Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

A comparison of oral health, nutrition, and swallowing function in older adults with and without sarcopenia: A cross-sectional study

BACKGROUND

Sarcopenia, the age-related loss of muscle mass and strength, may impact the muscles involved in oral functions and swallowing, leading to challenges that may impact quality of life in older adults. The aim of the study was to compare oral health, swallowing function, and malnutrition of older adults with and without sarcopenia.

MATERIALS AND METHODS

The cross-sectional study included volunteers ≥65 years of age. Sarcopenia status was evaluated by anthropometric (calf circumference and midupper arm circumference) and muscle strength (walking speed and handgrip strength) measurements. Oral health was assessed with the Oral Health Impact Profile (OHIP-14), swallowing function was assessed by the Eating Assessment Tool-10 (EAT-10), and nutrition status was determined using the Mini Nutritional Assessment.

RESULTS

This study included 65 older adults. The mean age was 80 years, 54% were female, and 43% were diagnosed with sarcopenia. Individuals with sarcopenia had a higher OHIP-14 score (which indicates poor quality of life related to oral and dental health, 16 ± 8 vs 11 ± 7; P = 0.008), were more likely to have a EAT-10 score ≥ 3 (indicating presence of dysphagia, 79% vs 41%; P = 0.002), and were more likely to be at risk for malnutrition (79% vs 54%; P = 0.03) compared with individuals without sarcopenia.

CONCLUSIONS

Older adults with sarcopenia may be at risk for poor quality of life related to oral health, malnutrition and dysphagia. Further studies with long-term follow-up are needed to determine the long-term effects of sarcopenia on oral health, swallowing function, and malnutrition in older adults.

Prevalence of malnutrition among adult inpatients in China: a nationwide cross-sectional study

Malnutrition substantially contributes to adverse clinical outcomes. However, no national survey has been conducted to characterize its epidemiology in hospital settings in China. We conducted the China Nutrition Fundamental Data 2020 project among a multistage stratified cluster sample of adult inpatients from 291 study sites across 30 provinces, autonomous regions and municipalities (except for Hong Kong, Macao, Taiwan Province, and the Xizang Autonomous Region, please see MATERIALS AND METHODS for details of the causes) of China to generate reliable data on the prevalence of malnutrition and explore the associated risk factors. We collected information on participants' sociodemographic characteristics, physical examinations, and laboratory test results. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. The standardized prevalence of malnutrition was calculated, and factors associated with malnutrition were examined using logistic regression analyses. We included 54,652 individuals with seven systemic diseases who completed all the survey documents in the final analysis. The overall prevalence of malnutrition was 12.5%, representing 7.6 million adult inpatients in China. The prevalence of malnutrition was higher in men, individuals aged ⩾ 60 years, residents of central and western regions, people from lower economic areas, and those with lower education levels than in women, individuals aged <60 years, residents of eastern regions, individuals from higher economic areas, and those with higher education levels. Patients with higher disease severity scores, infectious diseases, and neoplasms had a higher tendency for malnutrition than those without such conditions. Sex, age, region, economic level, education level, disease severity score, infectious diseases, and neoplasms were independently associated with malnutrition. In conclusion, malnutrition is prevalent among Chinese adult inpatients, necessitating national- and hospital-level interventions. This survey provides several avenues to begin addressing the burden of malnutrition in China.

Relationship between immediate memory, depressive symptomatology and loneliness in older adults: a longitudinal study

OBJECTIVES

We aimed to study the longitudinal relationship between immediate memory, depressive symptomatology and loneliness controlling for age and number of chronic diseases over time.

METHOD

The study sample consisted of 64,887 participants from three consecutive waves of the Survey of Health, Ageing and Retirement in Europe project, aged 50 or older at the first time (M = 66.68, SD = 10.034). We used cross-lagged panel model.

RESULTS

Within each temporal moment, associations between immediate memory and depressive symptomatology, and associations between immediate memory and loneliness were negative. Associations between depressive symptomatology and loneliness were positive. These three variables feedback on each other over time through small and medium effects. Immediate memory is more affected by depressive symptomatology than by loneliness. However, loneliness may exert a greater negative effect, in relative terms, on immediate memory when it coexists with depressive symptomatology. Depressive symptomatology is more affected by loneliness than by immediate memory deficits. However, deficits in immediate memory may affect depressive symptomatology more in relative terms because such deficits are exacerbated by elevated scores of depressive symptomatology.

CONCLUSION

Despite the effect sizes being small to medium, depressive symptomatology and loneliness are risk factors for cognitive functioning. In addition, cognitive impairment aggravates depressive symptoms and loneliness feelings.

Experiences and perceptions of meals on wheels volunteers in providing nutritional care to older adults: A qualitative evidence synthesis

In the community, Meals on Wheels (MoW) programmes are instrumental in the delivery of meals to nutritionally vulnerable older adults. This qualitative evidence synthesis aimed to explore the perceptions and experiences among volunteers of MoW services of their role in supporting nutrition care. Scopus, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and PsycINFO were searched employing qualitative data collection and analysis methods. Results were synthesized using Thomas and Harden's three step approach for thematic synthesis. Three articles were included and two themes were identified: (1) complexity in coordinating MoW to ensure service delivery, and (2) the MoW volunteers' perception of their role in providing nutrition care was eclipsed by the social element of their role. While MoW is pivotal to support older adults' independence, challenges like staffing, funding constraints, and limited community awareness of the service persist. Volunteers' express positivity but face concerns about time commitment and replacement recruitment. Exploring MoW volunteers' broader roles in food insecurity is imperative to understand and address the complex dynamics of providing nutrition care and support to older adults.

A qualitative descriptive study on the perspectives and experiences of multidisciplinary HCPs in providing nutritional care to older adults with cancer

OBJECTIVES

To explore the perceptions and experiences of healthcare professionals (HCPs) caring for older adults with cancer regarding dietary advice provision and dietetic referral.

METHODS

Qualitative descriptive study providing rich descriptions of the experiences of multidisciplinary HCPs in providing care to older adults with cancer, excluding dietitians or nutritionists. Purposive and snowball sampling methods were used for recruitment. Semi-structured interviews and a focus group session were conducted. Data was analysed using qualitative content analysis. Inductive codes were generated, and codes representing factors influencing HCPs' referral to dietetics and dietary advice provision were then mapped to domains in the Tailored Implementation of Chronic Diseases (TICD) checklist using a deductive approach.

RESULTS

Twenty HCPs across various Australian healthcare settings participated, with a broad range of working experience (1.5 to 53 years) being interviewed. Most participants perceived their role in the provision of general dietary advice, and there was a consensus that nutrition is important. Key barriers (e.g. lack of time and resources, perceived lack of knowledge, scope of practice), including unique patient-related barriers (e.g. co-morbidities, fatalistic mindset), and key facilitators (e.g. need for education, evidence-based resources, multidisciplinary team approach) to dietary advice provision fell within five TICD domains (intervention, health professional factors, patient factors, professional interactions, incentives and resources). Common barriers (e.g. disconnections in multidisciplinary care, lack of structured referral pathways) and facilitators (e.g. clear referral pathways) to referral fell within four TICD domains (intervention, health professional factors, professional interactions, incentives and resources).

