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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.
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Desnutrição , Humanos , Arábia Saudita/epidemiologia , Masculino , Feminino , Desnutrição/epidemiologia , Idoso , Estudos Transversais , Pessoa de Meia-Idade , Fatores de Risco , Prevalência , Fatores Sexuais , Idoso de 80 Anos ou mais , Avaliação Nutricional , Avaliação Geriátrica , Estado NutricionalRESUMO
BACKGROUND: Although the Mini Nutritional Assessment (MNA) is recognized as a useful tool for evaluating nutritional status in patients with various diseases, its applicability in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) remains undetermined. METHODS: We designed a prospective cross-sectional study to investigate whether the MNA Short-Form (MNA-SF) score can serve as a screening tool to assess the nutritional status of patients with NTM-PD. The MNA-SF was conducted upon patient enrollment, and correlation analyses were performed to compare MNA-SF scores with other nutritional measurements and disease severity. Multivariable logistic regression analyses were conducted to evaluate the association between MNA-SF scores and NTM-PD severity. RESULTS: The 194 patients with NTM-PD included in the analysis had a median age of 65.0 (59.0-69.0) years; 59.3% (n = 115) had low MNA-SF scores (< 12). The low MNA-SF group exhibited a lower body mass index (19.7 vs. 22.4 kg/m2, p < 0.001) and fat-free mass index (14.7 vs. 15.6 kg/m2, p < 0.001) than the normal MNA-SF group, as well as higher incidences of sarcopenia (20.0% vs. 6.3%, p = 0.008) and adipopenia (35.7% vs. 5.1%, p < 0.001). However, no significant differences in calorie and protein intakes were observed between the two groups. Low MNA-SF scores were associated with radiographic severity (adjusted odds ratio 2.72, 95% confidence interval 1.38-5.36) but not with forced vital capacity. CONCLUSIONS: The MNA-SF can effectively assess the nutritional status of patients with NTM-PD and can serve as an important clinical indicator in NTM-PD where treatment timing is determined by clinical judgment.
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Infecções por Mycobacterium não Tuberculosas , Avaliação Nutricional , Estado Nutricional , Humanos , Estudos Transversais , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Micobactérias não Tuberculosas/isolamento & purificação , Pneumopatias/microbiologiaRESUMO
BACKGROUND: Long-term effects of COVID-19 showed a wide range of symptoms. Also, it was found that older patients were five times more likely than younger patients to develop long-COVID symptoms (1). This study aimed to investigate the use of Nutrition Risk Screening 2002 (NRS-2002) and the Mini Nutrition Assessment-Short Form (MNA-sf) among COVID-19 in elderly patients in Saudi Arabia. METHODS: A total of (n = 159) COVID-19 elderly patients were recruited in the study; the relationship between patients' characteristics, including age, gender, Body Mass Index (BMI), infection history, vaccination and chronic disease were evaluated using NRS-2002 and MNA-sf. Multivariate logistic regression to estimate the Odd Ratio (OR) by comparing the OR of different variables between normal nutritional Status and at-risk and Cohen's kappa (κ) coefficient was assessed to analyse the agreement between both tools. RESULTS: MNA-sf showed a positive association between age and malnutrition risk ≥ 66 years old P = 0.035. Both tools showed a negative association between BMI (P < 0.001 and P = 0.046), respectively and vaccination (P = 0.002 and P = 0.01), respectively, with risk for malnutrition. There was no significant association between Diabetes (DM) and malnutrition risk, but elderly Cardiovascular Disease (CVD) were at malnutrition risk using the NRS- 2002 tool P = 0.003. Inversely, people infected six months or more before malnutrition assessment have a lower risk of malnutrition P = 0.05. CONCLUSIONS: Both tools were valuable and practical tools for screening elderly people with COVID-19 who are at nutritional risk and those in need of additional nutritional intervention. Further research needed to be applied in the relationship between nutritional status during and post-infectious disease for elderly people using cross-sectional and intervention studies in order to prevent malnutrition complications in Saudi Arabia.
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COVID-19 , Desnutrição , Humanos , Idoso , Estado Nutricional , Avaliação Nutricional , Síndrome de COVID-19 Pós-Aguda , Estudos Transversais , COVID-19/epidemiologia , Medição de Risco , Desnutrição/complicações , Desnutrição/epidemiologia , Desnutrição/diagnósticoRESUMO
BACKGROUND: Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS: Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS: In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS: At-risk of malnutrition was associated with discontinuation of home medical care among older patients.
