Institute of Biomedicine of Ageing (IBA), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kobergerstraße 60, D-90408, Nürnberg, Germany
| | - Martin Ritt
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, D-91054, Erlangen, Germany. .,Institute of Biomedicine of Ageing (IBA), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kobergerstraße 60, D-90408, Nürnberg, Germany.
| |
Collapse
|
31
|
Pavlovic J, Racic M, Ivkovic N, Jatic Z. Comparison of Nutritional Status Between Nursing Home Residents and Community Dwelling Older Adults: a Cross-Sectional Study from Bosnia and Herzegovina. Mater Sociomed 2019; 31:19-24. [PMID: 31213950 PMCID: PMC6511369 DOI: 10.5455/msm.2019.31.19-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of the study was to determine the differences in nutritional status and risk for malnutrition between nursing home and community-dwelling residents. Methods: Cross-sectional study included 146 nursing home residents and 300 community-dwelling elderly adults from four municipalities in Bosnia and Herzegovina. Anthropometric measurements, biochemical analyses, nutritive, functional and cognitive assessments were carried out. Nutritional status and risk for malnutrition were assessed by Mini Nutritional Assessment (MNA), Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (Screen II) and the food intake analysis for the past 24 hours. Functional status was assessed by the Lawton scale, the Katz Independence Index, Timed Up and Go test, the Functional Reach Test. Mini Cog test and Six-item cognitive impairment test were used for the evaluation of cognitive functioning. Results: The incidence of high nutritive risk by SCREEN II (100%) and being “at risk for malnutrition” by MNA (81.60%) was higher among nursing home residents compared to community-dwellers. Community-dwelling elderly people had higher BMI (27.94 ± 4.73), weight (78.40 ± 13.99), height (167.69 ± 9.74), waist circumference (97.77 ± 12.88), hip circumference (104.61 ± 11.47), mid-arm arm (27.54 ± 3.58), hip (27.54 ± 3.58) and calf circumference (34.02 ± 5.16 ). Statistical differences in regards to place of living were found in functional status (p<0.001), cognitive functioning (p<0.001) and hand grip strength (p<0.001). Conclusion: The frequency of malnutrition and high nutritional risk was higher in respondents who were living in the nursing homes compared to community-dwellers. The results of this study showed that health professionals involved in the care for institutionalized elderly people should implement routine screening of malnutrition within the comprehensive geriatric assessment in their daily practice.
Collapse
Affiliation(s)
- Jelena Pavlovic
- Department of Nursing, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Maja Racic
- Thomas J. Stephens & Associates, Phoenix, USA
| | - Nedeljka Ivkovic
- Department of Oral Rehabilitation, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Zaim Jatic
- Departmenf of Family Medicine, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
32
|
Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer's disease: Study protocol for a cross-over randomized controlled trial. Contemp Clin Trials Commun 2019; 15:100385. [PMID: 31338476 PMCID: PMC6627000 DOI: 10.1016/j.conctc.2019.100385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/03/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5-2 mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs. Clinical trials number NCT02351882.