CONCLUSION

The barriers and facilitators to referral and provision of dietary advice by HCPs suggest the need for system-level changes via a multi-pronged approach. Simple and accessible nutrition resources, stronger nutrition education for HCPs, improved referral pathways and role clarity are required to support a multidisciplinary approach to nutritional care. More qualitative research on patient-level factors involving older adults with cancer is warranted.

The relationship between depression and nutritional status among the elderly adults with cardiovascular diseases in Northern Iran

BACKGROUND

Malnutrition and depression among the elderly people with cardiovascular diseases are important public health concerns. This study made an attempt to determine the relationship between these people's depression and their nutritional status in northern Iran.

METHODS

This analytical cross-sectional study was conducted on 190 elderly patients hospitalized with cardiovascular diseases in Dr. Heshmat Heart Hospital in Rasht (Iran) in the 2022-2023. The research instruments included demographic information questionnaire, mini-nutritional assessment questionnaire, and geriatric depression scale. Data were analyzed by SPSS-21 software and using Chi-Square tests and ordinal logistic regression.

RESULTS

The participants' mean age was 68.4 ± 6.5 and 50.5% of the participants were women.56.3% of the elderly participants suffered from malnutrition and 96.3% of them suffered from various degrees of depression. Additionally, there was a relationship between the participants' severity of depression and their nutritional status. Significant relationships were also observed between the participants' depression (OR = 1.28 and p < 0.001), marital status (OR = 1.52 and p = 0.006), and underlying diseases (OR = 0.814, p = 0.035) with nutritional status.

CONCLUSION

Given the significant relationship depression with nutritional status in cardiovascular patients, early diagnosis and treatment of depression in these patients is essential to prevent the effects of depression on nutritional status and disease course.

Association between geriatric nutritional risk index and clinical outcome of elderly aneurysmal subarachnoid hemorrhage patients: insights from a large cohort study

Geriatric nutritional risk index (GNRI), a simple, objective index for evaluating nutritional status of elderly patients, is demonstrated to be associated with the prognosis of several diseases. This study aims to explore the association between GNRI and prognosis of elderly aneurysmal subarachnoid hemorrhage (aSAH) patients. A total of 168 patients older than 65 years old were included in this research. The modified Rankin Scale (mRS) was applied to assess the prognosis of patients. Favorable outcome was defined as mRS <3 and unfavorable outcome was defined as mRS ≥ 3. The GNRI, calculated by albumin, height, and weight, was used to evaluate the nutritional status of elderly patients. Multivariate logistic regression was performed to identify the association between GNRI and prognosis of elderly aSAH patients. Compared with unfavorable outcome groups, favorable outcome group had higher GNRI level. After adjusting for several important factors, multivariate logistics regression analysis showed that low GNRI was associated with higher risk of unfavorable outcome. The receiver operating curve (ROC) analysis demonstrated that the area under the curve (AUC) was 0.720, which meant GNRI might be a reliable prognostic predictor. A low GNRI was independently associated with unfavorable outcome of elderly aSAH patients. The registration number is NCT04785976 and the registration data is February 2021.

Malnutrition in survivors of critical illness and long-term survival outcomes: A cohort study

PURPOSE

This study aimed to determine the prevalence of malnutrition and associated risk factors among intensive care unit (ICU) survivors and to investigate whether malnutrition after ICU admission is associated with long-term survival outcomes.

MATERIALS AND METHODS

We collected data from a National Health Insurance Service database in South Korea. Adults admitted to the ICU between January 1, 2017, and December 31, 2017, who survived >1 year after the date of ICU admission were included. The statistical method used was multivariable Cox regression modeling.

RESULTS

Overall, 228,702 ICU survivors were included. Malnutrition before and after ICU admission was diagnosed in 12,513 (5.5 %) and 18,487 (8.1 %) ICU survivors, respectively. The multivariable Cox regression model revealed that newly developed malnutrition after ICU admission was associated with a 1.49-fold increased risk of mortality between 1 and 5 years after ICU admission among survivors (hazard ratio: 1.49, 95 % confidence interval: 1.46-1.52; P < 0.001).

CONCLUSIONS

Malnutrition within 1 year of ICU admission was reported in 8.1 % of survivors. Notably, malnutrition after ICU admission was associated with an increased risk of mortality between 1 and 5 years after ICU admission among ICU survivors.

Malnutrition risk and associated factors in hospitalized older adult patients with neurological diseases: a retrospective cohort study

INTRODUCTION

Malnutrition risk (MR) in older adults with neurological disorders is high, but there is little evidence for validated screening tools in this group, as well as for the clinical and socioeconomic factors associated with a high MR.

OBJECTIVES

To determine the association of MR using the Malnutrition Universal Screening Tool (MUST) with mortality and length of stay (LOS) in older adults with neurological diseases. Secondarily, the association of clinical, and socioeconomic factors with MR and clinical outcomes was sought.

METHODS

A retrospective cohort study was carried out at a third-level neurological disease referral center in Mexico. All patients older than 60 years admitted from January 2017 to December 2018 were considered. MUST, clinical and socioeconomic factors were assessed at hospital admission. Outcomes were followed up to hospital discharge or a maximum of 6 months.

RESULTS

A total of 765 patients were included, of whom 24.7% (n = 189) were at high risk. A high MR was independently associated with mortality (OR 3.09; 95% CI 1.60-5.98, p = .001) and LOS >14 days (OR 4.38; 95% CI 2.79-6.89, p = <.001). The only factors independently associated with high MR was economic dependence and unemployment. Patients with high MR and economic dependence (OR 4.0; 95% CI 1.34-11.99, p = .013) or unemployment (OR 3.43; 95% CI 1.17-10.06, p = .025) had the highest mortality.

CONCLUSIONS

In hospitalized older adults with neurological diseases, high MR is independently associated with increased mortality and LOS. Economic dependence or unemployment are associated with worse clinical outcomes in patients with high MR.

Screening of the effect of new food prototypes based on fermented lentil and quinoa flours on the colonic microbiota of older adults through a static in vitro colonic fermentation model

In view of the increasing demand for plant-based protein alternatives, along with the increased protein requirements of older adults, the formulation of new food concepts based on protein-rich ingredients from legumes or pseudo-cereals seems a promising approach. Previous studies have found that solid-state fermentation can improve the nutritional value and digestibility of plant-based commodities; however, scarce evidence exists regarding the effect on prebiotic potential. This study aimed to compare the effect of fermented and unfermented quinoa and lentil flours on the colonic microbiota, as well as that of new food prototypes (gels and breads) made with the flours. After simulating static colonic fermentation of the substrates by using a pool faecal inoculum obtained from four older adults, the microbiota composition (16S rRNA gene sequencing) and short-chain fatty acids (SCFA, gas chromatography GC-FID) were determined. The results showed statistically significant changes in the microbiota at the genus taxonomic level in the range of -5.8% to +17.6% relative abundance. Common findings in all experiments were increased Bacteroides, Acidaminococcus and Parabacteroides and decreased Asteroleplasma, Oscillospiraceae UCG-002 group and Alistipes, as well as increased SCFA production. Overall, the food matrix (flour, gel or bread) was the variable that most affected the changes in the microbiota composition and diversity, while the impact of fermentation of the lentils or quinoa was not statistically significant for most cases. Concretely, the gel-like prototypes produced the most beneficial changes in microbiota composition, while the bread-like formulations were more favourable for increased SCFA and decreased bSCFA production. In conclusion, new food prototypes based on lentil and quinoa flour could have beneficial prebiotic potential. However, few additional advantages were observed from previous solid-state fermentation for obtaining the fermented lentils and quinoa flour.

