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Nishioka S, Kokura Y, Momosaki R, Taketani Y. Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review. Nutrients 2024; 16:223. [PMID: 38257116 PMCID: PMC10820477 DOI: 10.3390/nu16020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, 4-11, Gin-yamachi, Nagasaki 850-0854, Japan
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
| | - Yoji Kokura
- Department of Nutrition Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, 15-39-8, Mugigaura, Anamizu, Hosu-gun 927-0023, Japan;
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Mie, Japan;
| | - Yutaka Taketani
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
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Nishioka S, Wakabayashi H. Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle? Nutr Rev 2023; 81:191-205. [PMID: 35831980 DOI: 10.1093/nutrit/nuac047] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.
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Affiliation(s)
- Shinta Nishioka
- is with the Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- is with the Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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3
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Lindner-Rabl S, Wagner V, Matijevic A, Herzog C, Lampl C, Traub J, Roller-Wirnsberger R. Clinical Interventions to Improve Nutritional Care in Older Adults and Patients in Primary Healthcare - A Scoping Review of Current Practices of Health Care Practitioners. Clin Interv Aging 2022; 17:1-13. [PMID: 35023909 PMCID: PMC8747528 DOI: 10.2147/cia.s343307] [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: 10/08/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
In light of the increasing life expectancy of Europe's population and the rising significance of active and healthy ageing relating thereto, an integrated approach of nutritional care within primary health care is gaining importance. The aim of the review was to summarize evidence on the effectiveness of nutritional interventions in primary health care. The scoping review is based upon a comprehensive literature search of relevant literature published between January 2010 and August 2021 in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Embase and Medline databases. Overall, 15 studies were included for evidence synthesis and interventions were basically clustered according to their type, into 1) eHealth and tele-medical interventions; 2) targeted single interventions; and 3) comprehensive, multi-faceted interventions. The review presents diverging evidence regarding the efficacy and effectiveness of interventions for nutritional care in primary health care, however, demonstrates encouraging outcomes. eHealth and tele-medical interventions partly show a careful positive tendency. Likewise, manifold single interventions on patient level present significant improvements in patient health outcomes. Multifaceted and comprehensive interventions found in the literature also partly demonstrate significant changes in intervention groups. Primary health care represents a critical setting for the care of older citizens and patients with complex health needs. This scoping review provides an overview of current nutrition care practices in primary health care and results reinforce the need to strengthen implementation of multi-faceted interventions carried out by the inter-disciplinary primary care team for advanced nutritional care.
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Affiliation(s)
- Sonja Lindner-Rabl
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Valentina Wagner
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Andreas Matijevic
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Carolin Herzog
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Christina Lampl
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Julia Traub
- University Hospital Graz, Department of Clinical Medical Nutrition, Graz, Austria
| | - Regina Roller-Wirnsberger
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
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Lengfelder L, Mahlke S, Moore L, Zhang X, Williams G, Lee J. Prevalence and impact of malnutrition on length of stay, readmission, and discharge destination. JPEN J Parenter Enteral Nutr 2021; 46:1335-1342. [PMID: 34967019 DOI: 10.1002/jpen.2322] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies indicate one in three hospitalized patients are malnourished upon admission, however, the documented malnutrition rate in acute care hospitals is often lower. This study measured prevalence of malnutrition upon admission and correlated the relationship among malnutrition status, length of stay (LOS), discharge disposition, and readmission rate. MATERIALS AND METHODS A prospective observational cohort study was performed across nine tertiary care hospitals in Houston, Texas. Registered Dietitians screened patients age ≥18 within 24 hours of admission for 2 consecutive days per hospital. Malnourished patients were diagnosed using a modified version of 2012 Consensus Statement from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Data collected included demographics, LOS, discharge disposition, and 30-day re-admission status. RESULTS In 416 patients, 31.7% were malnourished upon admission. Malnourished patients were significantly older (67.8 vs 57.6 years, P<.001) and had a lower BMI (26.2 vs 32.4 kg/m2 , P<.001) than nonmalnourished patients. Malnourished patients had higher odds of having a LOS ≥3 days (2.38 [95% CI 1.45-3.88], P<.001) and higher odds of readmitting within 30 days (2.28 [95% CI 1.26-4.12], P<.006) when compared to nonmalnourished patients. There were no significantly different clinical outcomes between moderately and severely malnourished groups. CONCLUSION The study successfully utilized the modified AND-ASPEN criteria to show that approximately one in three patients presented with malnutrition upon admission. Malnourished patients were more likely to have longer LOS and more likely to be readmitted within 30 days. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sarah Mahlke
- Memorial Hermann Health System, Houston, Texas, USA
| | - Lynn Moore
- Memorial Hermann Health System, Houston, Texas, USA
| | - Xu Zhang
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - George Williams
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Jenny Lee
- Memorial Hermann Health System, Houston, Texas, USA
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Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Kayashita J, Mori N. Nutritional Management Enhances the Recovery of Swallowing Ability in Older Patients with Sarcopenic Dysphagia. Nutrients 2021; 13:nu13020596. [PMID: 33670314 PMCID: PMC7917588 DOI: 10.3390/nu13020596] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
Abstract
This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group (p = 0.004 and p < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
- Correspondence: ; Tel.: +81-53-471-8331; Fax: +81-53-474-8819
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan;
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University, Shinjuku-ku 162-8666, Japan;
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan;
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan; (T.O.); (A.N.)