Collapse
Key Words
- AD, Alzheimer's disease
- Agitation
- Alzheimer's disease
- CB, cannabinoids
- CB1, cannabinoid receptor 1
- CB2, cannabinoid receptor 2
- CGIC, Clinician's Global Impression of Change
- CMAI, Cohen Mansfield Agitation Inventory
- Cannabinoid
- Clinical trial
- EC50, half maximal effective concentration
- FDA, Food and Drug Administration
- IPA, International Psychogeriatric Association
- LTC, long-term care
- MAR, Medication Administration Record
- MNA-SF, Mini-Nutritional Assessment-Short form
- NPI-NH, Neuropsychiatric Inventory-Nursing home version
- NPS, neuropsychiatric symptoms
- Neuropsychiatric symptoms
- PAINAD, Pain Assessment in Advanced AD
- RCT, randomized controlled trial
- SIB, Severe Impairment Battery
- THC, tetrahydrocannabinol
- sMMSE, standardized Mini-Mental Status Examination
Collapse
|
33
|
Vandewoude MFJ, van Wijngaarden JP, De Maesschalck L, Luiking YC, Van Gossum A. The prevalence and health burden of malnutrition in Belgian older people in the community or residing in nursing homes: results of the NutriAction II study. Aging Clin Exp Res 2019; 31:175-183. [PMID: 29714028 PMCID: PMC6373383 DOI: 10.1007/s40520-018-0957-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/20/2018] [Indexed: 12/12/2022]
Abstract
Introduction In 2008, the NutriAction study showed that (risk of) malnutrition was highly prevalent (57%) among Belgian older people living in the community or in a nursing home. In 2013, this study was repeated to re-evaluate the occurrence of malnutrition, as well as mobility problems and dependence in activities of daily living (ADL). Methods Health care professionals (HCPs) associated with homecare organizations and nursing homes across Belgium were invited to screen their patients and complete an online questionnaire. Nutritional status, presence of pre-specified comorbidities, mobility, and ADL dependency were assessed. Results In total, 3299 older patients were analysed: 2480 (86.3 ± 6.3 years) nursing home (NH) residents and 819 (82.7 ± 6.1 years) community dwelling (CD). Overall, 12% was malnourished (MNA-SF score < 8) and 44% was at risk of malnutrition (MNA-SF 8–11). The highest prevalence of (risk of) malnutrition was observed in NHs (63%) and in patients with dementia (CD: 68%; NH: 82%) or depression (CD: 68%; NH: 79%). Of all malnourished individuals, 49% was recognized as malnourished by HCPs and 13% of the malnourished recognized themselves as such. Mobility (stair climbing and walking) and ADL dependency (Belgian KATZ score) were impaired in older people with (risk of) malnutrition in comparison with individuals with normal nutritional status (p < 0.001). Discussion Despite public awareness initiatives, the prevalence of malnutrition remained stable among Belgian older people seen by HCPs in the period 2008–2013. Moreover, malnutrition is not well recognized. Conclusion Under-recognition of malnutrition is problematic, because associated loss of mobility and independence may accelerate the transformation of frailty into disability in older people. Electronic supplementary material The online version of this article (10.1007/s40520-018-0957-2) contains supplementary material, which is available to authorized users.
Collapse
|
34
|
Håkonsen SJ, Pedersen PU, Bygholm A, Peters MD, Bjerrum M. Speaking the same language: Development of a Nutrition Minimum Data Set for healthcare professionals in primary healthcare. Health Informatics J 2019; 26:248-263. [PMID: 30681037 DOI: 10.1177/1460458218824707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Providing the best possible nutritional care requires accurate and precise communication between healthcare professionals. Developing a Nutrition Minimum Data Set will inform professionals in primary healthcare of which core elements should be documented and facilitate a standardized approach to the documentation of nutritional care. A two-step methodological approach was utilized in this study: (1) a systematic scoping review was conducted to map evidence underpinning the development of a Minimum Data Set and (2) the datasources were categorized using the inductive content analysis approach. A total of 32 items were identified in the datasources. Five categories were inductively derived from the data: (1) physiologic measurements, (2) ability to eat, (3) intake, (4) stress factors and (5) factors which indirectly affect intake and needs. Organizing the documentation following the structure presented in this Minimum Data Set will contribute to a standardized terminology, which may lead to increased quality of documentation, increased continuity of care and improved health outcomes.
