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Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116164. [PMID: 34200317 PMCID: PMC8201329 DOI: 10.3390/ijerph18116164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before-after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ≥ 75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.
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van den Broek S, Heiwegen N, Verhofstad M, Akkermans R, van Westerop L, Schoon Y, Hesselink G. Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals. BMJ Open 2020; 10:e040431. [PMID: 33444202 PMCID: PMC7682455 DOI: 10.1136/bmjopen-2020-040431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Older adults are hospitalised from the emergency department (ED) without potentially needing hospital care. Knowledge about rates, associative factors and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to determine the rates, associative factors and causes for PEAs of older adults. DESIGN A mixed-method observational study. SETTING The EDs of two Dutch hospitals. PARTICIPANTS 492 patients aged >70 years and hospitalised from the ED. MEASUREMENTS Quantitative data were retrospectively extracted from the electronical medical record over a 1-month period. Admissions were classified (non)preventable based on a standardised approach. Univariate and multivariate multilevel logistic regression analyses were performed to identify possible associations between PEAs and demographic, clinical and care process factors. Qualitative data were prospectively collected by email and telephone interviews and analysed thematically to explore hospital physician's perceived causes for the identified PEAs. RESULTS Of the 492 included cases, 86 (17.5%) were classified as PEA. Patients with a higher age (adjusted OR 1.04, 95% CI 1.01 to 1.08; p=0.04), a low urgency classification (adjusted OR 1.89, 95% CI 1.14 to 3.15; p=0.01), and attending the ED in the weekend (adjusted OR 2.02, 95% CI 1.22 to 3.37; p<0.01) were associated with an increased likelihood of a PEA. 49 physicians were interviewed by telephone and email. Perceived causes for PEAs were related to patient's attitudes (eg, postponement of medical care at home), provider's attitudes (eg, deciding for admission after family pressure), health system deficiencies (eg, limited access to community services during out-of-hours and delayed access to inpatient diagnostic resources) and poor communication between primary care and hospital professionals about patient treatment preferences. CONCLUSIONS Our findings contribute to existing evidence that many emergency admissions of older adults are preventable, thereby indicating a possible source of unnecessary expensive, and potentially harmful, hospital care.
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Affiliation(s)
| | - Nikki Heiwegen
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
| | | | - Reinier Akkermans
- Department of Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Yvonne Schoon
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
- Department of Geriatrics, Radboudumc, Nijmegen, Gelderland, Netherlands
| | - Gijs Hesselink
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, Netherlands
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Griffin A, O'Neill A, O'Connor M, Ryan D, Tierney A, Galvin R. The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr 2020; 20:455. [PMID: 33160319 PMCID: PMC7648316 DOI: 10.1186/s12877-020-01852-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. Methods Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. Results Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. Conclusion Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. Trial registration Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018.
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Affiliation(s)
- Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Aoife O'Neill
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Damien Ryan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Audrey Tierney
- School of Allied Health, Faculty of Education and Health Sciences, Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology 2019; 37:185-190. [PMID: 31874118 DOI: 10.1111/ger.12455] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. BACKGROUND Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. METHODS The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. RESULTS The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35). CONCLUSION Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo, Japan.,Yamabe Dental Clinic, Sasebo, Japan.,Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood K. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018; 18:139. [PMID: 29898673 PMCID: PMC6000922 DOI: 10.1186/s12877-018-0823-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. Methods This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. Results Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. Conclusions Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined. Electronic supplementary material The online version of this article (10.1186/s12877-018-0823-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada. .,Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Emma Squires
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Kayla Mallery
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Jacques S Lee
- Sunnybrook Health Service, 2075 Bayview Avenue, BG-04, Toronto, ON, M4N 3M5, Canada
| | - Sherri Fay
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Judah Goldstein
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B 2B2, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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Wester P, Angus R, Easlea D, Lin M, Chen B, Bisset L. Use of the malnutrition screening tool by non-dietitians to identify at-risk patients in a rehabilitation setting: A validation study. Nutr Diet 2018; 75:324-330. [PMID: 29498182 DOI: 10.1111/1747-0080.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/04/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
Abstract
AIM Malnutrition is highly prevalent in rehabilitation patients, and screening is important to allow for timely intervention to reduce the incidence of adverse clinical outcomes. We aimed to determine the reliability and validity of the commonly employed malnutrition screening tool by non-dietitian staff in categorising patients at risk of malnutrition in the rehabilitation setting. METHODS This prospective observational cohort study recruited 100 participants on admission to a rehabilitation ward. The malnutrition screening tool was applied by nursing staff and repeated by nutrition assistants. Results were compared to malnutrition as determined by dietitian-applied subjective global assessment of each patient. Inter-rater reliability tests were conducted with two dietitians, two nutrition assistants and two nurses independently but simultaneously recording malnutrition screening tool scores on a subgroup of 15 participants. RESULTS Agreement between dietitian-determined malnutrition and risk as identified by nutrition assistant and nursing staff screening tool application was only modest (64% and 51%, respectively). While both professions met the a priori criteria for acceptable specificity (≥60%), neither met the criterion for adequate sensitivity (≥80%). The inter-rater reliability of the tool was excellent, with almost perfect agreement (≥0.89) between ward dietitian and nutrition assistants, and moderate to substantial agreement (0.56-0.65) with nursing staff, when compared to a senior dietitian. CONCLUSIONS Non-dietitian staff failed to apply the malnutrition screening tool with sufficient sensitivity in normal ward practice to warrant its use in the rehabilitation setting. Alternative options for identification of malnutrition need to be considered to ensure appropriate treatment.