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan; (T.O.); (A.N.)
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima 734-8558, Japan;
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (K.M.); (N.M.)
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van der Laag PJ, Arends SAM, Bosma MS, van den Hoogen A. Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis. Geriatr Nurs 2021; 42:83-93. [PMID: 33387828 DOI: 10.1016/j.gerinurse.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023]
Abstract
Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admitted to geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of early discharge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to present an overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation. Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factors were analysed via Bakker's five levels of evidence. Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extracted factors, limited (n=3), moderate (n=5) and conflicting (n=5) evidence found a significant association. Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantly related to successful rehabilitation. These factors could support healthcare professionals to indicate successful rehabilitation at admission and contributes to deployment of early discharge planning and development of more custom-made rehabilitation trajectories.
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Affiliation(s)
- Patricia J van der Laag
- Zorggroep Florence, Rijswijk, The Netherlands; Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Susanne A M Arends
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Stichting Humanitas, Rotterdam, The Netherlands
| | - Martine S Bosma
- Zorggroep Florence, Rijswijk, The Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Agnes van den Hoogen
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
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7
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Ueshima J, Mori N. Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan. Geriatr Gerontol Int 2020; 20:811-816. [PMID: 33058420 DOI: 10.1111/ggi.13976] [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: 03/17/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
AIM The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut-off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. METHODS This retrospective cross-sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut-off value of GNRI, and the results were compared against the Mini Nutritional Assessment - Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut-off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. RESULTS The mean age of the patients was 76.0 ± 7.0 years. The optimal cut-off value of GNRI for Mini Nutritional Assessment - Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817-0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776-0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut-off in the European Society of Clinical Nutrition and Metabolism-defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment - Short Form-based and MUST-based diagnosis, respectively. CONCLUSIONS The study showed GNRI <96 points as the optimal cut-off value for nutritional screening. GNRI might be one of the easy-to-use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811-816.
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Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Ryoko Kato
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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8
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Maurer E, Wallmeier V, Reumann MK, Ehnert S, Ihle C, Schreiner AJ, Flesch I, Issack PS, Stollhof LE, Nüssler AK. Risk of malnutrition in orthopedic trauma patients with surgical site infections is associated with increased morbidity and mortality - a 3-year follow-up study. Injury 2020; 51:2219-2229. [PMID: 32620329 DOI: 10.1016/j.injury.2020.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Malnutrition is a worldwide problem which can result in prolonged hospitalization from complications such as poor wound healing and increased morbidity. There is increasing evidence of the effect of risk of malnutrition (ROM) on outcomes in orthopedic surgical patients. However, there is little data on the effect of nutritional status on clinical outcomes in orthopedic trauma patients with surgical site infections (SSI). Therefore, our aim was to investigate how malnutrition risk affects clinical outcomes in a prospective cohort of orthopedic trauma patients with SSI. METHODS The study included 345 patients who underwent surgery due to SSI at a level 1 trauma center. All patients were evaluated on their nutritional status as assessed by the Nutritional Risk Screening in 2014/15 and 2017/18. 238 (69.0%) datasets were available for the follow-up analysis. Twenty patients (8.4%) had died, resulting in 218 patients. Outcomes investigated included comorbidities, medication intake, destination of discharge, degree of mobility, support for procuring food, mortality risk and quality of life. RESULTS 32.8% were at risk of malnutrition (ROM) at EXAM1. Female patients had a higher ROM than males (p < 0.05). Patients with ROM had more comorbidities (p < 0.001), an increased need for medication intake (p < 0.001), a decreased level of mobility (p < 0.001) and increased need of support in procuring food (p < 0.001). The destination of discharge was independent of the nutritional status (p = 0.641). Twenty (8.4%) of the available 238 patients had died during follow-up time period, resulting in a 6.2-times higher risk of mortality in patients with ROM. EQ-5D revealed that mobility, self-supply and usual activities of daily living were increased in well-nourished patients (p < 0.001). CONCLUSION ROM in orthopedic trauma patients with SSI is associated with an increased number of comorbidities and need for medication intake, a decrease in mobility and a higher dependency for food acquisition. Patients at ROM exhibited a 6.2-times higher mortality rate than well-nourished patients. EQ-5D evaluation showed better mobility, self-supply, and activity of daily living in well-nourished patients. We therefore strongly recommend supplementing patients with ROM with a specific diet during and after discharge from the hospital in order to reduce postoperative complications and long-term mortality.