Collapse
|
35
|
Sakamoto M, Watanabe Y, Edahiro A, Motokawa K, Shirobe M, Hirano H, Ito K, Kanehisa Y, Yamada R, Yoshihara A. Self-Feeding Ability as a Predictor of Mortality Japanese Nursing Home Residents: A Two-Year Longitudinal Study. J Nutr Health Aging 2019; 23:157-164. [PMID: 30697625 DOI: 10.1007/s12603-018-1125-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine the ability of different elements of the Self-Feeding Assessment Tool for Elderly with Dementia (SFED) to predict mortality risk in nursing home residents. DESIGN AND SETTING Data from 387 residents in five nursing homes for the elderly in Japan were obtained using a baseline survey. This measure's ability to predict mortality risk was examined over a two-year observation period. Participants and Measurement: Demographic information (sex, age, height, weight, medical history) on 387 initial participants was gathered. A total of 10 individuals were excluded from the analysis because of the inability to eat by mouth at baseline, while 36 were excluded owing to missing mortality data during the observation period. The resulting 341 residents were divided into a death group or survival group according to whether they were still alive after two-year observation period. In addition to basic information and the SFED, the baseline survey included the Barthel Index (BI), Clinical Dementia Rating (CDR), and Mini Nutritional Assessment-Short Form (MNA®-SF). The ability of SFED to predict time-to-event mortality was examined using Cox proportional hazards regression analysis, including other measures associated with mortality as confounding variables. RESULTS In total, 129 participants (37.8%) died during the observation period, and their mean SFED score was significantly lower than that of surviving ones (11.1 ± 6.7 vs. 15.0 ± 5.6, P<0.001). SFED score was significantly associated with two-year mortality in the Cox proportional hazards regression analysis after adjusting for sex, age, medical history, BI, CDR, and MNA®-SF (hazard ratio = 0.941, 95% confidence interval = 0.898-0.985, P = 0.010). Additionally, three SFED categories were significantly associated with mortality risk: movement ("able to eat without dropping food"), concentration ("able to maintain attention to meal"), and safety ("able to swallow without choking, with no change in vocal quality after eating"). CONCLUSIONS Self-feeding ability as measured by SFED score was associated with long-term mortality in elderly living in nursing homes. Accordingly, adjusting feeding assistance based on regular SFED-based assessments may help maintain self-feeding ability and enhance quality of life in this population, as well as providing evidence for end-of-life care options and greatly improving care quality.
Collapse
Affiliation(s)
- M Sakamoto
- Yutaka Watanabe, Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Hsu YH, Chou MY, Chu CS, Liao MC, Wang YC, Lin YT, Chen LK, Liang CK. Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study. J Nutr Health Aging 2019; 23:876-882. [PMID: 31641739 DOI: 10.1007/s12603-019-1246-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.
Collapse
Affiliation(s)
- Y-H Hsu
- Chih-Kuang Liang, Address: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.), Phone: 886-7-3422526, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Kaya T, Açıkgöz SB, Yıldırım M, Nalbant A, Altaş AE, Cinemre H. Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients. J Clin Lab Anal 2018; 33:e22636. [PMID: 30058169 DOI: 10.1002/jcla.22636] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND 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. METHODS This cross-sectional study included 95 geriatric (age ≥ 65 years) 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. RESULTS A total of 59 patients were female, and the mean age was 73 ± 9.8 years. 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Seyyid Bilal Açıkgöz
- Department of Internal Medicine, Kargı Ahmet Hamdi Akpınar State Hospital, Çorum, Turkey
| | - Mehmet Yıldırım
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ahmet Nalbant
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ayfer Erdoğan Altaş