[Malnutrition and obesity in self-sufficient elderly and health determinants related to both nutritional disorders]

OBJECTIVE

Evaluate the nutritional status in older adults in the community, to determine malnutrition, obesity and their risks and to identify determinants related to both clinical situations.

DESIGN

Cross-sectional study. SITE: 3 Primary care health centers in La Rioja in urban, semiurban and rural areas.

PARTICIPANTS

409 people ≥ 65 years old who came to receive consultation, with 3 abandonments.

INTERVENTIONS

Nutritional assessment by tools screening and anthropometric measurements.

MAIN MEASUREMENT

The MNA SF® was used to determine the prevalence of malnutrition and the BMI for obesity. Sociodemographic, socioeconomic, health-disease variables, lifestyle habits, metabolic status, and anthropometric measurements were included. Binary logistic regression was performed to predict dichotomous dependent variables.

RESULTS

The prevalence of malnutrition and its risk (DR) were 18.7% and obesity and its risk were 66,5%. The multivariate model for malnutrition and DR includes polypharmacy, dyslipidemia, sedentary lifestyle, and having mental pathology (OR=3.09, 2.01, 2.12, 1.72, respectively). On the other hand, the probability of presenting obesity is associated with cardiovascular risk, age, excessive-moderate alcohol consumption, hypertension and low adherence to the Mediterranean diet (OR=2.73, 4.27, 2.03, 1.97, 1.81 respectively).

CONCLUSION

This results stand out that the study population has a poor nutritional status, detecting a risk of malnutrition, obesity and overweight. The identified predictors related to lifestyle habits, presence of diseases, psychosocial problems, metabolic alterations, etc. They can guide the selection of those people who would benefit from screening to detect and approach the risk of malnutrition early.

Use of Mindex and Demiquet for assessing nutritional status in older adults

BACKGROUND

The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated.

OBJECTIVES

This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand.

METHODS

The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman's rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses.

RESULTS

MNA scores were significantly correlated with Mindex (P < 0.001) and Demiquet (P = 0.001), and BMI was related to Mindex and Demiquet (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (P = 0.048) in males but not females.

CONCLUSIONS

Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.

Prognostic value of preoperative nutritional status for postoperative moderate to severe acute kidney injury among older patients undergoing coronary artery bypass graft surgery: a retrospective study based on the MIMIC-IV database

OBJECTIVE

To investigate the association between preoperative nutritional scores and moderate-to-severe acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery and the predictive significance of nutritional indices for moderate to severe AKI.

METHODS

This study retrospectively included older patients underwent CABG surgery from the Medical Information Mart for Intensive Care (MIMIC) database. Nutritional scores were calculated by the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI), respectively. Moderate-to-severe injury was determined by KDIGO criteria. Logistic regression, subgroup analysis, and restricted cubic splines were utilized to investigate the association. The predictive value was also assessed by the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI).

RESULTS

A total of 1,007 patients were retrospectively included, of which 100 (9.9%) and 380 (37.7%) had malnutrition calculated by GNRI and PNI scores. The incidence of moderate-to-severe AKI was 524 (52.0%). After adjustment for selected risk factors, worse nutritional scores were associated with a higher incidence of moderate-to-severe AKI (PGNRI<0.001; PPNI=0.001). Integrating these indices into different base models improves their performance, as manifested by significant improvements in AUCs and NRIs (p < 0.05).

CONCLUSION

Worse preoperative nutritional status was associated with an elevated risk of postoperative moderate-to-severe AKI. Integrating these indices into base models improve their predictive performance. These results highlight the importance of assessing nutritional status among older patients had CABG surgery.

Nourishing sustainability: Clinical nutrition's impact on climate change

INTRODUCTION

Preserving our planet's delicate balance is not merely a choice but a responsibility we owe to future generations, ensuring equitable, and sustainable world. The 2030 Agenda for Sustainable Development, adopted by all United Nations (UN) member states in 2015, offers a collective vision for global peace and prosperity. Central to this agenda are the 17 Sustainable Development Goals (SDGs), which call for unified action from all nations, irrespective of their developmental status, under a global partnership.

METHOD

This paper examines the SDGs' framework and its applicability to clinical nutrition (CN). We provide a comprehensive narrative review relating to the integration of SDGs in CN practices. Whilst recognising the importance of the SDG framework we elected to focus specifically upon the environmental aspects of CN care.

RESULTS

The analysis revealed that the SDGs provide a robust framework for promoting sustainability in clinical nutrition. Key findings highlight the interconnection between health improvement and other SDGs, such as poverty reduction and climate action. Effective CN practices contribute to broader sustainable development by ensuring better health outcomes, which in turn support economic growth and reduce inequalities. Additionally, strategies in CN that focus on reducing waste and improving resource efficiency align with environmental sustainability goals.

CONCLUSION

The 17 SDGs offer a comprehensive guide for advancing sustainability across various fields, including clinical nutrition. By adopting these goals, healthcare providers can implement holistic strategies that not only improve health outcomes but also support broader efforts to achieve global sustainability.

Determinants of Malnourishment in the Institutionalized Older Population: The FRAGILESS Study

BACKGROUND/OBJECTIVES

Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess the associations between malnutrition and its determinants in a group of institutionalized older people via the Mini Nutritional Assessment-Short Form (MNA-SF) and the full MNA.

METHODS

The MNA-SF was compared with the full MNA to evaluate the nutritional status of 207 older people. A multinomial logistic regression analysis was performed.

RESULTS

The data revealed that institutionalized older people with cognitive impairment, frailty syndrome, dysphagia, a low BMI, a high duration of institutionalization, and a low educational level are more likely to be malnourished or at risk of malnutrition.

CONCLUSIONS

The results reveal that the MNA or MNA-SF may not identify common determinants of malnutrition or nutritional risk. The identified determinants depend on the test. Therefore, the data obtained determine the need to use adequate nutritional screening tools to control the presence of malnutrition. Nutritional screening is essential to decrease public costs, hospitalizations, rates of disability, dependence, morbidity, and even mortality among institutionalized older people.