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Affiliation(s)
- Elke Maurer
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - Vera Wallmeier
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Marie K Reumann
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Christoph Ihle
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Anna J Schreiner
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Ingo Flesch
- Department of Septic Trauma Surgery, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Paul S Issack
- Department of Orthopaedic Surgery, New York - Presbyterian Hospital, 170 William St, New York, NY 10038, United States
| | - Laura E Stollhof
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Andreas K Nüssler
- Siegfried Weller Research Institute, BG Unfallklinik, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Malnutrition at Admission Predicts In-Hospital Falls in Hospitalized Older Adults. Nutrients 2020; 12:nu12020541. [PMID: 32093144 PMCID: PMC7071417 DOI: 10.3390/nu12020541] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
Malnutrition leads to poor prognoses, including a predisposition to falls. Few studies have investigated the relationship between malnutrition and falls during hospitalization. This study aimed to determine malnutrition’s association with falls during hospitalization. A retrospective observational study was conducted. Patients aged ≥65 years that were admitted to and discharged from a university hospital between April 2018 and March 2019 were examined. Patients with independent basic activities of daily living were included. Diagnosis of malnutrition was based on the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria at admission. Disease information such as the Charlson Comorbidity Index (CCI) and reasons for hospitalization were reviewed. Kaplan–Meier curve and multivariate Cox regression analyses were performed. Data from 6081 patients (mean age: 74.4 ± 6.1 years; males: 58.1%) were analyzed. The mean CCI was 2.3 ± 2.8 points. Malnutrition was detected in 668 (11.0%) and falls occurred in 55 (0.9%) patients. Malnourished patients experienced a higher fall rate than those without malnutrition (2.4% vs. 0.7%, log-rank test p < 0.001). In multivariate analysis, malnutrition had the highest hazard ratio for falls among covariates (hazard ratio 2.78, 95% confidence interval 1.51–5.00, p = 0.001). In conclusion, malnutrition at the time of admission to hospital predicts in-hospital falls.
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Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
- Nutritional Therapy Support Center, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi 480-1195, Japan; (T.N.); (R.K.)
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8511, Japan;
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (Y.Y.); (R.M.)
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan; (Y.Y.); (R.M.)
| | - Ryoko Kato
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi 480-1195, Japan; (T.N.); (R.K.)