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Atividades Cotidianas , Desnutrição , Humanos , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Desnutrição/etiologia , Desnutrição/complicações , Estado Nutricional , Avaliação Nutricional , Avaliação GeriátricaRESUMO
OBJECTIVE: We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. METHODS: Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants' age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment-Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. RESULTS: Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. CONCLUSIONS AND IMPLICATIONS: Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.
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Serviços de Assistência Domiciliar , Desnutrição , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Polimedicação , Estudos Transversais , Desnutrição/epidemiologia , Estado NutricionalRESUMO
OBJECTIVE: This study aimed to investigate the association between nutritional status assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) and activities of daily living (ADL) after 1 year and changes in ADL among community-dwelling older adults. METHODS: This study included 95 community-dwelling older adults using outpatient rehabilitation (74.7% female). ADL was assessed using the Barthel index (BI), and the MNA-SF was used to assess nutritional status. Multiple regression analysis was performed with the BI after 1 year as the objective variable and MNA-SF, age, sex, updated Charlson comorbidity index, number of medications, body mass index, Food Intake Level Scale (FILS), and baseline BI as independent variables. Logistic regression analysis was performed with improvement or deterioration in ADL as the objective variable. RESULTS: The results of multiple regression analysis with BI after 1 year as the objective variable indicated that baseline BI, FILS, and MNA-SF were significant variables (R2 = 0.835). The results of the logistic regression analysis with ADL improvement/deterioration as the objective variable indicated only MNA-SF as a significant variable (odds ratio: 0.663 [95% CI: 0.528-0.923]). CONCLUSIONS: These results indicate that the MNA-SF was related to changes in ADL and ADL after 1 year among community-dwelling older adults.
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The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. METHODS: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. RESULTS: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3-25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3-11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02-13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3-8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35-6.7; p = 0.007] at 12 months. CONCLUSION: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.
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Fraturas do Quadril , Desnutrição , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Avaliação Nutricional , Estado Nutricional , Estudos Prospectivos , Força da Mão , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Fraturas do Quadril/complicaçõesRESUMO
BACKGROUND: Physical activity is one of the most important prognostic factors for patients with chronic obstructive pulmonary disease (COPD). Physical activity correlates significantly with skeletal muscle mass and strength. Pulmonary rehabilitation has been conducted to improve physical activity, but its effectiveness has been inconsistent. Nutritional status is also related to physical activity in patients with COPD. The relationships between skeletal muscle mass, strength, and nutritional status evaluated using the Mini Nutritional Assessment Short Form (MNA-SF) were investigated. How nutritional status alters the relationships between physical activity, exercise capacity, skeletal muscle mass, and strength was also investigated. METHODS: This retrospective, cross-sectional study enrolled 81 outpatients with COPD. In all patients, physical activity, exercise capacity, body composition assessment, and MNA-SF were assessed. The relationships between physical activity, exercise capacity, skeletal muscle mass, and strength were examined according to the MNA-SF. RESULTS: The MNA-SF high group had significantly higher skeletal muscle mass than the MNA-SF low group when skeletal muscle strength was the covariate. In the MNA-SF low group, physical activity positively correlated with skeletal muscle mass. In the MNA-SF high group, physical activity positively correlated with skeletal muscle strength. CONCLUSIONS: This study showed that the nutritional status of patients with COPD alters the relationship between physical activity and skeletal muscle mass or strength. Optimizing rehabilitation with nutrition interventions according to nutritional status might improve physical activity in patients with COPD.