The Social Determinants of Health in a Cohort of Romanian Patients with Diabetic and Nondiabetic Neuropathy

Background/Objectives: The importance of the social determinants of health (SODHs) in diabetic and nondiabetic neuropathy has recently gained more attention. This retrospective study examined the correlation of incident diabetic neuropathy and neuropathy of other etiologies with SODH in Romania. Methods: All cases with the primary or secondary discharge diagnosis codes of neuropathy reported across Romania in 2019 were analyzed. The crude incidence rate was calculated per 100,000 persons for the whole population resident in Romania on the 1 July 2019. As SODHs sex, gross domestic product (GDP) per capita, unemployment rate, and the number of physicians/1000 persons were evaluated. Results: In total, 207,026 hospitalizations with a discharge diagnosis of neuropathy were recorded. Of these, 80,480 had a discharge diagnosis of diabetic neuropathy, with an incidence rate of 414.97 cases/100,000 persons. The incidence rate of diabetic neuropathy by county was correlated with the corresponding GDP (p = 0.013) and unemployment rate (p = 0.001). By sex, the correlation with GDP remained significant only for women (p = 0.010), while the correlation with unemployment rate remained significant in both sexes. No correlation was observed with the number of physicians/1000 persons/county. The incidence rate of neuropathy of other etiology was 652.49 cases/100,000 persons. No correlation between the incidence rate of neuropathy of other etiology by county and the corresponding GDP, unemployment rate or number of physicians/1000 persons was observed neither in the total sample nor by sex. Conclusions: Lower socioeconomic status was correlated with a higher incidence rate of hospitalized diabetic neuropathy and not with neuropathies of other etiologies.

Omega-3 long-chain polyunsaturated fatty acids and their bioactive lipids: A strategy to improve resistance to respiratory tract infectious diseases in the elderly?

Age-related changes in organ function, immune dysregulation, and the effects of senescence explain in large part the high prevalence of infections, including respiratory tract infections in older persons. Poor nutritional status in many older persons increases susceptibility to infection and worsens prognosis. Interestingly, there is an association between the amount of saturated fats in the diet and the rate of community-acquired pneumonia. Polyunsaturated fatty acids, particularly omega-3 long chain polyunsaturated fatty acids (ω-3 LC-PUFAs) including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have well-known anti-inflammatory, immunomodulatory, and antimicrobial effects, which may, in theory, be largely induced by PUFAs-derived lipids such as specialized pro-resolving mediators (SPMs). In adults, preliminary results of studies show that ω-3 LC-PUFAs supplementation can lead to SPM generation. SPMs have a crucial role in the resolution of inflammation, a factor relevant to survival from infection independent of the pathogen’s virulence. Moreover, the immune system of older adults appears to be more sensitive to ω-3 PUFAs. This review explores the effects of ω-3 LC-PUFAs, and PUFA bioactive lipid-derived SPMs in respiratory tract infections and the possible relevance of these data to infectious disease outcomes in the older population. The hypothesis that PUFAs have beneficial effects via SPM generation will need to be confirmed by animal experiments and patient-derived data.

Alcohol consumption in elderly people. What is the real magnitude of the problem?

The harmful effects of alcohol consumption have been well studied in the general population, but in the group of people over 80 years of age there is not much information regarding its relevance. It is estimated than 30%-40% of this population consumes alcohol regularly and around 10% engage in high-risk consumption. Furthermore, potential interactions between this substance and commonly consumed drugs in this age group, like oral antidiabetics, anticoagulants and antibiotics, may pose a risk of serious complications. In this sense, the aim of the present work was to analyze the magnitude of alcohol consumption within people over 80 years of age and the impact it has on their health. A narrative review of the available literature on the topic was carried out, which showed that alcohol consumption in people over 80 years of age is common in our environment and is associated with multiple complications and the development of different pathologies. The correct quantification of alcohol consumption in very elderly people must be integrated into the daily clinical practice of Medicine in general and Internal Medicine in particular.

Wound Care at the Intersection of Race, Ethnicity, and Malnutrition

ABSTRACT

Ensuring adequate nutrition is vital for maintaining skin health and promoting successful wound healing. Globally, the rise in malnutrition and diet-related diseases is contributing to increased rates of illness and disability. Populations in food deserts and those experiencing food insecurity are particularly at risk. Being at risk for or having malnutrition associated with chronic conditions such as diabetes and cardiovascular disease can increase the incidence of wounds. Healthcare disparities and varied clinical outcomes among ethnic minorities further contribute to these challenges. Research indicates that racial and ethnic minorities experience a higher prevalence and severity of wounds, including pressure injuries. Detecting early-stage wounds in individuals with darker skin tones can be difficult, adding to the disparities.Culturally appropriate nutrition interventions are essential in addressing these health inequities because tailored approaches tend to be more effective than uniform strategies. Understanding diverse dietary patterns and incorporating cultural food preferences into care plans can improve patient adherence and outcomes. Promoting equity in wound care through culturally sensitive practices helps to foster respect, dignity, and trust within healthcare settings, particularly for minority populations.In this review, the authors highlight the need for inclusive interventions that provide culturally aligned nutrition, supporting patients' clinical and holistic well-being.

Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study

BACKGROUND

The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition.

OBJECTIVE

This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences.

METHODS

A nonrandomized cross-sectional study was conducted for older adults aged ≥60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95% CI were determined using a binary logistic regression.

RESULTS

The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95% CI 0.747-0.952; P=.006).

CONCLUSIONS

The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population.

Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

BACKGROUND

Postoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients' underlying medical conditions on the refracture of osteoporotic compression fractures following surgery.

METHODS

A retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses.

RESULTS

Among the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture (P = 0.018, OR = 0.548), while alcohol intake ≥ 10years (P = 0.003, OR = 2.165), mental abnormality (P < 0.001, OR = 4.093), scoliosis (P < 0.001, OR = 6.243), chronic kidney disease (P = 0.002, OR = 2.208), and traumatic injuries (P = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis.

CONCLUSIONS

Hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Health Outcomes of Elder Orphans: An Umbrella and Scoping Review of the Literature

Objectives

As the population of elder orphans grows, little research has investigated the health outcomes of these socially and physically isolated older adults without caregiving support. Umbrella and scoping reviews were performed for studies examining health outcomes of older adults experiencing elements of elder orphanhood.

Methods

Studies published 2010- June 2021 and indexed on PubMed, Web of Science, CINAHL, Medline, or SocINDEX were eligible. Results of included studies were examined both by individual category and overall to determine overlapping outcomes.

Results

Umbrella review returned 1,686 studies, with 14 meeting criteria for social isolation (n=10) and physical isolation (n=4). The scoping review of studies examining unmet caregiving need returned 3,741 results: five met inclusion criteria.

Discussion

Included studies reviewed differing health outcomes in older adults, with a focus on dementia, frailty, and healthcare utilization. Further studies are needed that appraise targeted policies and interventions to improve health outcomes of elder orphans.

Comparison of Dietary Behaviors and Health-Related Quality of Life of the Elderly Based on Their Household Type in Korea

This study analyzed the raw data from the 2021 National Health and Nutrition Survey conducted annually in Korea to investigate the dietary behavior, nutrient intake, and health-related quality of life of the elderly in the community based on their household type: single-person, couple, or non-couple family household. As a result of the study, based on the household type, significant differences were found in the frequency of breakfast, lunch, and dinner, as well as in the frequency of consuming vegetables and fruits (P<0.05, P<0.01, P<0.001). After analyzing the impact of household type on the depression and happiness levels of the surveyed elderly, it was found that the depression levels of elderly individuals in single-person households were significantly 1.279 times higher, while their feelings of happiness were 0.561 times lower compared to elderly individuals living with their family, including a spouse (P<0.05, P<0.001). In order to enhance the health-related quality of life for elderly individuals living alone with low income and education levels, it is essential to provide systematic management and support activities.