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Cinemre
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| |
Collapse
|
38
|
Håkonsen SJ, Pedersen PU, Bjerrum M, Bygholm A, Peters MD. Nursing Minimum Data Sets for documenting nutritional care for adults in primary healthcare: a scoping review. ACTA ACUST UNITED AC 2018; 16:117-139. [DOI: 10.11124/jbisrir-2017-003386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
39
|
Adherence to a Mediterranean diet is associated with lower incidence of frailty: A longitudinal cohort study. Clin Nutr 2017; 37:1492-1497. [PMID: 28918168 DOI: 10.1016/j.clnu.2017.08.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/17/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS There is a paucity of data investigating the relationship between the Mediterranean diet and frailty, with no data among North American people. We aimed to investigate if adherence to a Mediterranean diet is associated with a lower incidence of frailty in a large cohort of North American people. METHODS This study included subjects at higher risk or having knee osteoarthritis. Adherence to the Mediterranean diet was evaluated using a validated Mediterranean diet score (aMED) as proposed by Panagiotakos and classified into five categories. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of ≥2 out of: (i) weight loss ≥5% between baseline and the subsequent follow-up visit; (ii) inability to do five chair stands; (iii) low energy level. RESULTS During the 8 years follow-up, of the 4421 participants initially included (mean age: 61.2 years, % of females = 58.0), the incidence of frailty was approximately half in those with a higher adherence to the Mediterranean diet (8 for 1000 person years) vs. those with a lower adherence (15 for 1000 persons-years). After adjusting for 10 potential confounders (age, sex, race, body mass index, education, smoking habits, yearly income, physical activity level, Charlson co-morbidity index and daily energy intake), participants with the highest aMED scores were found to have a significant reduction in incident frailty (hazard ratio = 0.71; 95% CIs: 0.50-0.99, p = 0.047) with respect to those in a lower category. Regarding individual components of the Mediterranean diet, low consumption of poultry was found to be associated with higher risk of frailty. CONCLUSIONS A higher adherence to a Mediterranean diet was associated with a lower incidence of frailty over an 8-year follow-up period, even after adjusting for potential confounders.
Collapse
|
40
|
Jaroch A, Główczewska-Siedlecka E, Jaroch K, Kędziora-Kornatowska K. Application of Nutritional Risk Score-2002 Questionnaire and Other Nutritional Status Parameters Among Hospitalized Elderly. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
41
|
Saarela RKT, Muurinen S, Suominen MH, Savikko NN, Soini H, Pitkälä KH. Changes in malnutrition and quality of nutritional care among aged residents in all nursing homes and assisted living facilities in Helsinki 2003-2011. Arch Gerontol Geriatr 2017; 72:169-173. [PMID: 28672199 DOI: 10.1016/j.archger.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/11/2017] [Accepted: 06/14/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time. OBJECTIVES To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland. METHODS We combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N=1987), (2) residents from all ALFs in 2007 (N=1377), (3) residents from all NHs in 2011 (N=1576) and (4) residents from all ALFs in 2011 (N=1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA). RESULTS The mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, p<0.001) and in 2007 (ALF: 82.1% vs. 78.1%, p=0.007). The use of nutritional, vitamin D and calcium supplements, and snacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples. CONCLUSIONS In 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement.
Collapse
Affiliation(s)
- Riitta K T Saarela
- City of Helsinki, Department of Social Services and Health Care, Oral Health Care, Finland; General Practice and Primary Health Care, University of Helsinki, Finland.
