Fast and simple screening for nutritional status in hospitalized, elderly people

Association of Nutritional Risk With Gait Function and Activities of Daily Living in Older Adult Patients With Hip Fractures

OBJECTIVE

To investigate the association of nutritional risk with gait function and activities of daily living (ADLs) in older adult patients with hip fractures.

METHODS

The retrospective data of older adult patients diagnosed with hip fractures who visited the recovery-phase rehabilitation ward between January 2019 and December 2022 were reviewed. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index; gait function and ADLs were assessed using the modified Harris Hip Score subitem and Functional Independence Measure, respectively. Multivariate linear regression and path analysis with structural equation modeling were used to examine the factors associated with ADLs and the associations among the study variables.

RESULTS

This study included 206 participants (172 females and 34 males; mean age, 85.0±7.3 years). In the multivariate analysis, gait function (β=0.488, p<0.001), cognitive function (β=0.430, p<0.001), and surgery (β=-0.143, p<0.001) were identified as independent factors. Pathway analysis revealed that nutritional risk was not directly correlated with ADLs but was directly associated with gait and cognitive functions. Gait and cognitive functions, in turn, were directly related to ADLs.

CONCLUSION

Nutritional risk was found to be associated with ADLs through an intermediary of gait and cognitive functions.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

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.

A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study

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.

Malnutrition Screening and Assessment in Hospitalised Older People: a Review

Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.

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

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.

Validity of the portuguese version of the mini nutritional assessment in brazilian elderly

BACKGROUND

Malnutrition is common and affects negatively the health of the older adult. The Mini Nutritional Assessment (MNA), a nutritional assessment tool allows to identify elders malnourished and at risk of malnutrition. The aim of this study is to validate the Portuguese version of the MNA.

METHODS

Cross-sectional study with 344 Brazilian elderly. The full version of the MNA was performed, also calf circumference (CC), mid arm circumference (MAC) and body fat (BF). Psychometric evaluation was carried out and correlation, diagnostic accuracy and ROC curves were generated.

RESULTS

Construct validity was supported, all four questionnaire dimensions were evidenced in the Principal Component Analysis and also significant Spearman correlation (P < 0.001) were demonstrated. Criterion validity was also evidenced with relevant sensitivity (MAC = 82.8; CI95% = 64.2-94.2) and specificity (CC = 80.0; CI95% = 74.0-85.1). In the ROC curve AUC was excellent (MAC = 0.832; CI95% =0.785-0.873).

CONCLUSIONS

The full MNA demonstrated significant results and sufficient exploratory psychometric properties that supported its validity. It seems to be valid tool to access nutritional status of Brazilian elderly.

Development and validation of criteria for determining undernutrition in community-dwelling older men and women: The Short Nutritional Assessment Questionnaire 65+

BACKGROUND & AIMS

There is no valid, fast and easy-to-apply set of criteria to determine (risk of) undernutrition in community-dwelling older persons. The aim of this study was to develop and validate such criteria.

METHODS

Selection of potential anthropometric and undernutrition-related items was based on consensus literature. The criteria were developed using 15-year mortality in community-dwelling older persons ≥ 65 years (Longitudinal Aging Study Amsterdam, n = 1687) and validated in an independent sample (InCHIANTI, n = 1142).

RESULTS

Groups distinguished were: (1) undernutrition (mid-upper arm circumference <25 cm or involuntary weight loss ≥4 kg/6 months); (2) risk of undernutrition (poor appetite and difficulties climbing staircase); and (3) no undernutrition (others). Respective hazard ratio's for 15-year mortality were: (1) 2.22 (95% CI 1.83-2.69); and (2) 1.57 (1.22-2.01) ((3) = reference). The area under the curve (AUC) was 0.55. Comparable results were found stratified by sex, excluding cancer/obstructive lung disease/(past) smoking, using 6-year mortality, and applying results to the InCHIANTI study (hazard ratio's 2.12 and 2.46, AUC 0.59).

CONCLUSIONS

The developed set of criteria (SNAQ⁶⁵⁺) for determining (risk of) undernutrition in community-dwelling older persons shows good face validity and moderate predictive validity based on the consistent association with mortality in a second independent study sample.

Is serum albumin a marker of malnutrition in chronic disease? The scleroderma paradigm

BACKGROUND

Malnutrition is common in many chronic diseases, but physicians may rely on a low albumin value before deciding that malnutrition is present.

OBJECTIVE

To determine the relationship between serum albumin and malnutrition in systemic sclerosis (SSc) as a paradigm for other chronic diseases.

DESIGN

Cross-sectional, multicenter study of patients from the Canadian Scleroderma Research Group Registry. We used the Malnutrition Universal Screening Tool (MUST) to evaluate patients for malnutrition. Disease extent was measured in several ways, including physician global assessment. Multiple linear regression was performed to identify independent predictors of serum albumin.

