Relationship between admission nutritional status and clinical outcomes in malnourished older adults

Abstract Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

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Association between baseline geriatric domains and survival in older adults with chronic lymphocytic leukemia (CLL).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12041 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12041-12041

Author(s):

Julia Rice ◽

Ryan David Nipp ◽

Daniel E Lage ◽

Ashley M. Nelson ◽

Richard Newcomb ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Nutritional Status ◽

Activities Of Daily Living ◽

Functional Status ◽

Clinical Outcomes ◽

Daily Living ◽

Social Activity ◽

Psychological Status ◽

Timed Up And Go

12041 Background: CLL is a disease that commonly affects older adults. Although the value of geriatric assessment is increasingly being recognized in older adults with cancer, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in older adults with CLL. Methods: We conducted a secondary data analysis of 369 adults diagnosed with CLL and treated in a phase 3 randomized trial of patients age ≥65 with bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone. We evaluated geriatric domains of functional status (activities of daily living [ADL], instrumental activities of daily living [IADL], Timed “Up and Go,” and number of falls in last 6 months), psychological status (Mental Health Inventory), social activity (Medical Outcomes Study [MOS] Social Activity Survey), cognition (Blessed Orientation Memory Concentration Test), social support (MOS Social Support Tangible and Emotional/Informational subscales), and nutritional status ( > 5% weight loss in the preceding 6 months). We examined associations among baseline geriatric domains with overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: The median age of patients was 71 years (range: 65-89). Most were male (67.1%) and had an ECOG performance status of 0 or 1 (96.9%). In multivariable models, the following geriatric domains were significantly associated with OS: better functional status (ADL score: HR 0.67, p = 0.012; IADL score: HR 0.98, p = 0.007); social activity score (HR 0.97, p = 0.004); and nutritional status (HR 2.58, p = 0.008). Similarly, functional status (ADL score: HR 0.77, p = 0.028; IADL score: HR 0.99, p = 0.007); social activity score (HR 0.97, p < 0.001); and nutritional status (HR 2.87, p < 0.001) were all associated with PFS. Additionally, the number of impaired geriatric domains was also associated with OS (HR 1.50, p = 0.004) and PFS (HR 1.45, p < 0.001). Timed “Up and Go”, number of falls in last 6 months, psychological status, cognition, and social support were not significantly associated with clinical outcomes. Conclusions: Geriatric domains of functional status, social activity, and nutritional status were associated with OS and PFS in this cohort of older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during their treatment.

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Self-reported morbidities, nutritional characteristics, and associated factors in institutionalized and non-institutionalized older adults

BMC Geriatrics ◽

10.1186/s12877-021-02067-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abdelhafid Benksim ◽

Rachid Ait Addi ◽

Elhassania Khalloufi ◽

Aziz Habibi ◽

Mohamed Cherkaoui

Keyword(s):

Older Adults ◽

Health Insurance ◽

Nutritional Status ◽

Statistical Significance ◽

Well Being ◽

Public Institution ◽

Subjective Well Being ◽

Number Of Children ◽

Significant Difference ◽

Nutritional Characteristics

Abstract Background As the world’s population ages and people live longer, it seems important to ensure that older people have a good quality of life and positive subjective well-being. The objective of this study is to determine socio-economic, health and nutritional characteristics of institutionalized and non-institutionalized elders in the province of Marrakech. Methods This study was conducted among 368 older adults in the province of Marrakech between March 2017 and June 2019. Of all participants, 180 older adults reside in a public institution and 188 of them live in their own homes. Data on health conditions, nutritional status, functional and socio-economic characteristics were collected. Data was analyzed using SPSS Statistics for Windows, Version 16.0. Statistical significance was set at p < 0.05. Results Institutionalized elders were illiterate (80.0%), had low incomes (95.5%), and unmarried (73.3%), they reported also no children (56.1%) and no health insurance (98.9%). Institutional residents suffered from malnutrition (22.2%), hearing impairments (35.6%) and severe edentulism (43.3%). There was no significant difference between both groups on daily activities and depression. A multivariate analysis identified a model with three significant variables associated with non-institutionalized elders: health insurance (P = 0.001; OR = 107.49), number of children (P = 0.001; OR = 1.74) and nutritional status (p = 0.001; OR = 3.853). Conclusions This study shows that the institutionalization of older adults is considerably induced by various factors such as nutritional problems, lack of health insurance and family structure. To mitigate the effects of this phenomenon, home care strategies and preventive actions should be implemented to delay the institutionalization of older adults and therefore keep them socially active in their own homes.