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
- Nutritional Therapy Support Center, Aichi Medical University Hospital, Nagakute 480-1195, Japan
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10
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Tyler R, Barrocas A, Guenter P, Araujo Torres K, Bechtold ML, Chan L, Collier B, Collins NA, Evans DC, Godamunne K, Hamilton C, Hernandez BJD, Mirtallo JM, Nadeau WJ, Partridge J, Perugini M, Valladares A. Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States. JPEN J Parenter Enteral Nutr 2020; 44:395-406. [DOI: 10.1002/jpen.1768] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Renay Tyler
- University of Maryland Medical Center Baltimore Maryland USA
| | | | - Peggi Guenter
- Clinical Practice, Quality, and AdvocacyAmerican Society for Parenteral Nutrition Silver Spring Maryland USA
| | | | - Matthew L. Bechtold
- Division of Gastroenterology & HepatologyDepartment of Medicine University Hospital & Clinics Columbia Missouri USA
| | - Lingtak‐Neander Chan
- Department of PharmacyInterdisciplinary FacultyNutritional Sciences ProgramUniversity of Washington Seattle Washington USA
| | - Bryan Collier
- Virginia Tech Carilion School of Medicine Roanoke Virginia USA
| | - Nilsa A. Collins
- Clinical Integration ProgramsWellStar Clinical Partners Marietta Atlanta Georgia USA
| | - David C. Evans
- Ohio Health Trauma and Surgical Services Columbus Ohio USA
| | | | - Cindy Hamilton
- Digestive Disease and Surgery Institute Cleveland Clinic Cleveland Ohio USA
| | | | - Jay M. Mirtallo
- Clinical Practice, Quality, and AdvocacyAmerican Society for Parenteral Nutrition Silver Spring Maryland USA
- The Ohio State UniversityCollege of Pharmacy Columbus Ohio USA
| | | | - Jamie Partridge
- Field Health Economics and Outcomes ResearchBayer Pharmaceuticals Whippany New Jersey USA
| | - Moreno Perugini
- Global Head of Medical Affairs & Marketing AccessNestlé Health Science Bridgewater New Jersey USA
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Shirado K, Wakabayashi H, Maeda K, Nishiyama A, Asada M, Isse H, Saito S, Kakitani C, Momosaki R. Impact of Energy intake at One Week after Hospitalization on Prognosis for Older Adults with Pneumonia. J Nutr Health Aging 2020; 24:119-124. [PMID: 31886818 DOI: 10.1007/s12603-019-1282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study objectives to investigate the influence of average energy intake at 1 week of hospitalization on prognosis for older adults with pneumonia. DESIGN Retrospective observational cohort study. SETTING The Japan Rehabilitation Nutrition Database comprise those with pneumonia in acute care hospitals. PARTICIPANTS The study included 329 pneumonia patients (aged over 65 years) who entered into the Japan Rehabilitation Nutrition Database (JRND) from November 2015 to March 2018. MEASUREMENTS Logistic regression analysis was performed to confirm the relationship of energy intake with the rate of mortality, discharge home, and pneumonia recurrence during hospitalization. Variables included in the multiple regression analysis model were age, sex, Mini Nutritional Assessment-Short Form score (MNA-SF) at hospitalization, A-DROP, Charlson comorbidity index (CCI), and presence or absence of rehabilitation. RESULTS Of 315 patients with pneumonia (median age 85 years), 63.8% were men. 57.7% were assigned to the lack of energy intake (LEI) at 1 week after admission. Patients in the LEI group were older (p = 0.033), had higher A-DROP score (p < 0.001), and showed higher malnutrition rate in MNA-SF at hospitalization (p < 0.001) than those in the control group. Mortality, pneumonia recurrence (p = 0.001), median body mass index (p = 0.012), and low malnutrition in MNA-SF (p < 0.001) at discharge were significantly higher in the LEI group than in the control group. Logistic regression analysis showed that LEI was an independent risk factor for mortality (Odds ratio: 5.07, p = 0.002), discharge home (Odds ratio: 0.33, p = 0.007), and pneumonia recurrence (Odds ratio: 3.26, p = 0.007). CONCLUSIONS LEI at 1 week after hospitalization in older adults with pneumonia was an independent risk factor for mortality, difficult at-home recovery, and pneumonia recurrence. These findings suggest the importance of adequate energy intake from the early days of hospitalization.