| | - Seija Muurinen
- General Practice and Primary Health Care, University of Helsinki, Finland
| | - Merja H Suominen
- General Practice and Primary Health Care, University of Helsinki, Finland
| | - Niina N Savikko
- General Practice and Primary Health Care, University of Helsinki, Finland
| | - Helena Soini
- General Practice and Primary Health Care, University of Helsinki, Finland; City of Helsinki, Department of Social Services and Health Care, Developmental and Operational Support, Finland
| | - Kaisu H Pitkälä
- General Practice and Primary Health Care, University of Helsinki, Finland; Helsinki University Hospital, Finland
| |
Collapse
|
42
|
Aoun M, Corsetto PA, Nugue G, Montorfano G, Ciusani E, Crouzier D, Hogarth P, Gregory A, Hayflick S, Zorzi G, Rizzo AM, Tiranti V. Changes in Red Blood Cell membrane lipid composition: A new perspective into the pathogenesis of PKAN. Mol Genet Metab 2017; 121:180-189. [PMID: 28456385 DOI: 10.1016/j.ymgme.2017.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/14/2017] [Accepted: 04/14/2017] [Indexed: 01/12/2023]
Abstract
Pantothenate Kinase-Associated Neurodegeneration (PKAN) is a form of Neurodegeneration with Brain Iron Accumulation (NBIA) associated with mutations in the pantothenate kinase 2 gene (PANK2). The PANK2 catalyzes the first step of coenzyme A (CoA) biosynthesis, a pathway producing an essential cofactor that plays a key role in energy and lipid metabolism. The majority of PANK2 mutations reduces or abolishes the activity of the enzyme. In around 10% of cases with PKAN, the presence of deformed red blood cells with thorny protrusions in the circulation has been detected. Changes in membrane protein expression and assembly during erythropoiesis were previously explored in patients with PKAN. However, data on red blood cell membrane phospholipid organization are still missing in this disease. In this study, we performed lipidomic analysis on red blood cells from Italian patients affected by PKAN with a particular interest in membrane physico-chemical properties. We showed an increased number of small red blood cells together with membrane phospholipid alteration, particularly a significant increase in sphingomyelin (SM)/phosphatidylcholine (PC) and SM/phosphatidylethanolamine (PE) ratios, in subjects with PKAN. The membrane structural abnormalities were associated with membrane fluidity perturbation. These morphological and functional characteristics of red blood cells in patients with PKAN offer new possible tools in order to shed light on the pathogenesis of the disease and to possibly identify further biomarkers for clinical studies.
Collapse
Affiliation(s)
- Manar Aoun
- Unit of Molecular Neurogenetics, Pierfranco and Luisa Mariani Centre for the Study of Mitochondrial Disorders in Children, Foundation IRCCS Neurological Institute C. Besta, Via Temolo 4, 20126 Milan, Italy
| | - Paola Antonia Corsetto
- Department of Pharmacological and Biomolecular Sciences, Laboratory of Membrane Biochemistry and Applied Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Guillaume Nugue
- IRBA, Unité des Risques Technologiques Emergeants BP 73, 91223 Brétigny sur Orge Cedex, France
| | - Gigliola Montorfano
- Department of Pharmacological and Biomolecular Sciences, Laboratory of Membrane Biochemistry and Applied Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Emilio Ciusani
- Unit of Clinical Pathology and Medical Genetics, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - David Crouzier
- IRBA, Unité des Risques Technologiques Emergeants BP 73, 91223 Brétigny sur Orge Cedex, France
| | - Penelope Hogarth
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, United States
| | - Allison Gregory
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, United States
| | - Susan Hayflick
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, United States
| | - Giovanna Zorzi
- Unit of Child Neurology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Angela Maria Rizzo
- Department of Pharmacological and Biomolecular Sciences, Laboratory of Membrane Biochemistry and Applied Nutrition, Università degli Studi di Milano, Milan, Italy.
| | - Valeria Tiranti
- Unit of Molecular Neurogenetics, Pierfranco and Luisa Mariani Centre for the Study of Mitochondrial Disorders in Children, Foundation IRCCS Neurological Institute C. Besta, Via Temolo 4, 20126 Milan, Italy.
