Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit.

BACKGROUND: Despite decades of research evaluating different predictive strategies to identify persons at risk for falls, nutritional issues have received little attention. Malnutrition leads to weight loss associated with muscle weakness and consequently increases the risk of falls. AIMS: The current study assessed the association between nutritional state and fall risk scores in a geriatric in-patient unit in Ain Shams University Hospital, Cairo, Egypt. METHODS: A cross-sectional study was conducted to assess the nutritional state of 190 older inpatients using a short form of the Mini-Nutritional Assessment (MNA-SF), and the risk of falls was assessed using the Morse Fall Scale (MFS), Johns Hopkins fall risk assessment tool (JH-FRAT), Schmid Fall Risk Assessment Tool (Schmid-FRAT), Hendrich II Fall Risk Model (HII-FRM) and Functional Assessment Instrument (FAI). The generalised linear models (GLM) and odds ratio (OR) were calculated to test the nutritional status as a risk factor for falls. RESULTS: Malnutrition was significantly associated with high fall risk as assessed by MFS and HII-FRM (OR = 2.833, 95% CI 1.358-5.913, P = 0.006; OR = 3.477, 95% CI 1.822-6.636, P < 0.001), with the highest OR for JH-FRAT (OR = 5.455, 95% CI 1.548-19.214, P = 0.008). After adjusting for age, the adjusted Charlson Comorbidity Index (ACCI), number of fall risk-increasing drugs (FRIDs), risk of malnutrition or malnourished were significantly associated with high fall risk as assessed by MFS (OR = 2.761, 95% CI 1.306-5.836, P = 0.008), JH-FRAT (OR = 4.938, 95% CI 1.368-17.828, P = 0.015), and HII-FRM (OR = 3.486, 95% CI 1.783-6.815, P < 0.001). CONCLUSIONS: This study demonstrated a significant association between malnutrition and fall risk assessment scores, especially JH-FRAT, in hospitalised older patients.

Risk stratification among metabolically unhealthy obese in independent physically inactive aged women.

OBJECTIVES: To determine whether or not adiponectin levels or basal metabolic rate (BMR) could predict worse risk stratification in patients with insulin resistance (IR) among metabolically healthy and unhealthy obese (MUHO) elderly females with Metabolic syndrome (MetS). METHODS: A cross-sectional survey was conducted on 109 elderly females in geriatric nursing home with MetS. The participants were reclassified according to adiponectin levels and IR. RESULTS: Group (1) (with IR, n = 41) compared to group (2) (without IR, n = 45) had lower squared adiponectin level and higher fat mass and fat percent (p value = 0.037, 0.030, and 0.035 respectively). Quadratic adiponectin level was an independent predictor for better BMR in group (2) with higher R2 compared to linear adiponectin level (R2 = 0.19, 0.15 consecutively, p value = 0.02, 0.008 consecutively) in group (2) rather than group (1). This revealed U-shaped relation between adiponectin level and BMR in group (2). By ROC curve, fat and lean percentages were statically significant predictors of IR between groups (1) and (2) (AUC = 0.643, 0.636; p value = 0.024, 0.032 Sensitivity = 89.2%, 72.97%; and Specificity = 55.1%, 24.48% respectively). CONCLUSION: Current findings supported the possibility of risk stratification among MUHO individuals based on IR, squared adiponectin level, lean and fat percentages.

The relation between falls and medication use among elderly in assisted living facilities.

PURPOSE: Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case-control study was to assess the relation between medication use and falls among elderly in ALF. METHODS: A matched case-control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall risk-increasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed. RESULTS: The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. CONCLUSION: The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.

Salivary amyloid ß42 levels in mild cognitive impairment among aged diabetics.

PURPOSE: The underlying pathology for cognitive decline in diabetic patients is uncertain. It was originally linked to vascular causes; however, possible contribution of Alzheimer's pathology was debated. This study explored the link between salivary amyloid ß42 level (as a surrogate marker for Alzheimer's pathology) and mild cognitive impairment (MCI) among old diabetic patients. METHODS: A case-control study included 90 diabetic participants, ≥ 60 years of age, divided into 45 cases with MCI and 45 controls. Patients with history of head trauma, any central nervous system pathology, depression, dementia or delirium, those who received anticholinergic drugs, or refused to participate in the study were excluded. Assessment of the relationship between salivary Aß42 level and neuropsychological performance was done using a battery consisting of the logical memory test, forward and backward digit span tests, category fluency test, go/no go test, stick design test, and second-order belief. RESULTS: Salivary Aß42 levels were higher in MCI diabetics versus controls (P = 0.014), it predicted MCI among aged diabetics, even after adjustment for confounding vascular risk factors. Salivary Aß42 had moderate accuracy to identify MCI (area under curve = 0.654, P = 0.008). At cut-off ≥ 47.5 pg/ml, sensitivity, specificity, positive predictive value and negative predictive value were 80%, 47%, 60% and 70%, respectively. CONCLUSION: Current data support that MCI in diabetics, without CNS disorders, is associated with a surrogate marker of Alzheimer's pathology.