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Affiliation(s)
- Paulina Wester
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Rebecca Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Dayle Easlea
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michelle Lin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Benjamin Chen
- Rehabilitation Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Leanne Bisset
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Bjerk M, Brovold T, Skelton DA, Bergland A. A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial. BMC Health Serv Res 2017; 17:559. [PMID: 28806904 PMCID: PMC5556992 DOI: 10.1186/s12913-017-2516-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. METHODS The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. DISCUSSION This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service and for policy makers. TRIAL REGISTRATION ClinicalTrials.gov . NCT02374307 . First registration, 16/02/2015.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College, PO box 4 St. Olavs plass, Oslo, 0130 Norway
| | - Therese Brovold
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College, PO box 4 St. Olavs plass, Oslo, 0130 Norway
| | - Dawn A. Skelton
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College, PO box 4 St. Olavs plass, Oslo, 0130 Norway
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Burks CE, Jones CW, Braz VA, Swor RA, Richmond NL, Hwang KS, Hollowell AG, Weaver MA, Platts-Mills TF. Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study. J Am Geriatr Soc 2017; 65:1741-1747. [PMID: 28322438 DOI: 10.1111/jgs.14862] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. OBJECTIVE To identify modifiable risk factors associated with malnutrition in older patients. DESIGN Prospective cross-sectional multicenter study. SETTING 3 EDs in the South, Northeast, and Midwest. PARTICIPANTS Non-critically ill, English-speaking adults aged ≥65 years. MEASUREMENTS Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. RESULTS In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). CONCLUSION Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.
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Affiliation(s)
- Collin E Burks
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey
| | - Valerie A Braz
- Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Natalie L Richmond
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kay S Hwang
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison G Hollowell
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark A Weaver
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Huang C, Momma H, Niu K, Chujo M, Otomo A, Cui Y, Nagatomi R. High serum adiponectin levels predict incident falls among middle-aged and older adults: a prospective cohort study. Age Ageing 2016; 45:366-71. [PMID: 27013505 PMCID: PMC4846795 DOI: 10.1093/ageing/afw043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/23/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE adiponectin is an adipocyte-derived hormone with anti-obesity and anti-diabetic properties. However, higher circulating adiponectin levels are related to poor muscle function and physical disability, which suggests a potential link between adiponectin and risk of falls. Nevertheless, no direct association between circulating adiponectin levels and incident fall risk has been reported. Therefore, this study aimed to investigate the relationship between serum adiponectin levels and incident falls in a population of middle-aged and older adults. DESIGN a prospective cohort study. SETTING Oroshisho Center in Sendai City, Japan. SUBJECTS Japanese adults who were ≥45 years old (n = 430). MEASUREMENTS serum adiponectin levels were measured at baseline, and the subjects were divided into sex-specific tertiles. Data regarding a history of falls were collected via participant recall using a self-reported questionnaire. Incident falls were defined as falls that were experienced by people without a history of falls at baseline. RESULTS during the 2-year follow-up, 15.6% (67/430) of the subjects experienced an incident fall. In the univariate logistic regression analysis, incident falls were significantly more frequent across the increasing sex-specific serum adiponectin tertiles (P for trend = 0.008). Adjusted odds ratios (95% confidence interval) for incident falls were 2.31 (1.07-4.98) in the middle tertile and 3.61 (1.63-7.99) in the highest tertile; this risk was significantly higher than that for the lowest adiponectin tertile (P for trend = 0.002). CONCLUSIONS the findings of this prospective cohort study indicate that higher serum adiponectin levels may be a predictor of incident falls.