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Affiliation(s)
- K Shirado
- Kengo Shirado, R.P.T. Department of Rehabilitation, Aso Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka 820-8505, Japan; Tel: +81-948-29-8038; Fax: +81-948-25-8018,
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Suzuki R, Nagano A, Wakabayashi H, Maeda K, Nishioka S, Takahashi M, Momosaki R. Assignment of Dental Hygienists Improves Outcomes in Japanese Rehabilitation Wards: A Retrospective Cohort Study. J Nutr Health Aging 2020; 24:28-36. [PMID: 31886805 DOI: 10.1007/s12603-019-1284-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To clarify the effectiveness of ward-assigned dental hygienists (DHs) on rehabilitation outcomes in rehabilitation wards. DESIGN Retrospective cohort study. SETTING The registry data from the Japanese Rehabilitation Nutrition Database. PARTICIPANTS 656 patients with hip fracture or stroke admitted to convalescent rehabilitation wards. MEASUREMENTS The main outcome measures were the Functional Independence Measure (FIM), the Food Intake Level Scale (FILS), and the home discharge rate. Patients were divided into two groups based on the ward setting: with an assigned DH (DH group) and without an assigned DH (NDH group). Clinical characteristics and outcomes were compered between the groups. Between-facility differences were adjusted by generalized estimating equation. We performed post-hoc power analysis to confirm that there were enough samples included in this study to detect a significant difference. RESULTS Of 656 patients (mean age, 77 years; 57.1% female; 65.5% stroke) from 10 facilities, 454 patients (69.2%) from 4 facilities were in the DH group. FIM score at discharge (107 vs 90, P<0.001), percentage improvement in FILS score from admission to discharge (44.5% vs 22.8%, P<0.001) and home discharge rate (72.5% vs 61.4%, P<0.001) were significantly higher in the DH group than in the NDH group. After multivariate analysis, the FIM score at discharge (P=0.007), FILS score at discharge (P=0.024), and home discharge rate (P=0.007) were significantly higher in the DH group than in the NDH group. CONCLUSIONS ADL and swallowing function were significantly improved at discharge and the home discharge rate was higher among patients in rehabilitation wards with DHs. Having a ward-assigned DH may lead to better rehabilitation outcomes in rehabilitation wards.
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Affiliation(s)
- R Suzuki
- Ayano Nagano, RN, Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan, E-mail address: , Tel: +81-798-33-2211
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13
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Jia W, Wang S, Han K, Liu M, Yang S, Cao W, He Y. Association of Anemia with Activities of Daily Living in Chinese Female Centenarian. J Nutr Health Aging 2020; 24:346-351. [PMID: 32115618 DOI: 10.1007/s12603-020-1326-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians. DESIGN, SETTING AND PARTICIPANTS We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016. MEASUREMENTS Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60. RESULTS The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability. CONCLUSION These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.
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Affiliation(s)
- W Jia
- Yao He, Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, China, ; Tel.: 86-10-66876411
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Lambert K, Taylor E, Bowden S, Charlton K. Nutritional Status According to the Mini Nutritional Assessment Predicts Speed and Degree of Functional Improvement and Discharge Outcomes in Rehabilitation Patients. J Nutr Gerontol Geriatr 2019; 39:16-29. [PMID: 31718490 DOI: 10.1080/21551197.2019.1689882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This retrospective observational study evaluated the association between nutritional status, functional ability and discharge outcomes. Data from 1430 older rehabilitation patients (43% male, median age 79 years, interquartile range: 74-84) were analyzed. One fifth (20.6%, n = 294) of patients were malnourished on admission to rehabilitation. Three important findings were evident. Firstly, nutritional status on admission to rehabilitation was associated with reduced functional, motor, cognitive and feeding scores on admission and discharge (all P < 0.05). Secondly, malnutrition at admission was associated with significantly slower gains in rehabilitation. Finally, malnutrition at admission was associated with significantly higher odds of a decline in functional ability during admission (OR 3.95; 95% CI: 2.14-7.27), and almost three times greater odds of additional care requirements on discharge (OR: 2.9 ((95% CI: 1.02-8.3). The nutritional status of patients on admission to inpatient rehabilitation is a predictor of both the speed and degree of rehabilitation gains and discharge outcomes.