Breaking the Silence on Food Risks for Elderly People Living Alone

(1) Background: Currently, numerous qualitative research studies on food and its influence on health are being conducted. In qualitative research, data are obtained by analyzing participants' responses. However, silence during conversation has been little studied. The aim of this study was to interpret the silences in the narratives of elderly people living alone about the potential risks of not keeping a healthy diet. (2) Methods: This is a descriptive and interpretative observational study under the qualitative research paradigm following a phenomenological and ethnographic perspective. The study was developed in two phases with people over 65 years old. In the first phase, from June 2021 to January 2022, 90 interviews, 12 life history analyses, 58 food diaries and 51 free listings (cultural domain technique) were conducted. In the second phase, from March to June 2022, 3 participatory workshops and 24 pile sorts (cultural domain technique) were conducted, as well as 3 focus groups. Only data from participants over 65 years old living alone are analyzed in this paper. The ATLAS-ti (Version 22) qualitative analysis software was used for coding and data analysis. (3) Results: The results show that elderly people living alone would sometimes remain silent during the various conversations conducted within the research. This silence reflects their desire to downplay the risks to their health from not eating well due to their unwanted loneliness. The people participating in our research had chronic health problems, financial insecurity and emotional problems. (4) Conclusions: We concluded that elderly people living alone are unable to maintain a healthy diet because they downplay their risk of malnutrition. This mindset is caused by their loneliness and bolstered by a situation of learned helplessness and social injustice.

Malnutrition and micronutrient deficiencies among elderly persons attending University College Hospital, Ibadan: a pilot study

Introduction

malnutrition and micronutrient deficiencies are pressing health concerns, particularly among the elderly. As this population is vulnerable to nutritional imbalances, understanding the prevalence and contributing factors is crucial for designing targeted interventions. This pilot study focuses on assessing the extent of these issues among elderly people attending a geriatric center in the University College Hospital, Ibadan.

Methods

this study employs a cross-sectional design, involving a sample of elderly individuals attending a geriatric center at the University College Hospital, Ibadan. Anthropometric measurements and dietary assessments were conducted using the Mini Nutritional Assessment (MNA) tool. A structured questionnaire was used to gather information on socio-demographic factors and other medical parameters. Continuous and categorical variables were compared respectively by Student's t-test or Chi-square test respectively.

Results

in this study, findings indicated that none of the participants exhibited malnutrition. Instead, 72.7% demonstrated a normal nutritional status, while 27.3% were identified as being at risk of malnutrition. A lesser fraction had deficiency of vitamins A (10%) and D (1%). Furthermore, males aged 60-69 years and those above 80 years showed a higher likelihood of a favorable nutritional assessment compared to females.

Conclusion

the study revealed an absence of malnutrition among the elderly individuals attending the geriatric center in the University College Hospital, Ibadan. Notably, females had a higher probability of malnutrition compared to males. These findings underscore the importance of targeted nutritional interventions, especially among at-risk groups, to promote the overall well-being of this population.

A Review of Infant and Young Child Feeding Practices and Their Challenges in India

This review focuses on infant and young child feeding (IYCF) practices in India, aiming to offer information on its trends, challenges, and opportunities for improvement. The overview starts by exploring the importance of IYCF practices and their results on child health, growth, and development. It delves into cultural norms, conventional practices, and local variations that impact feeding behaviors, acknowledging the range of nutritional habits across communities. The role of healthcare systems and community interventions in promoting the most desirable feeding practices is mentioned, addressing issues consisting of different breastfeeding practices, well-timed introduction of complementary meals, and micronutrient supplementation. By making this assessment, the goal of this review is to make healthcare professionals, policymakers, and researchers aware of the current trends of IYCF and its demanding situations, and regions for development in India. It gives an understanding of the improvement of strategies and interventions that can make contributions to the increase and improvement of infant and young child nutrients, thereby nurturing the Upcoming generations.

Advancing the Understanding of Malnutrition in the Elderly Population: Current Insights and Future Directions

Malnutrition is a growing public health problem leading to increased morbidity and mortality worldwide. Up to 50% of elderly patients are hospitalized due to this condition. In this review, we focused on analyzing the current diagnostic criteria for malnutrition among the elderly population and proposing promising solutions. Currently used diagnostic methods such as BMI or serum albumin levels are not sufficient to indicate malnutrition, which is affected by many factors, including the number of chronic diseases, multiple medications taken, or physical condition. Moreover, current recommendations are inadequate because they fail to account for various factors such as chronic illnesses, multiple medications, and bodily changes that are crucial in diagnostic evaluations. There is a noticeable gap between these recommendations and actual clinical practice. Nevertheless, developing more precise, non-invasive biomarkers and personalized nutrition strategies has to be explored. One of these strategies we discuss in our review is multidisciplinary approaches that combine nutrition, physical activity, and psychosocial support. Addressing malnutrition among the elderly should rely on standardized protocols and personalized interventions to enhance their nutritional health and overall well-being.

Malnutrition among the older adult: an additional challenge for the rehabilitation team-insights of a small population of Switzerland

Introduction

Nutritional deficiency among the older adult is a widespread concern, significantly affecting their health. The prevalence of malnutrition increases with age, concurrent health conditions, and the level of care provided. Hospital stays can affect as 90% of the older adult. Malnutrition can hinder efforts to improve health and regain function in individuals undergoing rehabilitation. This study aims to assess the frequency of malnutrition among geriatric rehabilitation patients.

Materials and methods

A retrospective quantitative analysis was conducted on 357 patients admitted to the geriatric unit at Lucerne Cantonal Hospital Wolhusen in Switzerland. The patients' nutritional status was evaluated using the standardized Mini Nutritional Assessment Long Form questionnaire.

Results

The initial analysis indicated a considerable prevalence of malnutrition among the geriatric population: 31.1% were identified as malnourished (MNA < 17), while an additional 35.8% were at risk of malnutrition (MNA 17-23.5), totaling 66.9% of patients. The Kruskal-Wallis ANOVA test revealed a statistically significant difference in MNA scores among different age groups (p = 0.035). Statistical analysis also suggested a slightly higher prevalence of malnutrition among female patients. The duration of rehabilitation varied from 20.07 ± 6.93 to 22.20 ± 7.50 days, with longer durations associated with lower MNA scores. A correlation analysis between MNA values and body mass index (BMI) showed a positive correlation coefficient (r = 0.56), indicating that lower MNA scores were associated with lower BMI and vice versa.

Conclusion

Malnutrition is prevalent among individuals over 65 years old, highlighting the importance of regular and timely nutritional assessments for geriatric patients to mitigate the complications and enhance prognoses in both acute care and rehabilitation settings. Such assessments can also improve the efficacy of rehabilitation programs and potentially reduce the duration of rehabilitation, thus carrying significant economic implications.