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Desnutrição , Doença Pulmonar Obstrutiva Crônica , Humanos , Estado Nutricional , Estudos Transversais , Estudos Retrospectivos , Exercício Físico , Músculo EsqueléticoRESUMO
Japan's notably high aging rate presents the risk of malnutrition. This study aimed to clarify the nutritional status and factors related to the nutritional status of single older residents in a semi-mountainous rural region of Japan. Using a cross-sectional study design, surveys were administered to older adults in the semi-mountainous rural region in the area of Kochi Prefecture, Japan. Factors associated with a risk of malnutrition were identified using binomial logistic regression analysis. In addition, nutritional status was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Among 53 participants, the MNA-SF score was 12.1 ± 1.5 (mean ± standard deviation), and 71.7% had a normal nutritional status. We observed that participation in local residents' association gatherings (odds ratio [OR]: 7.42, 95% confidence interval [CI]: 1.17-47.01) and risk of depression/anxiety (OR: 12.77, 95% CI: 1.99-81.94) were associated with an increased risk of malnutrition, whereas social interaction with friends (OR: 0.11, 95% CI: 0.02-0.76) were associated with a decreased risk. The nutritional status was normal overall. Community health workers should share information on the health of residents and promote social events to enable older residents living alone to continue leading healthy lifestyles.
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BACKGROUND: Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes. Despite its large population, few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units (EDOUs). METHODS: Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled. Demographic information, laboratory parameters, nutritional support therapies, and 28-day mortality were recorded. Risk factors for mortality were examined using multi-variate-adjusted logistic regression analysis. Receiver operating characteristic (ROC) curves for each predictor of mortality were plotted, and the area under the ROC (AUROC) curves was compared. RESULTS: A total of 2,005 eligible patients were finally enrolled. At the 28-day follow-up, 1,911 patients survived, and 94 died. The group with a Nutritional Risk Screening 2002 (NRS 2002) score of 3-4 points was the largest (52.01%). The number of patients receiving oral nutritional supplements, enteral nutrition (EN), parenteral nutrition (PN), and the combination of EN and PN was 425, 314, 853, and 413, respectively. Among the total, 77.55% of patients had nutritional risk (NRS 2002 ≥3). The proportion of patients with high nutritional risk (NRS2002≥5) in the age group >80 years was significantly higher than that in the age group 66-80 years (29.00% vs. 23.93%, P=0.032), but not significantly higher than that in the age group 18-65 years (29.00% vs. 26.54%, P=0.449). Logistic regression analysis revealed that heart failure (odds ratio [OR] 1.856, 95% confidence interval [CI] 1.087-3.167, P=0.023), consciousness (OR 2.967, 95% CI 1.894-4.648, P<0.001), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.037, 95% CI 1.017-1.058, P<0.001), NRS 2002 score (OR 1.286, 95% CI 1.115-1.483, P=0.001), and Mini Nutritional Assessment-Short Form score (OR 0.946, 95% CI 0.898-0.997, P=0.039) were all independent risk factors for 28-day mortality. APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC. CONCLUSIONS: Nutritional risk is prevalent among older patients in EDOUs in China. APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU. Timely and appropriate nutritional screening and support measures are critical to reduce patients' length of hospital stay and mortality.
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BACKGROUND & AIMS: While cross-sectional studies report associations between behavioral and psychological symptoms of dementia (BPSD) and nutritional status as a modifiable factor, their causal relationship remains unclear. Therefore, this study investigated the impact of nutritional status on BPSD. METHODS: This study included women with mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD) from Memory Clinic, National Center for Geriatrics and Gerontology. The participants were assessed for nutritional status and BPSD using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Based on their MNA-SF scores, the subjects were classified as well-nourished, at risk of malnutrition, or malnourished. Nutritional status and change in BPSD was examined for association by univariate and multivariate linear regression analyses. RESULTS: This study analyzed 181 women (79 with MCI and 102 with early-stage AD). The multivariate analysis showed that the malnourished subjects or those at risk of malnutrition (54.1%) were significantly associated with increased DBD scores (ß = 0.255, P = 0.003) during follow-up. In addition, multivariate regression analysis incorporating change in DBD sub-score as a dependent variable showed that the malnourished subjects or those at risk of malnutrition were associated with increased DBD sub-scores for "verbal aggressiveness/emotional disinhibition" (ß = 0.247, P = 0.005). CONCLUSIONS: Poor nutritional status increased BPSD, especially verbal aggressiveness/emotional disinhibition, in those with MCI and early-stage AD during 2.5-year follow-up. Patients with MCI and early-stage AD may need to be assessed for nutritional status from early on, at the onset of mild cognitive decline, and require intervention to prevent worsening of BPSD. Further intervention studies in large prospective cohorts are needed to establish nutritional measures to prevent progression of BPSD in older adults with cognitive impairment.