| |
Collapse
|
43
|
Agarwal E, Marshall S, Miller M, Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas 2016; 92:70-78. [DOI: 10.1016/j.maturitas.2016.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023]
|
44
|
Donini LM, Poggiogalle E, Molfino A, Rosano A, Lenzi A, Rossi Fanelli F, Muscaritoli M. Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents. J Am Med Dir Assoc 2016; 17:959.e11-8. [DOI: 10.1016/j.jamda.2016.06.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
|
45
|
Christner S, Ritt M, Volkert D, Wirth R, Sieber CC, Gaßmann KG. Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002). J Hum Nutr Diet 2016; 29:704-713. [DOI: 10.1111/jhn.12376] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- S. Christner
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
| | - M. Ritt
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
| | - D. Volkert
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
| | - R. Wirth
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
- Department of Geriatrics; St Marien-Hospital Borken; Borken Germany
| | - C. C. Sieber
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
- Department of Internal Medicine and Geriatrics; Hospital of the Order of St John of God; Regensburg Germany
| | - K.-G. Gaßmann
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
| |
Collapse
|
46
|
Bolmsjö BB, Mölstad S, Gallagher M, Chalmers J, Östgren CJ, Midlöv P. Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study. Geriatr Gerontol Int 2016; 17:791-797. [DOI: 10.1111/ggi.12789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 01/04/2023]
Affiliation(s)
| | - Sigvard Mölstad
- Department of Clinical Sciences; Lund University; Malmö Sweden
| | - Martin Gallagher
- The George Institute for Global Health; Sydney Medical School, University of Sydney; NSW Australia
| | - John Chalmers
- The George Institute for Global Health; Sydney Medical School, University of Sydney; NSW Australia
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Primary Care; Linköping University; Linköping Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences; Lund University; Malmö Sweden
| |
Collapse
|
47
|
Lannering C, Ernsth Bravell M, Midlöv P, Östgren CJ, Mölstad S. Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents. J Clin Nurs 2016; 25:940-50. [DOI: 10.1111/jocn.13154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Marie Ernsth Bravell
- Institute of Gerontology; School of Health Sciences; Jönköping University; Jönköping Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, General Practice/Family Medicine; Lund University; Malmö Sweden
| | - Carl-Johan Östgren
- Department of Medical and Health Sciences, General Practice; Linköping University; Linköping Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences in Malmö, General Practice/Family Medicine; Lund University; Malmö Sweden
| |
Collapse
|
48
|
Chen LY, Liu LK, Hwang AC, Lin MH, Peng LN, Chen LK, Lan CF, Chang PL. Impact of Malnutrition on Physical, Cognitive Function and Mortality among Older Men Living in Veteran Homes by Minimum Data Set: A Prospective Cohort Study in Taiwan. J Nutr Health Aging 2016; 20:41-7. [PMID: 26728932 DOI: 10.1007/s12603-016-0674-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the prevalence of malnutrition and its impact on mortality, functional decline and cognitive impairment among elder residents in long-term care settings. DESIGNS A prospective cohort study. SETTINGS Two veteran homes in Taiwan. PARTICIPANTS A total of 1,248 male residents aged equal or more than 65 years. MEASUREMENTS Charlson's comorbidity index (CCI), Minimum data set (MDS), resident assessment protocols (RAP), Activity of daily living-Hierarchy scale, Cognitive Performance Scale, MDS Social engagement scale. RESULTS The mean age of participants is 83.1 ± 5.1 years, and the prevalence of malnutrition was 6.1%. Inadequate dietary content (57.9%) and unintentional weight loss (31.6%) account for the majority of malnutrition identified by MDS tool. Higher 18-month mortality rate (25% vs. 14.2%), higher baseline CCI (median 1 vs. 0), and higher baseline sum of RAP triggers (median 8.5 vs. 5) were noted among residents with malnutrition. Furthermore, malnutrition was shown predictive for functional decline (OR: 3.096, 95% CI: 1.715-5.587) and potential cognitive improvement (OR: 2.469, 95% CI: 1.188-5.128) among survivors after adjustment for age, body mass index and CCI. CONCLUSION Malnutrition among elder men residing in veteran homes was associated with multimorbidities and higher care complexity, and was predictive for mortality and functional decline.