RESULTS

Two hundred fifty-eight patients were studied. The mean (SD) serum albumin level was 44.4 (4.2) g/L. Only 2% of the values were below normal and all these patients were in MUST category > or =2, or high risk for malnutrition, which included 21.3% of the cohort. MUST, shorter disease duration, greater disease severity (physician global assessment of disease severity and modified Rodnan skin score), and greater disease activity (physician global assessment of disease activity, C-reactive protein, and Scleroderma Disease Activity Index) all correlated significantly but weakly with albumin. Multivariate analysis demonstrated that a higher MUST score and worse disease severity were independently associated with lower serum albumin, but only 7% of the variance of albumin was explained in the adjusted model.

CONCLUSIONS

Serum albumin is not useful as a marker for malnutrition in SSc and should not be assumed to be useful as a marker in other chronic diseases. More attention should be paid to clinical features of malnutrition, including assessment of body mass index and unplanned weight loss, and overall disease severity.

Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home

OBJECTIVES

To describe the nutritional status of older persons living at home, to investigate factors of importance for nutritional status, and to describe possible relationships between nutritional status and health-related quality of life (HRQoL).

DESIGN

A longitudinal study using data from older persons born between 1916 and 1925. Data were collected at three occasions separated by four-year intervals.

SETTING

Data collection was carried out in the participants' own homes. An experimenter administered all tests and conducted the interviews.

PARTICIPANTS

A randomized selection from the Swedish Twin Register included 258 persons, all still living at home.

MEASUREMENTS

Nutritional status was assessed using the Mini Nutritional Assessment (MNA), cognitive function using the Mini-Mental State Examination (MMSE) and HRQoL using the Nottingham Health Profile (NHP). Questions covering physical, psychological and social factors that may have an impact on nutritional status were also posed.

RESULTS

Approximately 17% of participants were assessed as being at risk for malnutrition or as being malnourished. Cognitive impairment, reduced perceived health, recent hospital stay and receiving meals-on-wheels were factors associated with being at risk for malnutrition.

CONCLUSION

Being at risk for malnutrition is common in older persons living at home, and many factors related to frailty increase this risk in later life. Making use of knowledge of these factors when giving care to older persons may be important in preventing nutritional problems.

Vitamin D deficiency and nutritional status in elderly hospitalized subjects in Iceland

Objective

Poor nutrition and limited sunlight exposure (season) can be related to reduced serum 25-hydroxyvitamin D (25(OH)D) concentrations. Thus, elderly people in the Nordic countries might be at high risk for vitamin D deficiency. The aims of the study were to describe the prevalence of vitamin D deficiency in elderly hospitalized patients in Reykjavik, Iceland, and to investigate the effects of nutritional status and season on serum 25(OH)D.

Design

Cross-sectional study. Nutritional status was assessed and fasting blood was drawn and analysed for serum 25(OH)D and other clinical routine measurements.

Setting

Departments of Geriatrics, Landspitali-University Hospital, Reykjavik, Iceland.

Subjects

Sixty hospitalized patients (mean age 83·0 (sd7·9) years) were randomly assigned.

Results

Of the patients, 12·3 % suffered from vitamin D deficiency (serum 25(OH)D < 25 nmol/l) and 71·9 % suffered from hypovitaminosis D (serum 25(OH)D = 25–75 nmol/l). There were no significant effects of gender or nutritional status on serum 25(OH)D. Anthropometric variables correlated significantly with serum 25(OH)D, but on stepwise linear regression modelling for the prediction of serum 25(OH)D, BMI remained the only predictor variable (B= −1·454, 95 % CI −2·535, −0·373,P= 0·009).

Conclusions

BMI was significantly negatively associated with serum 25(OH)D in hospitalized elderly patients. Neither nutritional status nor season significantly affected serum 25(OH)D in our patient group. Higher levels of serum 25(OH)D in elderly subjects with lower BMI are most likely explained by volume of distribution rather than by mobilization of vitamin D from its storage in adipose tissue due to age and disease-related catabolism.

Nutritional status of cancer patients in chemotherapy; dietary intake, nitrogen balance and screening

OBJECTIVE

To evaluate a short screening sheet (SSM) for malnutrition and to investigate the nutritional status of patients receiving chemotherapy for cancer of the lungs, colon or breast at an outpatient clinic.

DESIGN

Full nutritional assessment was conducted to define malnutrition and validate the SSM. Additionally, weight change from earlier healthy weight was evaluated, and calculations for intake of energy-giving nutrients (three-day-weighed food records) and protein balance were performed. After the evaluation study, the SSM was tested in clinical routine and data collected about patients' need for nutritional counseling.