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Doença de Alzheimer , Disfunção Cognitiva , Desnutrição , Idoso , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico , Estudos Transversais , Feminino , Humanos , Desnutrição/complicações , Desnutrição/epidemiologia , Estado Nutricional , Estudos ProspectivosRESUMO
Introduction: The global population of the elderly with type 2 diabetes mellitus (T2DM) is growing due to improvement in DM care and increased life expectancy. Malnutrition is a recognized complication of DM especially in the elderly. However, despite the impact of malnutrition on the overall outcome of the elderly with DM, it has not received adequate attention. Aim: To determine the prevalence of malnutrition and associated factors in the elderly with T2DM. Methods: This was a cross-sectional study that involved 96 elderly with T2DM and 96 age and sex matched elderly without T2DM as controls. Malnutrition was assessed using mini-nutritional assessment-short form (MNA-SF), hypoalbuminemia and body mass index (BMI). The factors associated with some malnutrition indices were determined. Results: The mean age of T2DM and non-T2DM groups were 66.73⯱â¯5.18â¯years and 66.78⯱â¯5.25â¯years respectively. The observed malnutrition indices among elderly with T2DM and controls were hypoalbuminemia (79.2% vs 25.0%; P ≤0.001); overweight and obesity (58.3% vs 24.0%); and underweight (16.7% vs 4.2%). According to MNA-SF, malnutrition (7.3% vs 0%) and at risk of malnutrition (42.7% vs 16.7%) were significantly more prevalent among elderly with T2DM compared to controls (Pâ¯≤0.001). On logistic regression, the significant predictors of malnutrition were male gender (AOR:2.70; CI:1.11-6.55; Pâ¯=â¯0.028) and albuminuria (AOR:3.14; CI:1.18-8.35; Pâ¯=â¯0.022) and poor glycemic control (AOR:7.05; CI:2.01-24.71; Pâ¯=â¯0.002). Conclusion: Malnutrition is highly prevalent in elderly with T2DM. Poor glycemic control, albuminuria and male gender were significant predictors of malnutrition in this study. Nutritional assessment should be included in the routine DM care especially among the elderly.
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The optimal malnutrition screening tool in geriatric surgery has yet to be determined. Herein, we compare two main tools in older patients undergoing general surgery operations. Older patients (>65 years old) who underwent general surgery operations between 2012 and 2017 in a tertiary centre were included. The Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short Form (MNA-SF) were used for nutritional risk assessment. Preoperative variables as well as postoperative outcomes were recorded prospectively. Agreement between tools was determined with the weighted kappa (κ) statistic. Multiple regression analysis was used to assess the association of the screening tools with postoperative outcomes. A total of 302 patients (median age 74 years, range: 65-92) were included. A similar number of patients were classified as medium/high risk for malnutrition with the MNA-SF and MUST (26% vs. 36%, p = 0.126). Agreement between the two tools was moderate (weighted κ: 0.474; 95%CI: 0.381-0.568). In the multivariate analysis, MNA-SF was associated significantly with postoperative mortality (p = 0.038) and with postoperative length of stay (p = 0.001). MUST was associated with postoperative length of stay (p = 0.048). The MNA-SF seems to be more consistently associated with postoperative outcomes in elderly patients undergoing general surgery compared with the MUST tool.
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Nutrition is an important health issue for seniors. In nursing homes, simple, inexpensive, fast, and validated tools to assess nutritional risk/status are indispensable. A multisurvey cross-sectional study with a convenient sample was created, comparing five nutritional screening/assessment tools and the time required for each, in order to identify the most useful instrument for a nursing home setting. Nutrition risk/status was evaluated using the following tools: Subjective Global Assessment (SGA), Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS 2002), and calf girth (CG). The time spent completing each tool was recorded. Eighty-three subjects were included. MNA-SF and CG were the screening tools that ranked highest with regards to malnutrition identification. CG failed to identify nutritional risk/malnutrition in seniors with lower limb edema. CG was the fastest tool while SGA was the slowest. This was the first study comparing non-invasive nutritional tools with time expended as a consideration in the implementation. CG is responsive, fast, and reliable in elders without edema. MNA-SF was more efficient at detecting malnutrition cases in the elderly population. Both MNA-SF and CG are considered the most suitable for the nursing home setting.