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Affiliation(s)
- Cong Huang
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Haruki Momma
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Kaijun Niu
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Masahiko Chujo
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Otomo
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yufei Cui
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Ryoichi Nagatomi
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
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Voica AS, Oancea C, Tudorache E, Crisan AF, Fira-Mladinescu O, Tudorache V, Timar B. Chronic obstructive pulmonary disease phenotypes and balance impairment. Int J Chron Obstruct Pulmon Dis 2016; 11:919-25. [PMID: 27199555 PMCID: PMC4857826 DOI: 10.2147/copd.s101128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress, also having many nonrespiratory manifestations that affect both function and mobility. Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with COPD. Our objective was to investigate balance performance in two groups of COPD patients with different body compositions and to observe which of these groups are more likely to experience falls in the future. METHODS We included 27 stable COPD patients and 17 healthy individuals who performed a series of balance tests. The COPD patients were divided in two groups: emphysematous and bronchitic. Patients completed the activities balance confidence scale and the COPD assessment test questionnaire and afterward performed the Berg Balance Scale, timed up and go, single leg stance and 6-minute walking distance test. We analyzed the differences in the balance tests between the studied groups. RESULTS Bronchitic COPD was associated with a decreased value when compared to emphysematous COPD for the following variables: single leg stance (8.7 vs 15.6; P<0.001) and activities balance confidence (53.2 vs 74.2; P=0.001). Bronchitic COPD patients had a significantly higher value of timed up and go test compared to patients with emphysematous COPD (14.7 vs 12.8; P=0.001). CONCLUSION Patients with COPD have a higher balance impairment than their healthy peers. Moreover, we observed that the bronchitic COPD phenotype is more likely to experience falls compared to the emphysematous phenotype.
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Affiliation(s)
- Alina Sorina Voica
- Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Alexandru F Crisan
- Pulmonary Rehabilitation Center, Hospital of Pneumoftiziology and Infectious Diseases "Dr Victor Babeş", Timişoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Voicu Tudorache
- Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Bogdan Timar
- Department of Biostatistics and Medical Informatics, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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Loh DA, Hairi NN, Choo WY, Mohd Hairi F, Peramalah D, Kandiben S, Lee PL, Gani N, Madzlan MF, Abd Hamid MAI, Akram Z, Chu AS, Bulgiba A, Cumming RG. MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial. BMC Geriatr 2015; 15:8. [PMID: 25887235 PMCID: PMC4334409 DOI: 10.1186/s12877-015-0002-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/20/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia. METHODS This cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up. DISCUSSION Findings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults. TRIAL REGISTRATION ISRCTN22749696.
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Affiliation(s)
- Debbie Ann Loh
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Noran Naqiah Hairi
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Wan Yuen Choo
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Farizah Mohd Hairi
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Devi Peramalah
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shathanapriya Kandiben
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Pek Ling Lee
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Norlissa Gani
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohamed Faris Madzlan
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohd Alif Idham Abd Hamid
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Zohaib Akram
- Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ai Sean Chu
- Fitness First Malaysia, Menara MBF, Jalan Sultan Ismail, Kuala Lumpur, Malaysia.
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Hospital, Concord, NSW, Australia. .,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
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DiMaria-Ghalili RA. Integrating Nutrition in the Comprehensive Geriatric Assessment. Nutr Clin Pract 2014; 29:420-427. [DOI: 10.1177/0884533614537076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 2014; 99:875-90. [PMID: 24452240 DOI: 10.3945/ajcn.113.068122] [Citation(s) in RCA: 445] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear. OBJECTIVE The objective was to determine the association between BMI and all-cause mortality risk in adults ≥65 y of age. DESIGN A 2-stage random-effects meta-analysis was performed of studies published from 1990 to 2013 that reported the RRs of all-cause mortality for community-based adults aged ≥65 y. RESULTS Thirty-two studies met the inclusion criteria; these studies included 197,940 individuals with an average follow-up of 12 y. With the use of a BMI (in kg/m2) of 23.0-23.9 as the reference, there was a 12% greater risk of mortality for a BMI range of 21.0-21.9 and a 19% greater risk for a range of 20.0-20.9 [BMI of 21.0-21.9; HR (95% CI): 1.12 (1.10, 1.13); BMI of 20.0-20.9; HR (95% CI): 1.19 (1.17, 1.22)]. Mortality risk began to increase for BMI >33.0 [BMI of 33.0-33.9; HR (95% CI): 1.08 (1.00, 1.15)]. Self-reported anthropometric measurements, adjustment for intermediary factors, and exclusion of early deaths or preexisting disease did not markedly alter the associations, although there was a slight attenuation of the association in never-smokers. CONCLUSIONS For older populations, being overweight was not found to be associated with an increased risk of mortality; however, there was an increased risk for those at the lower end of the recommended BMI range for adults. Because the risk of mortality increased in older people with a BMI <23.0, it would seem appropriate to monitor weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities.