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Affiliation(s)
- Kelly Lambert
- Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Emily Taylor
- Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Steven Bowden
- Healthcare Improvement Analytics, Sutherland Hospital, Caringbah, Australia
| | - Karen Charlton
- Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
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Calsolaro V, Antognoli R, Pasqualetti G, Okoye C, Aquilini F, Cristofano M, Briani S, Monzani F. 30-Day Potentially Preventable Hospital Readmissions In Older Patients: Clinical Phenotype And Health Care Related Risk Factors. Clin Interv Aging 2019; 14:1851-1858. [PMID: 31806943 PMCID: PMC6842315 DOI: 10.2147/cia.s208572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Early readmission rate has been regarded as an indicator of in-hospital and post-discharge quality of care. Evaluating the contributing factors is crucial to optimize the healthcare and target the intervention. In this study we evaluated the potential for preventing 30-day hospital readmission in a cohort of older patients and identified possible risk factors for readmission. Patients and methods Diagnosis-Related Group (DRG) codes of patients consecutively hospitalized for acute disease in the Geriatrics Unit of the University Hospital of Pisa within a 1-year window were recorded. All the patients had received a comprehensive geriatric assessment. Crossing and elaboration of the DRG codes was performed by the Potentially Preventable Readmission Grouping software (3M™ Corporation). DRG codes were classified as stand-alone admissions (SA), index admissions (IA) and potentially preventable readmissions (PPR) within a time window of 30 days after discharge. Results In total, 1263 SA and 171 IA were identified, with an overall PPR rate of 11.9%. Hospitalizations were significantly longer in IA and PPR than SA (p<0.05). The more frequent readmission causes were acute heart failure, pulmonary edema, sepsis, pneumonia and stroke. In acute heart failure a nonlinear U-shaped readmission trend (with nadir at 5 days of hospitalization) was observed while, in all the other DRG codes, the PPR rate increased with increasing length of hospitalization. Comprehensive geriatric assessment showed a significantly lower degree of disability and comorbidity in SA than IA patients. At stepwise regression analysis, a high degree of disability and comorbidity as well as the diagnosis of sepsis emerged as independent risk factors for PPR. Conclusion Addressing PPR is crucial, especially in older patients. The adequacy of treatment during hospitalization (especially in cases of sepsis) as well as the setting of a comprehensive discharge plan, accounting for comorbidity and disability of the patients, are essential to reduce PPR.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | | | - Silvia Briani
- Health Management Department, University Hospital of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Uno C, Maeda K, Wakabayashi H, Nishioka S, Ogawa N, Okamoto T, Hoyano K, Momosaki R. Nutritional status change and activities of daily living in elderly pneumonia patients admitted to acute care hospital: A retrospective cohort study from the Japan Rehabilitation Nutrition Database. Nutrition 2019; 71:110613. [PMID: 31837639 DOI: 10.1016/j.nut.2019.110613] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of improved nutritional status on activities of daily living (ADLs) and dysphagia in elderly patients with pneumonia who were admitted to acute care hospitals. METHODS A retrospective cohort study was conducted using registry data from the Japan Rehabilitation Nutrition Database of patients with pneumonia who were admitted to acute care hospitals. Patients were divided into two groups based on the Mini Nutritional Assessment Short-Form (MNA-SF) status at discharge: Patients with no status change or with decreased status were allocated to the unimproved nutritional status (UN) group and those with increased status were assigned to the improved nutritional status (IN) group. The primary outcome was ADLs as assessed by Barthel Index (BI) score at hospital discharge. Secondary outcomes included dysphagia as assessed by the Food Intake Level Scale (FILS) at discharge. RESULTS The study included 143 patients with a mean age of 84.7 ± 7.8 y. Based on the MNA-SF categories at discharge, 127 (88.8%) patients were assigned to the UN group and 16 (11.2%) to the IN group. Patients in the IN group had significantly higher BI and FILS scores than those in the UN group. Multiple regression analysis indicated that improvement in nutritional status was independently associated with BI gain (B = 9.916; β = 0.153; 95% confidence interval [CI], 1.929-11.761; P = 0.017) and FILS gain (B = 1.259; β = 0.167; 95% CI, 1.224-2.814; P = 0.044). CONCLUSIONS Nutritional improvement is associated with improvements in ADL and dysphagia in patients with pneumonia and malnutrition.
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Affiliation(s)
- Chiharu Uno
- Institute of Innovation for Future Society, Nagoya University, Nagoya City, Aichi, Japan; Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan.