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Related Factors and Clinical Outcomes of Osteosarcopenia: A Narrative Review

Nutrients ◽

10.3390/nu13020291 ◽

2021 ◽

Vol 13 (2) ◽

pp. 291

Author(s):

Tatsuro Inoue ◽

Keisuke Maeda ◽

Ayano Nagano ◽

Akio Shimizu ◽

Junko Ueshima ◽

...

Keyword(s):

Older Adults ◽

Longitudinal Studies ◽

Clinical Outcomes ◽

Daily Living ◽

Community Dwelling ◽

Related Factors ◽

Cross Sectional ◽

Meta Analyses ◽

Community Dwelling Older Adults

Osteopenia/osteoporosis and sarcopenia are common geriatric diseases among older adults and harm activities of daily living (ADL) and quality of life (QOL). Osteosarcopenia is a unique syndrome that is a concomitant of both osteopenia/osteoporosis and sarcopenia. This review aimed to summarize the related factors and clinical outcomes of osteosarcopenia to facilitate understanding, evaluation, prevention, treatment, and further research on osteosarcopenia. We searched the literature to include meta-analyses, reviews, and clinical trials. The prevalence of osteosarcopenia among community-dwelling older adults is significantly higher in female (up to 64.3%) compared to male (8–11%). Osteosarcopenia is a risk factor for death, fractures, and falls based on longitudinal studies. However, the associations between osteosarcopenia and many other factors have been derived based on cross-sectional studies, so the causal relationship is not clear. Few studies of osteosarcopenia in hospitals have been conducted. Osteosarcopenia is a new concept and has not yet been fully researched its relationship to clinical outcomes. Longitudinal studies and high-quality interventional studies are warranted in the future.

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Nutritional Status and Pressure Ulcers. Risk Assessment and Estimation in Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.12855 ◽

2014 ◽

Vol 62 (6) ◽

pp. 1209-1210 ◽

Cited By ~ 3

Author(s):

Vincenzo Malafarina ◽

Francisco Úriz-Otano ◽

Claudia Fernández-Catalán ◽

Dolores Tejedo-Flors

Keyword(s):

Older Adults ◽

Risk Assessment ◽

Nutritional Status ◽

Pressure Ulcers

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Nutritional status and physical activity level predict Timed Up and Go performance in Irish older adults

Proceedings of The Nutrition Society ◽

10.1017/s002966512100015x ◽

2021 ◽

Vol 80 (OCE1) ◽

Author(s):

M.L. O'Connell ◽

T. Coppinger ◽

J. Walton ◽

A.L. McCarthy

Keyword(s):

Physical Activity ◽

Older Adults ◽

Nutritional Status ◽

Physical Activity Level ◽

Activity Level ◽

Timed Up And Go

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A High Masticatory Muscle Tone Predicts the Risk of Malnutrition and Frailty in Inpatient Older Adults: A Cross-Sectional Study

Gerontology ◽

10.1159/000516627 ◽

2021 ◽

pp. 1-7

Author(s):

Yin-Hwa Shih ◽

Zhen-Rong Hong ◽

Shih-Min Hsia ◽

Shang-Yu Yang ◽

Tzong-Ming Shieh

Keyword(s):

Older Adults ◽

At Risk ◽

Nutritional Status ◽

Masseter Muscle ◽

Muscle Tone ◽

Handgrip Strength ◽

Muscle Performance ◽

Masticatory Muscle ◽

Masticatory Performance ◽

Poor Nutritional Status

Introduction: The prevalence of malnutrition among inpatient older adults is as high as 20∼50%. Masticatory performance is known to affect the nutritional status of individuals. However, an objective measurement to reflect the real status of masticatory muscle performance is lacking at the bedside. Methods: This pilot study analyzed the masticatory performance using surface electromyography (sEMG) of masticatory muscles that measures both muscle strength and muscle tone at the bedside. The nutritional status was measured using the Mini Nutritional Assessment tool. The handgrip strength was measured using a hand dynamometer. The statistical data were analyzed using SPSS 25 software. Results: The data revealed that female inpatient older adults more frequently had substandard handgrip strength (p = 0.028), an at-risk and poor nutritional status (p = 0.005), and a higher masseter muscle tone (p = 0.024). Inpatient older adults with an at-risk and poor nutritional status had an older age (p = 0.016), lower handgrip strength (p = 0.001), and higher average masseter muscle tone (p = 0.01). A high masseter muscle tone predicted the risk of having an at-risk and poor nutritional status. The at-risk or poor nutritional status predicted having a substandard handgrip strength by 5-fold. Conclusions: A high masticatory muscle tone predicts malnutrition and frailty. Medical professionals should combat masticatory dysfunction-induced malnutrition by detecting masticatory muscle performance using sEMG and referring patients to dental professionals. Additionally, encouraging inpatient older adults to perform oral motor exercise is recommended.

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