Risk Factors of Wasting-Based Malnutrition in the Flood-Affected Areas of Pakistan: A Cross-Sectional Study

The current study aimed to find the risk factors of wasting in flood-affected areas of Khyber Pakhtunkhwa, Pakistan. Sociodemographic and anthropometric data was collected. Children living in large family are 2.59 times more likely to be wasted (AOR = 2.59, 95% confidence interval (CI): 1.10, 6.10; p value = .029) and children living in medium size family are 2.23 times more likely to be wasted (AOR = 2.23, 95% CI: 1.03, 4.80; p value = .04) as compared to children in small family size. The study underscores the need for targeted interventions to address the identified risk factors and mitigate the impact of flooding on child nutrition.

Challenges in Managing Malnutrition in the Elderly

Malnutrition in aging is currently considered a public health problem characterized by a multifactorial physiological state. Diverse and complex factors can contribute to the risk of developing malnutrition or even worsening. This chapter aims to provide a conceptual overview of malnutrition in elderly individuals, covering aspects related to nutritional assessment, monitoring, and recommendations, as well as possible challenges in managing this condition in clinical nutrition. The management is complicated and challenging. Nutritionists should perform interventions based on recommendations to prevent or minimize malnutrition in elderly individuals. Depending on the environment and the condition of the elderly patient, different therapeutic approaches will be needed to manage malnutrition. All family and health professionals involved with elderly care must stay engaged in preventing or identifying malnutrition in these patients.

Malnutrition and its associated factors among community-dwelling older men living alone

BACKGROUND/OBJECTIVES

Older men who live alone are more vulnerable to poor nutrition. However, little attention has been paid to malnutrition among this population. This study aimed to examine malnutrition and its associated factors among community-dwelling older men living alone.

SUBJECTS/METHODS

This cross-sectional descriptive study used cohort data of community-dwelling older adults living alone in South Korea. A total of 230 older men aged 65 and over were included in this study. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form. Multidimensional factors (sociodemographic, health-related, psychosocial, and lifestyle characteristics) were evaluated. Hierarchical logistic regression analyses were conducted to identify the malnutrition-related factors.

RESULTS

The prevalence of malnutrition was 32.2% in older men living alone. Low income (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.01-5.90), polypharmacy (OR, 2.23; 95% CI, 1.16-4.28), suicidal ideation (OR, 2.13; 95% CI, 1.02-4.45), meal skipping (OR, 3.26; 95% CI, 1.60-6.64), and smoking (OR, 2.86; 95% CI, 1.43-5.73) were significantly associated with malnutrition.

CONCLUSION

Malnutrition is a severe health problem in older men living alone. This study highlights the importance of comprehensive and tailored interventions to mitigate malnutrition among older men living alone.

Association between diet quality and malnutrition: pooled results from two population-based studies in older adults

BACKGROUND

The role of diet quality on malnutrition in older adults is uncertain, due the paucity of the research conducted and the use of use of screening tools that did not consider phenotypic criteria of malnutrition.

OBJECTIVE

To evaluate the association of two indices of diet quality, namely the Mediterranean Diet Adherence Screener (MEDAS) and the Alternative Healthy Eating Index (AHEI-2010), with malnutrition among community-dwelling older adults in Spain.

METHODS

Cross-sectional analysis of data from 1921 adults aged ≥ 60 years from the Seniors-ENRICA-1 (SE-1) study, and 2652 adults aged ≥ 65 years from the Seniors-ENRICA-2 (SE-2) study. Habitual food consumption was assessed through a validated diet history. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) phenotypic criteria. Statistical analyses were performed with logistic regression with adjustment for socioeconomic and lifestyle variables as well as for total energy and protein intake.

RESULTS

The prevalence of malnutrition in the SE-1 study was 9.5% (95% confidence interval: 8.2 to 10.9) and 11.7% (10.5 to 13.9) in the SE-2. Adherence to the MEDAS score was associated with lower prevalence of malnutrition [pooled odds ratio for high (≥ 9 points) vs. low adherence (< 7 points): 0.64 (0.48-0.84); p-trend < 0.001]. Higher adherence to the AHEI-2010 also showed an inverse association with malnutrition (pooled odds ratio for quartile 4 vs. 1: 0.65 (0.49-0.86); p-trend 0.006). Among the individual components, higher consumption of fish and long-chain n-3 fatty acids in MEDAS and AHEI-2010, and of vegetables and nuts and legumes in AHEI-2010, and lower intake of trans-fat and sugar-sweetened beverages and fruit juice in AHEI-2010 were independently associated with lower odds of malnutrition.

CONCLUSION

Adherence to high diet-quality patterns was associated with lower frequency of malnutrition among older adults.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov identifier: NCT02804672. June 17, 2016.; ClinicalTrials.gov NCT03541135. May 30, 2018.

Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study

With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ± standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ± 6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ± 1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ± 2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.

Causal relationship between nutritional assessment phenotypes and heart failure: A Mendelian randomization study

Introduction

Malnutrition is strongly associated with heart failure (HF); however, the causal link remains unclear. We used Mendelian randomization (MR) to infer causal associations between different nutritional assessment phenotypes and HF and to analyze whether these associations were mediated by common HF risk factors.

Methods

Two-sample bidirectional MR was used to infer causal associations between nutritional assessment phenotypes and HF. Mutual influences between different nutritional assessment phenotypes and potential correlations were estimated using multivariate MR methods. Two-step MR was used to quantify the mediating effects of common HF risk factors on the causal associations.

Results

Three phenotypes were positively associated with the development of HF: waist circumference (WC) (odds ratio [OR] = 1.74; 95% confidence interval [CI], 1.60-1.90; P = 3.95 × 10-39), body mass index (BMI) (OR = 1.70; 95%CI, 1.60-1.80; P = 1.35 × 10-73), and whole body fat mass (WBFM) (OR = 1.54; 95%CI, 1.44-1.65; P = 4.82 × 10-37). Multivariate MR indicated that WBFM remained positively associated with HF after conditioning on BMI and WC (OR = 2.05; 95%CI, 1.27-3.31; P = 0.003). Three phenotypes were negatively correlated with the development of HF: usual walking pace (UWP) (OR = 0.40; 95%CI, 0.27-0.60; P = 8.41 × 10-6), educational attainment (EA) (OR = 0.73; 95%CI, 0.67-0.79; P = 2.27 × 10-13), and total cholesterol (TC) (OR = 0.90; 95%CI, 0.84-0.96; P = 4.22 × 10-3). There was a bidirectional causality between HF and UWP (Effect estimate = -0.03; 95%CI, -0.05 to -0.01; P = 1.95 × 10-3). Mediation analysis showed that common risk factors for HF (hypertension, coronary artery disease, cardiomyopathy, and valvular heart disease) mediated these causal associations (all P < 0.05).

Conclusions

BMI, WC, and WBFM are potential risk factors for HF, and the correlation between WBFM and HF was significantly stronger than that between BMI and WC, and HF. EA, UWP, and TC are potential protective factors against HF. Common risk factors for HF mediate these causal pathways. Early identification of potential risk or protective factors for HF patients from the dimension of nutritional status is expected to further improve patient outcomes.