Collapse
Affiliation(s)
- L-Y Chen
- Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2nd, Shih-Pai Rd. Taipei, Taiwan 11217, Tel: +886-2-28757830, Fax: +886-2-28757711, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
49
|
The diagnostic accuracy of the Revised Mini Nutritional Assessment Short Form for older people living in the community and in nursing homes. J Nutr Health Aging 2015; 18:725-9. [PMID: 25286451 DOI: 10.1007/s12603-014-0460-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the diagnostic accuracy of the CC-SF, which was developed to use calf circumference (CC) instead of BMI in the MNA-SF, for elderly people living in the community and in nursing homes. It also aimed separately to determine the correlation of CC-SF and BMI-SF with the full MNA. STUDY DESIGN AND METHODS The study included 640 elderly people living in their community and 243 elderly people living in nursing homes. Accuracy was assessed by determining the sensitivity and selectivity of the nutritional assessments. The correlations between the MNA-SFs and the full MNA were analyzed. RESULTS The correlation between MNA-SFs and full MNAs was strong, significant and almost identical both in the community and in nursing homes (r=0.86-0.88; p<0.001). The observed agreement between the BMI-SF and the full MNA was 82.2% in the community and 77.8% in the nursing homes. There was a substantial agreement by kappa values in the comparison of community and nursing homes (the Kappa value of the BMI-SF was 0.63 in the community and 0.62 in the nursing homes, and the kappa value of the CC-SF was 0.62 in the community and 0.63 in the nursing homes). When compared to the full MNA the MNA-SFs tended to underestimate nutritional status. Both MNA-SFs had similarly high sensitivity and selectivity, both in the community and nursing homes. (when dichotomized as "malnourished-at risk of malnutrition" versus " well nourished" and "malnourished" versus "at risk of malnutrition-well nourished") (over 80%). CONCLUSION In cases where BMI cannot be determined, the CC-SF is a good substitute for the BMI-SF.
Collapse
|
50
|
Lilamand M, Kelaiditi E, Demougeot L, Rolland Y, Vellas B, Cesari M. The Mini Nutritional Assessment-Short Form and mortality in nursing home residents--results from the INCUR study. J Nutr Health Aging 2015; 19:383-8. [PMID: 25809801 DOI: 10.1007/s12603-014-0533-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To examine whether the Mini Nutritional Assessment-Short Form (MNA-SF) score and its individual items are predictors of mortality in a nursing home population. DESIGN Prospective, secondary analysis from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study with 1-year follow-up. PARTICIPANTS A total of 773 older persons (women 74.4%) living in 13 French nursing homes. MEASUREMENTS At baseline, nutritional status was assessed with the MNA-SF. Overall mortality rate was measured over a 12-month follow-up period after the baseline assessment visit. Cox proportional hazard models were performed to test the predictive capacity of the MNA-SF score and its single components for mortality. RESULTS Mean age of participants was 86.2 (standard deviation, SD 7.5) years. Mean MNA-SF score was 9.8 (SD 2.4). Among participants, 198 (25.6%) presented a normal nutritional status (12-14 points), 454 (58.7%) were at risk of malnutrition (8-11 points), and 121 (15.7%) were malnourished. After one year of follow-up, 135 (17.5%) participants had died. Age, female gender, baseline weight, BMI and MNA-SF were significant predictors of mortality whereas no specific chronic disease was. The total MNA-SF score was a significant predictor of mortality (Hazard Ratio=0.83; 95% CI 0.75-0.91; p<0.001), even after adjustment for potential confounders. Four individual items: weight loss, decrease in food intake, recent stress and BMI were independent predictors of mortality. CONCLUSIONS The MNA-SF appears to be an accurate predictor of one-year mortality in nursing home residents. Thus, this tool may be regarded not only as a nutritional screening tool, but also as an instrument for identifying the most-at-risk individuals in this population.
Collapse
Affiliation(s)
- M Lilamand
- Matthieu Lilamand, MD MSc. Gérontopôle - Institut du Vieillissement, 37 Allées Jules Guesde. 31000 Toulouse France. Phone: +33 (0)5 61145657. Fax: +33 (0)5 61145640
| | | | | | | | | | | |
Collapse
|