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Affiliation(s)
- Jane E Winter
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Melbourne, Australia (JEW, NW, and CAN); the Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia (RJM); and the Centre for MEGA Epidemiology, University of Melbourne, Melbourne, Australia (RJM)
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Tsai AC, Lai MY. Mini Nutritional Assessment and short-form Mini Nutritional Assessment can predict the future risk of falling in older adults - results of a national cohort study. Clin Nutr 2013; 33:844-9. [PMID: 24225376 DOI: 10.1016/j.clnu.2013.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/09/2013] [Accepted: 10/16/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS Falling is a major issue in geriatric health. Tools that identify individuals at risk of falling can help reduce the risk of falling. The study aimed to determine whether the full and short-form Mini Nutritional Assessment (MNAs) have the ability to predict the risk of falling in older adults. METHODS Subjects were 3118 ≥ 53-year old Taiwanese who completed both the 1999 and 2003 "Taiwan Longitudinal Study on Aging" surveys. We rated these subjects with normalized versions of the MNA and applied the standard cut-offs to define under-nutrition (≤23.5 and ≤11 points, respectively). We used multivariate logistic regression analysis and receiver operating characteristics to evaluate the ability of these tools in predicting the risk of falling three years later. RESULTS Older adults rated as at risk of malnutrition with the full MNA (OR = 1.87, 95% confidence interval = 1.33-2.63, p < 0.001) or the short-form (1.39, 1.07-1.80, p = 0.014) were associated with increased risk of falling three years later. Both versions significantly predicted the risk of falling and performed slightly better in ≥65-year old persons than in younger (53-64-year old) persons. The short-form performed relatively well compared to the full scale. CONCLUSIONS Results suggest that the full and short-form MNAs, in addition to rating the risk of malnutrition, also predict the risk of falling in older adults. Although the short-form is slightly less effective than the full scale in predicting the future risk of falling, its simplicity, effectiveness and efficiency make it ideal as a multipurpose screening tool in clinical settings.
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Affiliation(s)
- Alan C Tsai
- Department of Healthcare Administration, Asia University, 500 Liufeng Road, Wufeng, Taichung 41354, Taiwan, ROC; Department of Health Services Management, School of Public Health, China Medical University, Taichung 40402, Taiwan, ROC.
| | - Mei-Yen Lai
- Department of Healthcare Administration, Asia University, 500 Liufeng Road, Wufeng, Taichung 41354, Taiwan, ROC; Nursing Department, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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Winter J, Flanagan D, McNaughton SA, Nowson C. Nutrition screening of older people in a community general practice, using the MNA-SF. J Nutr Health Aging 2013; 17:322-5. [PMID: 23538653 DOI: 10.1007/s12603-013-0020-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND OBJECTIVE The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition. DESIGN Cross-sectional study of nutritional risk screen conducted over a six month period. PARTICIPANTS AND SETTING Patients attending a general practice clinic in Victoria, Australia, who attended for the "75 plus" health assessment check. MEASUREMENTS The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded. RESULTS Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category. CONCLUSION In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.