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Avaliação Geriátrica/métodos , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Avaliação Nutricional , Medição de Risco/métodos , Idoso , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Casas de Saúde , Fatores de TempoRESUMO
Malnutrition is a risk factor for postoperative infectious complications of elderly patients undergoing posterior lumbar arthrodesis. At present, there is no gold standard for nutrition screening tools. We analyzed the value of predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis by comparing the MNA-SF and GNRI. Demographic data, anthropometric measurements, serum albumin, surgical data and the occurrence of infectious complications and LOS were collected. Mini Nutritional Assessment short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI) were performed within 24 h before surgery. Multivariable logistic regression analyses were used to identify predictors of infectious complications. The discriminatory performances of GNRI and MNA-SF scores for the occurrence of infectious complications were determined by receiver operating characteristic curves (ROC) analyses and the area under the curve (AUC). The study included 252 patients with a median age of 76.82 ± 6.41 years (range 70-84 years), and 142 patients (56.3%) were female. There were no significant differences in infectious complications (p = 0.236) and LOS (p = 0.580) among different GNRI categories. 27.3% malnourished patients evaluated by the MNA-SF suffered from infectious complications and 10.1% patients at risk of malnourished had infectious complications. Those patients had statistically significant higher prevalence of infectious complications (p = 0.002) and longer LOS (p = 0.023) than well-nourished patients. Multivariable analysis revealed that preoperative malnutrition and at risk of malnourished by the MNA-SF was significantly associated with infections. The area under the curve (AUC) of MNA-SF was 0.754, which was significantly high than AUC of GNRI (0.623) (Delong's test, p = 0.033). This study demonstrated that MNA-SF is a simple and effective tool for predicting the risk of infectious complications in elderly patients undergoing posterior lumbar arthrodesis.
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Desnutrição , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Artrodese , Feminino , Avaliação Geriátrica , Humanos , Estado Nutricional , Estudos ProspectivosRESUMO
AIMS: Older adults at risk for malnutrition are known to have a high mortality rate. This study aimed to investigate whether the Mini Nutritional Assessment-Short Form (MNA-SF) could predict midterm mortality in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We applied the MNA-SF in 288 patients who had undergone TAVI from January 2016 to June 2019 at the St. Marianna University School of Medicine hospital. Using the MNA-SF cut-off value to indicate the risk of malnutrition, patients were divided into two groups, namely, those with an MNA-SF score ≤11 (impaired MNA-SF group) and those with an MNA-SF score ≥12 (maintained MNA-SF group). We used this value to investigate the association between the MNA-SF and all-cause mortality. Overall, 188 (65%) and 100 (35%) patients comprised the impaired MNA-SF and maintained MNA-SF groups, respectively, and 41 patients died after TAVI (mean follow-up duration, 458 ± 315 days). Kaplan-Meier analyses showed that patients in the impaired MNA-SF group had a significantly higher incidence of all-cause mortality (hazard ratio 2.67; 95% confidence interval 1.29-6.21; P = 0.01). Multivariate Cox regression analyses showed that the MNA-SF score was an independent predictor of all-cause mortality after adjusting for the Society of Thoracic Surgeons risk score, Katz Index, and brain natriuretic peptide test results (hazard ratio 1.14; 95% confidence interval 1.01-1.28; P = 0.04). CONCLUSIONS: The MNA-SF was useful to screen for the risk of malnutrition in patients with TAVI and in predicting midterm prognoses in patients undergoing TAVI and could predict patient mortality after the procedure.
