scholarly journals Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?

Geriatrics ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. 41
Author(s):  
David Smithard ◽  
Dharinee Hansjee ◽  
Darrien Henry ◽  
Laura Mitchell ◽  
Arjun Sabaharwal ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Older People ◽  
Older Adult ◽  
Screening Tools ◽  
Morbidity And Mortality ◽  
Nutritional Risk ◽  
Convenience Sample ◽  
The Mean ◽  
Medical Wards ◽  
Frailty Score

Introduction: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results: The mean age of the participants was 80.53 years (65–99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1–9), with 84 patients (68.9%) having a score of ≥5 (moderate or severely frail); The median SARC-F was 5 (0–10), with 64 patients (52.5%) having a score of ≥5; The median NRT was 0 (0–8) and 33 patients (27.0%) scored ≥ 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ≥ 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions: In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an “Older Adult Quartet”. Further study is required to investigate the effect of the “Older Adult Quartet” on morbidity and mortality.

A pilot study examining the profile of older people on clozapine

2018 ◽  
Vol 26 (6) ◽  
pp. 619-623
Author(s):  
Jen Benbow ◽  
Anne PF Wand ◽  
Brett Simpson
Keyword(s):  
Cognitive Impairment ◽  
Side Effects ◽  
Older People ◽  
Social History ◽  
Geriatric Medicine ◽  
Executive Dysfunction ◽  
Screening Tools ◽  
The Mean ◽  
Considerable Morbidity ◽  
And Function

Objective: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. Method: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. Results: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate–severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. Conclusions: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person’s Mental Health Services and/or a Geriatric Medicine service.

scholarly journals Nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay

2012 ◽  
Vol 4 (4) ◽  
pp. 299 ◽  
Author(s):  
Caroline McElnay ◽  
Bob Marshall ◽  
Jessica O’Sullivan ◽  
Lisa Jones ◽  
Tracy Ashworth ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Nutritional Status ◽  
Older People ◽  
Nutritional Risk ◽  
Community Living ◽  
Milk Product ◽  
Living Situation ◽  
Good Nutrition ◽  
Poor Nutrition

INTRODUCTION: Maintaining good nutrition is vital for healthy ageing. Poor nutrition increases the risk of hospitalisation, disability and mortality. Research shows clinical malnutrition is preceded by a state of nutritional risk and screening can identify older people at risk of poor nutrition or who currently have impaired nutritional status. AIM: To assess the population prevalence of nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay. METHODS: A postal survey of 1268 people aged 65 years or older on the electoral roll for Hawke’s Bay was conducted. Nutritional risk was measured using the SCREEN II questionnaire. RESULTS: Responses from 473 people were received (43.8% male, 49.9% female, 6.3% unspecified) with an estimated average age of 74 years. Nutritional risk was present amongst 56.5% of older people with 23.7% at risk and 32.8% at high risk. Maori were 5.2 times more likely to be at nutritional risk than non-Maori. Older people living alone were 3.5 times more likely to be at nutritional risk than those living with others. The most frequent risk factors were low milk-product intake, perception of own weight being more or less than it should be, and low meat and alternatives intake. Skipping meals and low fruit and vegetable intake were additional frequent risk factors for Maori. DISCUSSION: Both living situation and ethnicity are associated with nutritional risk. Further investigation is needed to confirm these findings and to determine issues specific for older Maori, including barriers to good nutrition and opportunities for nutritional improvement. KEYWORDS: Maori; nutritional status; older people

scholarly journals Improving the dietary intake of frail older people

2011 ◽  
Vol 70 (2) ◽  
pp. 263-267 ◽  
Author(s):  
W. S. Leslie
Keyword(s):  
Nutritional Status ◽  
Older People ◽  
Nutrition Knowledge ◽  
Screening Tools ◽  
Care Staff ◽  
Community Settings ◽  
Frail Older People ◽  
Population Subgroup ◽  
Poor Nutritional Status ◽  
And Training

As a population subgroup, older people are more vulnerable to malnutrition especially those who are institutionalised. Recognition of deteriorating or poor nutritional status is key in reversing the effects of undernutrition and reinforces the value of regular weight checks and/or the use of screening tools. Commercially produced supplements are often the first option used to address undernutrition in both acute and community settings. They can be expensive and, although regularly prescribed, have undergone only limited evaluation of their effectiveness in community settings. An alternative but less researched approach to improve the nutritional status of undernourished people is food fortification. This approach may be particularly useful for older people, given their often small appetites. The ability to eat independently has been significantly related to decreased risk of undernutrition. Assisting people who have difficulty feeding themselves independently should become a designated duty and may be crucial in optimising nutritional status. Lack of nutrition knowledge has been identified as the greatest barrier to the provision of good nutritional care. Education and training of care staff are pivotal for the success of any intervention to address undernutrition. The development of undernutrition is a multi-factorial process and a package of approaches may be required to prevent or treat undernutrition. Nutrition must be at the forefront of care if national care standards are to be met.