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Affiliation(s)
- J Winter
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Isenring E, Baker J, Kerr G. Malnutrition and falls risk in community-dwelling older adults. J Nutr Health Aging 2013; 17:277-9. [PMID: 23459982 DOI: 10.1007/s12603-012-0408-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Falls and fall-related injuries result in reduced functioning, loss of independence, premature nursing home admissions and mortality. Malnutrition is associated with falls in the acute setting, but little is known about malnutrition and falls risk in the community. The aim of this study was to assess the association between malnutrition risk, falls risk and falls over a one-year period in community-dwelling older adults. METHODS Two hundred and fifty four subjects >65 years of age were recruited to participate in a study in order to identify risk factors for falls. Malnutrition risk was determined using the Mini Nutritional Assessment-Short Form. RESULTS 28.6% had experienced a fall and according to the Mini Nutritional Assessment-Short Form 3.9% (n=10) of subjects were at risk of malnutrition. There were no associations between malnutrition risk, the risk of falls, nor actual falls in healthy older adults in the community setting. CONCLUSIONS There was a low prevalence of malnutrition risk in this sample of community-dwelling older adults and no association between nutritional risk and falls. Screening as part of a falls prevention program should focus on the risk of developing malnutrition as this is associated with falls.
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Affiliation(s)
- E Isenring
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Sherman H, Forsberg C, Karp A, Törnkvist L. The 75-year-old persons' self-reported health conditions: a knowledge base in the field of preventive home visits. J Clin Nurs 2012; 21:3170-82. [DOI: 10.1111/j.1365-2702.2012.04314.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Helena Sherman
- Centre for Family Medicine (CeFAM), Karolinska Institutet; Huddinge; Sweden
| | - Christina Forsberg
- Division of Nursing, Department of Neurobiology, Care Science and Society (NVS); Karolinska Institutet; Huddinge; Sweden
| | - Anita Karp
- Aging Research Centre (ARC); Stockholm; Sweden
| | - Lena Törnkvist
- Centre for Family Medicine (CeFAM), Karolinska Institutet; Huddinge; Sweden
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GIBSON S, SEQUEIRA J, CANT R, KU C. Identifying malnutrition risk in acute medical patients: Validity and utility of Malnutrition Universal Screening Tool and Modified Malnutrition Screening Tool. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01605.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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Miyata S, Tanaka M, Ihaku D. Usefulness of the Malnutrition Screening Tool in patients with pulmonary tuberculosis. Nutrition 2012; 28:271-4. [DOI: 10.1016/j.nut.2011.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/17/2011] [Accepted: 07/17/2011] [Indexed: 10/15/2022]
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Dent E, Visvanathan R, Piantadosi C, Chapman I. Use of the Mini Nutritional Assessment to detect frailty in hospitalised older people. J Nutr Health Aging 2012; 16:764-7. [PMID: 23131818 DOI: 10.1007/s12603-012-0405-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aims of this study were to: (1) determine the prevalence of undernutrition and frailty in hospitalised elderly patients and (2) evaluate the efficacy of both the Mini-Nutritional Assessment (MNA) screening tool and the MNA short form (MNA-SF) in identifying frailty. SETTING AND PARTICIPANTS A convenient sample of 100 consecutive patients (75.0 % female) admitted to the Geriatric Evaluation and Management Unit (GEMU) at The Queen Elizabeth Hospital in South Australia. MEASUREMENTS Frailty status was determined using Fried's frailty criteria and nutritional status by the MNA and MNA-SF. Optimal cut-off scores to predict frailty were determined by Youden's Index, Receiver Operator Curves (ROC) and area under curve (AUC). RESULTS Undernutrition was common. Using the MNA, 40.0% of patients were malnourished and 44.0% were at risk of malnutrition. By Fried's classification, 66.0 % were frail, 30.0 % were pre-frail and 4.0 % robust. The MNA had a specificity of 0.912 and a sensitivity of 0.516 in predicting frailty using the recommended cut-off for malnourishment (< 17). The optimal MNA cut-off for frailty screening was <17.5 with a specificity of 0.912 and sensitivity of 0.591. The MNA-SF predicted frailty with specificity and sensitivity values of 0.794 and 0.636 respectively, using the standard cut-off of < 8. The optimal MNA-SF cut-off score for frailty was < 9, with specificity and sensitivity values of 0.765 and 0.803 respectively and was better than the optimum MNA cut-off in predicting frailty (Youden Index 0.568 vs. 0.503). CONCLUSION The quickly and easily administered MNA-SF appears to be a good tool for predicting both under-nutrition and frailty in elderly hospitalised people. Further studies would show whether the MNA-SF could also detect frailty in other populations of older people.
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Affiliation(s)
- E Dent
- BAppSc (Hons), University of Adelaide, Department of Medicine, The Basil Hetzel Institute for Medical Research, 28 Woodville Road, Woodville South, SA, 5011.