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BACKGROUNDS: Malnutrition has been shown to be associated with poor prognosis in older surgical patients. Several tools are available for detecting malnutrition. But little is known about their ability to assess risks of postoperative adverse outcomes. The study aimed to compare the ability of the Geriatric Nutritional Risk Index (GNRI) and the Mini-Nutritional Assessment Short Form (MNA-SF) in predicting postoperative delirium (POD) and length of stay (LOS) among older non-cardiac surgical patients. METHODS: Prospective study of 288 older non-cardiac surgical patients from the West China Hospital of Sichuan University. Preoperative nutritional status was assessed using the GNRI and MNA-SF, and patients were followed for the occurrence of POD and LOS. Multivariable logistic regression and linear regression analyses were used to identify predictors of these outcomes. The relative performance of the GNRI and MNA-SF as predictors of these outcomes were determined by Receiver Operating Characteristic curves (ROC) analyses and the area under the curve (AUC). RESULTS: Multivariable analysis revealed that preoperative malnutrition by the MNA-SF was significantly associated with POD. Linear regression analysis showed that preoperative low/high nutritional risk of the GNRI and malnutrition by the MNA-SF were independent predictors of prolonged LOS. Moreover, the area under the curve (AUC) of MNA-SF scores for POD was better than GNRI scores (AUC = 0.718, 95%CI: 0.64-0.80, P < 0.001 vs AUC = 0.606, 95%CI: 0.52-0.69, P = 0.019; Delong's test, P = 0.006), but the AUC of GNRI scores and MNA-SF scores have no significant difference when predicting prolonged LOS (AUC = 0.611, 95%CI: 0.54-0.69, P = 0.006 vs AUC = 0.533, 95%CI: 0.45-0.62, P = 0.421; Delong's test, P = 0.079). CONCLUSION: The MNA-SF was more effective than the GNRI at predicting the development of POD, but the two nutrition screening methods have similar performance in predicting prolonged LOS among older non-cardiac surgical patients.
Assuntos
Delírio/diagnóstico , Avaliação Geriátrica/métodos , Tempo de Internação/estatística & dados numéricos , Desnutrição/epidemiologia , Idoso , China , Delírio/epidemiologia , Delírio/etiologia , Humanos , Masculino , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Dysphagia is a common problem among older adults, causing aspiration pneumonia and malnutrition. It has been reported that calf circumference (CC), an index of nutritional status and physical activity, correlated with dysphagia in acute care hospitals, suggesting that CC can be a useful index for assessing dysphagia. We therefore aimed to explore the association between dysphagia and CC among community elderly people who require long-term care and determined the optimal CC cut-off value for patients with dysphagia. Our cross-sectional study, conducted at Tokyo Metropolis, included 154 participants (65 men) aged > 65 years (mean age: 80.1 ± 7.1) who required long-term care and were examined for dental disease and dysphagia during home visiting treatment. Age, body mass index (BMI), mini-nutritional assessment short-form (MNA-SF) score, Barthel index (BI), CC, functional oral intake scale (FOIS), and dysphagia severity scale (DSS) were evaluated. A DSS score < 5 was defined as dysphagia. To determine the association between CC and dysphagia, we performed logistic regression analysis and calculated the CC cut-off value for dysphagia. Thirty-seven participants (24.0%) were diagnosed with dysphagia. The logistic regression analysis showed that the presence of dysphagia was independently associated with CC after adjusting for age and sex. The CC cut-off value for the presence of dysphagia was 31.0 cm in men (sensitivity, 0.818; specificity, 0.868) and 29.3 cm in women (sensitivity, 0.760; specificity, 0.859). CC is a useful index for assessing dysphagia among community dwelling individuals who require long-term care.
Assuntos
Antropometria , Transtornos de Deglutição/diagnóstico , Vida Independente , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Curva ROCRESUMO
Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5-2â¯mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs. CLINICAL TRIALS NUMBER: NCT02351882.
RESUMO
PURPOSE: Providing appropriate dental prostheses and dietary interventions may improve food and nutrient intake in elderly edentulous patients, but evidence to support their use is scarce. In this trial, we aimed to clarify the combined effect, on the nutritional statuses of edentulous elderly patients, of dentists providing complete dentures with dietary advice. METHODS: A randomized-controlled trial was performed on a healthy elderly population who required new complete dentures. All participants had new complete dentures fabricated and were randomly divided into an intervention or a control group. The intervention group received simple dietary advice through standardized patient information leaflets and the control group received advice on denture care only. Nutritional status was assessed using the Mini Nutritional Assessment short-form (MNA-SF) before and at 3 and 6months after treatment. At each assessment point, the MNA-SF scores were compared using the Mann-Whitney U test. The within-group differences in the MNA-SF scores were analyzed using the Wilcoxon signed-rank test with Bonferroni correction. RESULTS: In total, 59 participants completed all trial steps. At 6months after treatment, the MNA-SF score in the intervention group was significantly higher than that in the control group (p=0.01). Comparing the within-group changes in the MNA-SF score revealed that the score increased significantly from 3 to 6months in the intervention group (p=0.001, Bonferroni correction). CONCLUSIONS: Nutritional statuses of healthy edentulous elderly population might be improved by fabricating new complete dentures and providing simple dietary advice.