SUBJECTS

Patients at the outpatient clinic of the Department of Oncology at Landspitali-University Hospital (n=30 with lung-, colon- or breast cancer in the study population, n=93 with all cancer type in clinical routine screening).

RESULTS

Malnutrition was defined by full nutritional assessment in 20% of the participating patients and SSM had high sensitivity and specificity. Declining nutritional status of the patients was seen as a negative nitrogen balance and unintentional weight loss from healthy weight, but not as total energy intake, recent weight loss or underweight. The test of SSM in clinical routine showed that 40% were malnourished. According to the patients, 80% needed nutritional counseling but only 17% had such counseling.

CONCLUSION

Screening (SSM) for malnutrition in cancer patients is a valid simple approach to define cancer patients for nutritional care. More patients regard themselves in need for nutritional counseling than the number of patients really achieving any.

Anemia, nutritional status, and inflammation in hospitalized elderly

OBJECTIVE

Anemia (hemoglobin <120 g/L) in elderly patients is a health problem. The aim of this study was to investigate the prevalence of anemia and associations of anemia with nutritional status and inflammation in hospitalized elderly.

METHODS

Sixty patients from the Department of Geriatrics were randomly assigned to participate. Blood samples were drawn and analyzed at the laboratory of the University Hospital in Reykjavik. Nutritional status was assessed using anthropometric and hematologic parameters.

RESULTS

The prevalence of anemia was 36.7%. Female participants were more frequently anemic than male participants (47.4% versus 18.2%, P = 0.024). Anemic patients had a lower albumin level (31.3 versus 33.4 g/L, P = 0.019) and a higher erythrocyte sedimentation rate (29.6 versus 16.0 mm/h, P = 0.005) and were more often malnourished (81.8% versus 44.7%, P = 0.005) than non-anemic patients. Hemoglobin correlated with prealbumin (rho = 0.338, P = 0.008) and albumin (rho = 0.250, P = 0.054) levels, but negatively with age (rho = -0.310, P = 0.016) and erythrocyte sedimentation rate (rho = -0.412, P < 0.001). In the multivariate analysis, erythrocyte sedimentation rate and nutritional status were significant predictors of hemoglobin (R(2) = 34.0%).

CONCLUSION

This cross-sectional analysis provides evidence of anemia in 36.7% of patients hospitalized at the Landspitali-University Hospital in Reykjavik and shows an association among anemia, deteriorated nutritional status, and inflammation. Future prospective studies are needed to assess the efficacy of adjuvant nutritional support to stabilize or improve nutritional status including anemia in hospitalized elderly.

Which are the most efficient items of mini nutritional assessment in multimorbid patients?

OBJECTIVE

The aim of the study was to identify the most significant MNA-items to accelerate the determination of nutritional risk of elderly patients in routine clinical practice in a geriatric hospital. Since MNA requires 10-15 min it is hardly applicable to clinical routine.

DESIGN

The study was a cross-sectional study.

SETTING

The study centre was an acute geriatric hospital.

PARTICIPANTS

In total 808 multimorbid elderly patients were recruited.

METHODS

We applied the MNA in 808 (528 f/280 m) geriatric multimorbid patients (78.5+/-8.7f / 74.6+/-9 m yrs) without cognitive impairment 48 h after hospital admission. Admission diagnoses covered orthopaedical (40%), internal (34%) and cerebrovascular (24%) diseases. According to analysis of reliability the consistency of the MNA scale for multimorbid patients has been verified. In preparation for scale reduction a factor analysis was applied. A reduced scale with selected cutoffs was configured and compared with MNA.

RESULTS

According to MNA, 15% of patients were well-nourished, 65% at risk of malnutrition and 20% were malnourished. The reliability analyses showed a Cronbach's Alpha of 0.60 that represented a satisfactory result. By means of factor analysis the MNA-items were reduced from 18 to 7 items (weight loss, mobility, BMI, number of full meals, fluid consumption, mode of feeding, health status). with new cutoffs (12.5-15 well-nourished, 9-12 at risk of malnutrition, <9 malnourished). According to the modified MNA (m-MNA) 21.7% of the patients were well-nourished, 54.5% at risk of malnutrition and 21.7% were malnourished. The score of the MNA and m-MNA correlated with r=0.910. Furthermore, there was a strong correlation between MNA and m- MNA group classification of 83%.

CONCLUSION

The m-MNA enables a rapid (3 min) and efficient screening of malnutrition in multimorbid geriatric patients. The m-MNA is easy to apply and may also be suitable in multimorbid patients with cognitive dysfunction. Due to the variety of items the m-MNA seems to be superior to other screening tools.