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Vilaça KHC, Paula FJA, Ferriolli E, Lima NKC, Marchini JS, Moriguti JC. Body composition assessment of undernourished older subjects by dual-energy x-ray absorptiometry and bioelectric impedance analysis. J Nutr Health Aging 2011; 15:439-43. [PMID: 21623464 DOI: 10.1007/s12603-010-0300-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevention and treatment of diseases related to changes in body composition require accurate methods for the measurement of body composition. However, few studies have dealt specifically with the assessment of body composition of undernourished older subjects by different methodologies. OBJECTIVES To assess the body composition of undernourished older subjects by two different methods, dual energy x-ray absorptiometry (DXA) and bioelectric impedance (BIA), and to compare results with those of an eutrophic group. DESIGN The study model was cross-sectional; the study was performed at the University Hospital of the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. PARTICIPANTS Forty-one male volunteers aged 62 to 91 years. The groups were selected on the basis of anamnesis, physical examination and nutritional assessment according to the Mini Nutritional Assessment (MNA) score. Body composition was assessed by DXA and BIA. RESULTS Body weight, arm and calf circumference, body mass index (BMI), fat free mass (FFM) and fat mass (FM) were significantly lower in the undernourished group as compared to the eutrophic group. There were no significant differences between FFM and FM mean values determined by DXA and BIA in both groups, but the agreement between methods in the undernourished group was less strong. CONCLUSION Our results suggest caution when BIA is to be applied in studies including undernourished older subjects. This study does not support BIA as an accurate method for the individual assessment of body composition.
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Affiliation(s)
- K H C Vilaça
- Department of Internal Medicine, Division of General Internal and Geriatric Medicine, School of Medicine of Ribeirão Preto, University of Säo Paulo, Brazil.
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Allan-Gibbs R. Falls and hospitalized patients with cancer: a review of the literature. Clin J Oncol Nurs 2011; 14:784-92. [PMID: 21112855 DOI: 10.1188/10.cjon.784-792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preventing falls continues to be a serious issue faced by hospitals. Several studies have demonstrated an increased need for safety in hospitalized patients with cancer compared to other hospitalized populations. In addition, several fall-prevention studies in hospital settings have reported high rates of falls and injuries in this population. A cancer diagnosis is a significant risk factor for falling; however, few hospital studies have examined patients with cancer independently to determine why they are at greater risk for falls and injuries. Patients with cancer are a unique population because cancer treatments can cause side effects that may increase fall risk. Falls also can cause significant morbidity and mortality. More research is needed to better understand what specific oncology risk factors contribute to falls in the hospital setting.
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Zoltick ES, Sahni S, McLean RR, Quach L, Casey VA, Hannan MT. Dietary protein intake and subsequent falls in older men and women: the Framingham Study. J Nutr Health Aging 2011; 15:147-52. [PMID: 21365169 PMCID: PMC3136106 DOI: 10.1007/s12603-011-0028-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Poor nutritional status is often present among older adults who experience a fall. However, dietary intake and weight loss are often overlooked as potential factors. The objective of this study was to test the association between dietary protein intake and risk of subsequent falls in a population-based cohort of elderly men and women. METHODS Dietary intake and clinic data from 807 men and women (ages 67-93 years) from the Framingham Original Cohort Study were analyzed. Protein intake (total, animal and plant) was assessed as a continuous variable and by tertile of intake. Falls were reported by participants using a validated questionnaire at two time points. Weight was ascertained at each examination to examine the effect of weight loss over follow-up. RESULTS Higher dietary protein intakes were associated with a reduced odds of falling, although of borderline statistical significance (OR=0.80, 95% CI: 0.60-1.07) and were not associated with the rate of falls over follow-up (RR=0.93, 95%CI: 0.73-1.19). Tertile analyses tended towards a protective association, but most did not achieve statistical significance; there was no dose-response. For those who lost ≥ 5% of their baseline weight, higher intakes of total, animal and plant protein showed a significantly lower rate of subsequent falls. CONCLUSION This work highlights the importance of adequate protein intake as a potentially modifiable risk factor for fall prevention in older adults. Further exploration of the interaction of protein intake and weight loss as related to falls is needed.
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Affiliation(s)
| | - Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Medicine, Boston, MA
| | - Robert R. McLean
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Medicine, Boston, MA
| | - Lien Quach
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | | | - Marian T. Hannan
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Medicine, Boston, MA
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