Aging Increases Global Annual Food Greenhouse Gas Emissions up to 300 Million Tonnes by 2100

The dietary preferences of the elderly population exhibit distinct variations from the overall averages in most countries, gaining increasing significance due to aging demographics worldwide. These dietary preferences play a crucial role in shaping global food systems, which will result in changed environmental impacts in the future such as greenhouse gas (GHG) emissions. We present a quantitative evaluation of the influence of population aging on the changes in GHG emissions from global food systems. To achieve this, we developed regional dietary coefficients (DCs) of the elderly based on the Global Dietary Database (GDD). We then reconciled the GDD with the dataset from the Food and Agriculture Organization of the United Nations (FAO) to calculate the food GHG emissions of the average population in each of the countries. By applying the DCs, we estimated the national food GHG emissions and obtained the variations between the emissions from aged and average populations. We employed a modified version of the regional integrated model of climate and the economy model (RICE) to forecast the emission trends in different countries based on FAO and GDD data. This integrated approach allowed us to evaluate the dynamic relationships among aging demographics, food consumption patterns, and economic developments within regions. Our results indicate that the annual aging-embodied global food GHG emissions will reach 288 million tonnes of CO2 equivalent (Mt CO2e) by 2100. This estimation is crucial for policymakers, entrepreneurs, and researchers as it provides insights into a potential future environmental challenge and emphasizes the importance of sustainable food production and consumption strategies to GHG emission mitigations associated with aging dietary patterns.

Social isolation and depression as risk factors for weight loss of 5kg or more among older Korean adults

Given a well-known overlapping prevalence of social isolation with loneliness and depression among older adults, this study aimed to contextually investigate the relationship of these constructs with weight loss of more than 5kg in a year, with a special focus on the intersection of living alone and marital dissolution as key dimensions of isolation. The data were obtained from the Korean Longitudinal Study of Aging (KLoSA) from 2006, 2008, 2010, 2012, 2014, 2016, and 2018, with an adult sample of those aged 65 and older (n = 5,481). The study evaluated several critical dimensions of social isolation: living alone, transition to living alone, infrequent social contact with children or friends, and infrequent social participation. These dimensions were examined individually and as a composite scale, along with loneliness and depressive symptoms, to determine their association with weight loss of 5kg or greater among older men and women. Generalized Estimating Equation (GEE) regression models enabled investigation of whether socially isolated men and women tended to lose 5kg or more in weight, given other confounding factors. Surprisingly, the results showed no evidence of such a trend. However, significant associations were found between weight loss and changes in living alone and marital status. For older men, transitioning to living alone without a change in marital status was linked to significant weight loss. For older women, transitioning to living alone following widowhood or divorce was the risk factor. These relationships remained significant even after adjusting for depression and a wide range of covariates. Additional analysis testing a cumulative effect revealed that only depression was a risk factor for being underweight at the last observation. Therefore, to prevent a clinically risky extent of weight loss, health policies for older Koreans should focus on those who transition to living alone, especially due to spousal bereavement or divorce (among women) and separation from living with children (among men).

To assess the contributing factors of nutritional and health status amongst elderlies residing in the nursing homes of fars province, Iran: A cross sectional study

Background and Aims

In line with the global trend, the number of elderly is rising in Iran. It should be noted that the nutritional and health needs of these people, especially those living in nursing houses, are extremely significant. The present study aimed to identify the nutritional and health status and uncover their relationship with received care services by elderlies residing in nursing homes.

Methods

All 373 elderlies living in the nursing homes in Shiraz entered the study, and the requisite data were collected by references to elderlies' files, respective nurses, and elderlies themselves.

Results

The majority of the elderlies were at risk of malnutrition (62.5% of the total population, 55.4% of females, and approximately 44.6% of males). Elderlies with no insurance coverage mainly fell into the at-risk and malnutrition categories. There was a significant relationship between the needs assessment scores, reflecting the need for physical and psychological actions, and elderlies' malnutrition (odds ratio = 1.87, 95% confidence interval: 1.79-1.95). For each unit increase in the Physical and psychological need score, the odds of exposure to malnutrition (vs. nonmalnourished and at risk of malnutrition) was 1.87 times after adjustment for confounders.

Conclusion

The results of our study revealed that most of the elderlies living in the nursing homes of Shiraz had some levels of malnutrition such as at-risk for malnutrition (62.5%) and malnourished (18.9%). Based on these results, it is suggested that health policy-makers take practical steps toward promoting the nutritional care of old people and direct extra supervision to nursing homes and all healthcare provisions.

Marital status, marital transition and health behaviour and mental health outcomes among middle-aged and older adults in Thailand: A national longitudinal study

OBJECTIVES

The aim of this study was to assess the longitudinal association between marital status, marital transition, mental ill-health, and health risk behaviours among middle-aged and older adults in Thailand.

METHODS

We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015, 2017, and in 2020 (analytic sample, n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Sociodemographic and health variables were assessed by self-report.

RESULTS

Being single was positively associated with current smoking among men and transitioning to widowed or divorced was associated with incident current smoking among women. Divorced or separated was positively associated with current alcohol use among men and transitioning to marriage was associated with incident alcohol use among women. Being single or widowed was positively associated with underweight and negatively associated with obesity among women. Men who were divorced, single, or widowed had higher odds of having depressive symptoms and among women, transitioning to being widowed or divorced or separated was associated with incident depressive symptoms. Among both men and women, being divorced, single or widowed were positively associated with poor quality of life/happiness, and among men being divorced, single or widowed was positively associated with loneliness, and among women, being single or widowed was positively associated with loneliness. Among men, being single was positively associated with having an emotional or psychiatric disorder.

CONCLUSION

We found among men and/or women that being unmarried was associated with several health risk behaviours and mental-ill health indicators.

Nutritional Risk, Depression, and Physical Function in Older People Living Alone

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice

Background

Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors.

Methods

A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit.

Results

Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%.

Conclusion

In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.

Association between Depressive Mood, Antidepressant Therapy and Neuropsychological Performances: Results from a Cross-Sectional Study on Elderly Patients

BACKGROUND

Currently, the global demographic landscape is undergoing a transformative shift towards an increasingly aging population. This leads to an increase in chronic pathologies, including depression and cognitive impairment. This study aimed to evaluate the association between depressive mood, whether in treatment or not, and cognitive capacities, assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

METHODS

This study included 259 subjects, aged 65 years or older, evaluated at the Geriatric Outpatient Service of the University Hospital of Monserrato, Cagliari, between July 2018 and May 2022, who experienced subjective depressive mood and/or cognitive deficits.