scholarly journals Problems of nutritional assessment in the community

1999 ◽  
Vol 58 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Jacqueline Edington
Keyword(s):  
At Risk ◽  
Developmental Disabilities ◽  
Nutritional Status ◽  
Nutritional Assessment ◽  
Chronically Ill ◽  
The Elderly ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Community Practice ◽  
Children With Developmental Disabilities

The present paper explores the problems associated with assessment of nutritional status in the community and reviews the literature related to this subject. The first problem is one of terminology, since a logical first step before assessment is screening, which identifies characteristics known to be associated with dietary or nutritional problems. Its purpose is to differentiate individuals who are at high nutritional risk or have poor nutritional status. There are certain factors which should alert the primary health care team to the fact that nutritional intake may be reduced and that risk of malnutrition is increased. These include disease condition, functional disabilities, inadequate or inappropriate food intake, poor dentition or difficulty swallowing, polypharmacy, alcoholism, depression, poor social circumstances or recent discharge from hospital. Patients suffering from these factors need to be identified so that screening becomes a routine part of their medical treatment. At-risk groups include the elderly, the chronically ill, those with cancer and neurological disorders, post-surgical patients and children with developmental disabilities. In the community, practice and community nurses see the majority of at-risk patients and should carry out screening. A number of screening tools have been developed for community use. Most are aimed at the elderly population, but there are others designed to assess nutritional risk in children with developmental disabilities and the general population. These are reviewed and problems of content and validity identified. Some problems associated with nutritional assessment are also reviewed.

scholarly journals Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Feier Song ◽  
Huan Ma ◽  
Shouhong Wang ◽  
Tiehe Qin ◽  
Qing Xu ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Risk Index ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Hospital Death ◽  
Nutritional Screening ◽  
Nutritional Risk Index ◽  
Conut Score

Abstract Background Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and explored the relationship between risk for malnutrition at admission and in-hospital mortality. Methods A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. The risk for malnutrition was assessed using the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission. Results Two hundred ninety-five patients were enrolled, including 66 severe patients and 41 critically ill patients. Twenty-five deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI, as well as higher CONUT scores, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality. Conclusions Despite variant screening tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.

scholarly journals Nutritional status and screening tools to detect nutritional risk in hospitalized patients with hepatic echinococcosis

Parasite ◽  
2020 ◽  
Vol 27 ◽  
pp. 74
Author(s):  
Zhan Wang ◽  
Jin Xu ◽  
Ge Song ◽  
MingQuan Pang ◽  
Bin Guo ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Nutritional Assessment ◽  
Short Form ◽  
Risk Index ◽  
Mini Nutritional Assessment ◽  
Hospitalized Patients ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Nutritional Screening ◽  
Nrs 2002

Background: Echinococcosis is a chronic consumptive liver disease. Little research has been carried out on the nutritional status of infected patients, though liver diseases are often associated with malnutrition. Our study investigated four different nutrition screening tools, to assess nutritional risks of hospitalized patients with echinococcosis. Methods: Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), and the Nutrition Risk Index (NRI) were used to assess 164 patients with alveolar echinococcosis (AE) and 232 with cystic echinococcosis (CE). Results were then compared with European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition diagnosis. Results: According to ESPEN standards for malnutrition diagnosis, 29.2% of CE patients and 31.1% of AE patients were malnourished. The malnutrition risk rates for CE and AE patients were as follows: NRS 2002 – 40.3% and 30.7%; MUST – 51.5% and 50.9%; MNA-SF – 46.8% and 44.1%; and NRI – 51.1% and 67.4%. In patients with CE, MNA-SF and NRS 2002 results correlated well with ESPEN results (k = 0.515, 0.496). Area-under-the-curve (AUC) values of MNA-SF and NRS 2002 were 0.803 and 0.776, respectively. For patients with AE, NRS 2002 and MNA-SF results correlated well with ESPEN (k = 0.555, 0.493). AUC values of NRS 2002 and MNA-SF were 0.776 and 0.792, respectively. Conclusion: This study is the first to analyze hospitalized echinococcosis patients based on these nutritional screening tools. Our results suggest that NRS 2002 and MNA-SF are suitable tools for nutritional screening of inpatients with echinococcosis.

scholarly journals Malnutrition in the ICU: Current recommendations for the assessment of nutritional status and a review of the use of albumin as an indicator of malnutrition

2013 ◽  
Vol 1 (4) ◽  
pp. 8 ◽  
Author(s):  
Kristen Fuhrmann ◽  
Naree Panamonta ◽  
Shelley Roaten
Keyword(s):  
Nutritional Status ◽  
Screening Tools ◽  
Therapeutic Interventions ◽  
Nutritional Risk ◽  
Patient Specific ◽  
Integrated Analysis ◽  
Simple Method ◽  
Current Guidelines ◽  
Current Body Mass Index ◽  
Nutritional Risk Screening