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center. Yokohama City, Kanagawa, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki, Japan
| | - Nami Ogawa
- Department of Gerontology and Gerodontology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Okamoto
- Department of Rehabilitation, Kurashiki Rehabilitation Hospital, Kurashiki City, Okayama, Japan
| | - Kengo Hoyano
- Fukui Health Science University, Faculty of Health Science Department of Rehabilitation Division of Speech-Language-Hearing Therapy, eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki city, Kanagawa, Japan
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Impact of edema on length of calf circumference in older adults. Geriatr Gerontol Int 2019; 19:993-998. [DOI: 10.1111/ggi.13756] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Yuria Ishida
- Department of NutritionAichi Medical University Hospital Nagakute Aichi Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
| | - Tomoyuki Nonogaki
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Akio Shimizu
- Department of NutritionHamamatsu City Rehabilitation Hospital Hamamatsu Shizuoka Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Ryoko Kato
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Naoharu Mori
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
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Nishiyama A, Wakabayashi H, Nishioka S, Nagano A, Momosaki R. Energy Intake at Admission for Improving Activities of Daily Living and Nutritional Status among Convalescent Stroke Patients. Neurol Med Chir (Tokyo) 2019; 59:313-320. [PMID: 31118361 PMCID: PMC6694019 DOI: 10.2176/nmc.oa.2019-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.
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Affiliation(s)
- Ai Nishiyama
- Department of Clinical Nutrition and Food Service, Yasuoka Hospital
| | | | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital
| | - Ayano Nagano
- Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi
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Waza M, Maeda K, Katsuragawa C, Sugita A, Tanaka R, Ohtsuka A, Matsui T, Kitagawa K, Kishimoto T, Fukui H, Kawai K, Yamamoto M, Isono M. Comprehensive Tool to Assess Oral Feeding Support for Functional Recovery in Post-acute Rehabilitation. J Am Med Dir Assoc 2019; 20:426-431. [DOI: 10.1016/j.jamda.2018.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 01/07/2023]
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20
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Loman BR, Luo M, Baggs GE, Mitchell DC, Nelson JL, Ziegler TR, Deutz NE, Matarese LE. Specialized High-Protein Oral Nutrition Supplement Improves Home Nutrient Intake of Malnourished Older Adults Without Decreasing Usual Food Intake. JPEN J Parenter Enteral Nutr 2018; 43:794-802. [PMID: 30565718 PMCID: PMC6924274 DOI: 10.1002/jpen.1467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/08/2018] [Indexed: 11/09/2022]
Abstract
Background Reduced nutrient intake is common in patients after hospitalization, contributing to increased risk for readmission and mortality. Oral nutrition supplements can improve nutrition status and clinical outcomes, but intake of food is prioritized by clinicians. This study examines the impact of a high‐protein oral nutrition supplement (S‐ONS) on nutrient intake post discharge. Methods In a subset of patients (14 S‐ONS and 16 placebo) from the NOURISH (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients) trial, 24‐hour dietary recalls were conducted on 3 randomly selected days during the weeks of 30, 60, and 90 days post discharge. Nutrient intake was estimated using Nutrition Data System for Research software. Adequate energy and protein intake were defined as 30 kcal/kg/d and 1.2 g/kg/d, respectively. Dietary Reference Intakes (DRIs) were used for other nutrients. Results Less than half of patients met the requirements for energy, protein, and 12 micronutrients from food intake alone during the study. Energy and protein intakes from food were not diminished relative to placebo. Considering nutrient intake from both food and S‐ONS, 50% and 71% of patients receiving S‐ONSs met energy and protein goals respectively at 90 days (compared with 29% and 36%, in the placebo group), and 100% met the DRI for total carbohydrate, iron, phosphorus, copper, selenium, thiamin, and riboflavin at all time points, all of which were consumed at higher amounts vs placebo. Conclusion Three months of S‐ONS consumption increases intake of numerous nutrients without decreasing nutrient intake from food in older malnourished adults post discharge.
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Affiliation(s)
- Brett R Loman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Nutritional Sciences, College of Agricultural, Consumer, and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Menghua Luo
- Research and Development, Abbott Nutrition, Columbus, Ohio, USA
| | | | - Diane C Mitchell
- Department of Nutritional Sciences, Penn State University, University Park, Pennsylvania, USA
| | | | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Laura E Matarese
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Kokura Y, Wakabayashi H, Nishioka S, Maeda K. Nutritional intake is associated with activities of daily living and complications in older inpatients with stroke. Geriatr Gerontol Int 2018; 18:1334-1339. [DOI: 10.1111/ggi.13467] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 05/27/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Yoji Kokura
- Department of Clinical Nutrition; Keiju Medical Center and Noto Liaison Council for Cerebral Stroke; Nanao City Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama City Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services; Nagasaki Rehabilitation Hospital; Nagasaki City Japan
| | - Keisuke Maeda
- Palliative Care Center; Aichi Medical University; Nagakute City Japan
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