RESULTS

Only 25.1% of the sample showed no cognitive impairment on the RBANS. Education was a significant regressor of the RBANS Total Scale scores (p < 0.0001) and was negatively associated with mood deflection (r = -0.15, p = 0.0161). Subjects with depressive mood had more impaired attention and visuospatial/constructional abilities compared to untreated euthymic patients. Post-hoc analysis, conducted with the Conover test, showed that untreated euthymic patients (GDS-15 ≤ 5, group 2) had a higher score on the RBANS total scale than patients with mood deflection (GDS-15 > 5, group 1), and treated euthymic patients (GDS-15 ≤ 5, group 3). Finally, different logistic regression analyses revealed a significant negative coefficient for GDS as a regressor of the RBANS total scale (coefficient: -0.04, p = 0.0089), visuospatial/constructional abilities (coefficient: -0.03, p = 0.0009), language (coefficient: -0.05, p = 0.0140), and attention (coefficient: -0.05, p < 0.0001).

CONCLUSIONS

Our analysis demonstrated that "naturally" euthymic people show better cognitive performances than people with depressive mood and subjects with acceptable mood due to antidepressants. Furthermore, the gender-based difference observed in the language domain suggests the potential utility of incorporating an alternative category for male patients in the Semantic Fluency test.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan

Context

Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi.

Aims

To assess nutritional status and its associated factors among the elderly population.

Settings and Design

This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional.

Materials and Methods

The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital.

Statistical Analysis

Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21.

Results

A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment.

Conclusion

This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Exploring the Nutrition-Related Health of the Ageing Population in Fiji: A Narrative Review

Fijis' older population aged 55 years and over makes up 14% of the total population and is expected to reach 20% by 2050. This narrative review aimed to examine the health and nutrition status of the aging population of Fiji and sociodemographic determinants. A search strategy was conducted throughout databases, and gray literature from relevant websites was searched. Due to the limited evidence regarding the nutrition, health, and socio-economic factors that impact the aging population in Fiji the inclusion criteria were broad and included both genders (male and female), all publications up until December 2022, all study designs, and gray literature (government/institutional reports, conference proceedings, guidelines, Act, and Policies) . There was no filter for date applied in the search criteria. Studies that did not meet the search criteria were excluded. 20 documents including published articles were included for analysis and result synthesis. Life expectancy at birth for the Fiji population is 68 years. A significant annual increase in mortality rate from endocrine, nutritional, and metabolic diseases has been observed in women aged 75+ but not older men. Women of low-income status are more at risk than men. However, as most investigations aggregate those ≥18 years, there is a lack of information on older adults (≥65 years) health and nutrition status. To improve the health status of older adults, an understanding of the nutritional status of older adults is warranted, especially concerning lifestyle and sociodemographic determinants.

Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia

BACKGROUND AND AIMS

Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP.

METHODS

This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses.

RESULTS

In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies.

CONCLUSIONS

After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.

Financial stress, health and malnourishment among older adults in India

As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20-40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.

Multicenter Study to Validate a Hospitalization Risk Assessment Tool in Hemodialysis Patients

Introduction Protein-energy wasting is a prevalent condition in patients with chronic kidney disease. Our goal was to validate the risk assessment tool (Hashmi's tool) in multiple centers, developed in 2018, as it was easily applicable and cost-effective. Methods The following variables were scored as 0, 1, 2, or 3 as per severity: body mass index, HD vintage in years, functional capacity, serum albumin, serum ferritin, and the number of co-morbid conditions (diabetes mellitus, hypertension, ischemic heart disease, and cerebrovascular disease). This scoring system was applied to maintenance hemodialysis patients in six different centers. The patient's record was evaluated for two years. Patients were divided into low-risk (score <6) and high-risk (score ≥6). We compared the two groups using the chi-square test for the difference in hospitalization and mortality. Results A total of 868 patients' records were analyzed, and the maximum score was 13 with the application of Hashmi's tool. Four hundred twenty-nine patients were in the low-risk group, and 439 patients fell into the high-risk group. Four hundred sixty-seven patients were male, and 401 were females; 84% had hypertension, and 54% had diabetes mellitus. In the high-risk group, we identified more females. Patients' likelihood of being in the high-risk group was higher if they had diabetes mellitus, hypertension, or ischemic heart disease. Hospitalization due to vascular or non-vascular etiologies was more common in the high-risk group (p=0.036 and p<0.001, respectively). A total of 123 patients died during the study period, 92 from the high-risk group as compared to 31 from the low-risk group. This was three times higher and statistically significant (p<0.001). Conclusion Using a simple and cost-effective tool, we have identified malnourished patients who are at risk of hospitalization and mortality. This study has validated the previous work at a single center, which has now been reflected in six dialysis units across Saudi Arabia.

Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020

BACKGROUND

Malnutrition mortality in older adults is underrepresented in scientific literature. This obscures any recent changes and hinders needed social change. This study aims to assess malnutrition mortality trends in older adults (≥ 65 years old) from 1999 to 2020 in the United States (U.S.).

METHODS

Mortality data from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiology Research (WONDER) database were extracted. The ICD-10 Codes E40 - E46 were used to identify malnutrition deaths. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) were extracted by gender, age, race, census region, and urban-rural classification. Joinpoint regression analysis was used to calculate annual percentage changes (APC) of AAMR by the permutation test and the parametric method was used to calculate 95% confidence intervals. Average Annual Percentage Changes (AAPC) were calculated as the weighted average of APCs.

RESULTS

Between 1999 and 2020, 93,244 older adults died from malnutrition. Malnutrition AAMR increased from 10.7 per 100,000 in 1999 to 25.0 per 100,000 in 2020. The mortality trend declined from 1999 to 2006 (APC = -8.8; 95% CI: -10.0, -7.5), plateaued till 2013, then began to rise from 2013 to 2020 with an APC of 22.4 (95% CI: 21.3, 23.5) and an overall AAPC of 3.9 (95% CI: 3.1, 4.7). Persons ≥ 85 years of age, females, Non-Hispanic Whites, residents of the West region of the U.S., and urban areas had the highest AAPCs in their respective groups.

CONCLUSION

Despite some initial decrements in malnutrition mortality among older adults in the U.S., the uptrend from 2013 to 2020 nullified all established progress. The end result is that malnutrition mortality rates represent a historical high. The burden of the mortality uptrends disproportionately affected certain demographics, namely persons ≥ 85 years of age, females, Non-Hispanic Whites, those living in the West region of the U.S., and urban areas. Effective interventions are strongly needed. Such interventions should aim to ensure food security and early detection and remedy of malnutrition among older adults through stronger government-funded programs and social support systems, increased funding for nursing homes, and more cohesive patient-centered medical care.

Perioperative cognition in association with malnutrition and frailty: a narrative review

Postoperative delirium (POD) is a prevalent clinical entity characterized by reversible fluctuating altered mental status and cognitive impairment with acute and rapid onset a few days after major surgery. Postoperative cognitive decline (POCD) is a more permanent extension of POD characterized by prolonged global cognitive impairment for several months to years after surgery and anesthesia. Both syndromes have been shown to increase morbidity and mortality in postoperative patients making their multiple risk factors targets for optimization. In particular, nutrition imparts a significant and potentially reversible risk factor. Malnutrition and frailty have been linked as risk factors and predictive indicators for POD and less so for POCD. This review aims to outline the association between nutrition and perioperative cognitive outcomes as well as potential interventions such as prehabilitation.