Many critically ill patients have malnutrition at presentation or develop it during hospitalization, and this complication adversely affects outcomes, including length of stay, morbidity, and mortality. All ICU patients should be evaluated for malnutrition using simple screening tools, such as the Nutritional Risk Screening and Subjective Global Assessment. Laboratory tests, including serum albumin levels, are inaccurate indicators of malnutrition and do not provide a simple method for screening. In particular, albumin levels often fall rapidly because of transcapillary efflux and altered hepatic synthesis during acute illness. Current guidelines recommend that the nutritional status should be assessed by a review of recent energy intake, recent weight loss, and current body mass index and bedside assessment of muscle mass, fluid accumulation, and grip strength. An integrated analysis of nutritional status provides a better assessment and helps develop patient specific therapeutic interventions.

scholarly journals Concordância entre ferramentas de triagem nutricional pediátrica em indivíduos com síndrome nefrótica

2019 ◽  
Vol 29 (4) ◽  
pp. 33642
Author(s):  
Paula Emília Nunes Ribeiro Bellot ◽  
Geovanna Torres De Paiva ◽  
Sancha Helena de Lima Vale ◽  
Richele Janaína de Araújo Machado
Keyword(s):  
Nutritional Status ◽  
Normal Weight ◽  
Screening Tools ◽  
University Hospital ◽  
Nutritional Risk ◽  
Anthropometric Parameters ◽  
Upper Arm ◽  
Nutritional Screening ◽  
Cross Sectional ◽  
Moderate Agreement

AIMS: To evaluate the concordance between three validated nutritional screening tools for pediatrics among themselves and the correlation with the anthropometric parameters of patients hospitalized with nephrotic syndrome.METHOD: Cross-sectional study with children and adolescents of both sexes hospitalized in the pediatric ward of a university hospital and diagnosed with nephrotic syndrome. Three nutritional screening instruments were applied: Screening of Risk for Nutritional Status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). Data on weight, height and upper arm perimeter was collected, and three nutritional screening tools were applied: The estimate of relative agreement between the instruments was evaluated with the weighted Kappa test and the correlations with anthropometric parameters were assessed with the Spearman’s Correlation Test.RESULTS: We evaluated 11 patients, with a minimum age of 2 years and a maximum of 10 years. Screening tools detected prevalence of medium and high nutritional risk. Moderate agreement (k=0.47) was observed between PYMS and STAMP and there was no correlation between the screening tools’ result and the anthropometric data. Regarding the anthropometric parameters, 100% of the participants had adequate weight for age, 63.6% of the participants were diagnosed with normal weight by the BMI/Age index and 81.8% had adequate height for age according to the index Height/Age. After analysis of the upper arm perimeter, 27.3% were at risk of malnutrition.CONCLUSIONS: Despite the fact that are no recommendations for use of pediatric nutritional screening tools specific to each clinical situation, two of the three screening tools analyzed in this study demonstrated moderate agreement between them. However, the tested tools did not reflect the anthropometric nutritional status of the evaluated population.

scholarly journals Comparison of Three Nutritional Screening Tools with the New Glim Criteria for Malnutrition and Association with Sarcopenia in Hospitalized Older Patients

2020 ◽  
Vol 9 (6) ◽  
pp. 1898 ◽  
Author(s):  
Francesco Bellanti ◽  
Aurelio Lo Buglio ◽  
Stefano Quiete ◽  
Giuseppe Pellegrino ◽  
Michał Dobrakowski ◽  
...  
Keyword(s):  
High Risk ◽  
Nutritional Status ◽  
Hospital Admission ◽  
Older Patients ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Nutritional Screening ◽  
Aged Patients ◽  
European Working ◽  
Nrs 2002

The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.

Nutritional Risk in Vulnerable Community-Living Seniors

2003 ◽  
Vol 64 (4) ◽  
pp. 195-201 ◽  
Author(s):  
Heather H. Keller ◽  
Jacquelyn D. McKenzie
Keyword(s):  
Risk Evaluation ◽  
Vegetable Intake ◽  
Nutritional Risk ◽  
Community Living ◽  
Convenience Sample ◽  
Poor Appetite ◽  
Vulnerable Community ◽  
Community Risk ◽  
The Mean ◽  
Components Analysis

The purpose of this study was to quantify nutritional risk in a convenience sample of vulnerable, community-living seniors, and to determine patterns of nutritional risk in these seniors. The sample consisted of 367 seniors who provided health, functional, and nutritional risk information during an interview in which the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire was used. The majority (73.6%) of the sample was female, and the mean age was 79 years. Nutritional risk was identified in 68.7% of the sample, with 44.4% being at high nutritional risk. Common nutritional risk factors were weight change, restricting food, low fruit and vegetable intake, difficulty with chewing, cooking, or shopping, and poor appetite. Principal components analysis identified four independent components within the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire; these components can be described as low food intake, poor appetite, physical and external challenges, and instrumental activity challenges. Data are sparse on nutritional risk in community-living Canadian seniors; despite methodologic limitations in the recruitment process, this study provides some indication of the level of nutrition problems. The patterns of nutritional risk identified in this vulnerable population may help providers identify useful strategies for ameliorating risk. The Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire could be used to identify risk and patterns of risk in Canadian seniors, so that treatment could be individualized.

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