Evaluating the nutritional condition in complex diagnostics and management of geriatric frailty
Authors:
T. Klbíková; E. Topinková
Published in:
Geriatrie a Gerontologie 2018, 7, č. 1: 33-39
Category:
Original Article
Overview
Ageing is a complex process, which involves both anatomical and physiological changes to organs, including lowered organ function reserves. The dynamics of these changes can be variable. Chronic diseases or acute illnesses can accelerate these processes and lead to geriatric frailty – multicausal lowered health potential.
One of the key factors accelerating the development of geriatric frailty is lack of proper nutrition, both in quantitative and qualitative sense. Nutrition issues are very common among the elderly and past 80 years of age, some degree of malnutrition is present in practically all geriatric patients. In most at-risk patients admitted into a hospital their malnutrition progresses further unless it is diagnosed early on. In frail seniors this can be lethal.
The goal of the presented article is to document the nutritional and general condition/frailty of patients aged over 60, evaluated by the SPPB tests and to verify the relationship between geriatric frailty and nutritional condition.
Methodology:
For analysis data from commonly used screening tests within the framework of comprehensive geriatric assessment (CGA) – self-sufficiency (ADL) and physical fitness (SPPB), cognitive function (MMSE) and nutritional assessment (MNA-SF) were used.
Results:
The study included a total of 200 patients, of whom 46 (23%) were male and 154 (77%) were female with the mean age of 81±8 (range 60–101 years). Very low physical fitness and geriatric frailty were found in 119 (59.5%, SPPB <6 points), 59 patients (29.5%) were classified as „pre-frail“ (SPPB 7–9 points) and 22 (11%, SPPB 10-12 points) as robust. Malnutrition was diagnosed in 31 (15.5%, MNA-SF ≤ 7 points) patients and another 75 (37.5%, MNA-SF 8–11 points) were at risk of developing malnutrition. 91.5% of patients with nutritional disorders (high-risk or already suffering from malnutrition) were also frail or „pre-frail“. 94 (47 %, MNA-SF 12–14 points) were well-nourished.
In correlation analysis the total SPPB score correlated with the MNA-SF score, a significant positive correlation was found for the whole group (ρ = 0,503, p < 0,001), but SPPB scores correlated also with ADL andMMSE respectively (ρ = 0,372 and ρ = 0,499, p < 0,001 for both tests).
Conclusion:
In the sample of 200 patients, we demonstrated a strong correlation between geriatric frailty and nutritional status. Of significance to clinical practice is the finding that malnutrition can be both an indicator and a key factor influencing the development of geriatric frailty and also of disability. Although several well validated screening tools for the early detection of people at risk of eating disorders are available they are not sufficiently used in practice.
Keywords:
geriatric frailty – malnutrition – geriatric patient – self-sufficiency
Sources
1. Holmerová I. Geriatrická křehkost – významný klinický fenomén. Medicína pro praxi 2008; 5(2): 66–69.
2. Clegg A, Young J, Iliffe S,et al. Frailty in elderly people. Lancet 2013; 381(9868): 752–762.
3. Chen LK, Hwang A, Liu L,et al. Frailty is a geriatric syndrome characterized by multiple impairments: a comprehensive approach is needed. Journal of frailty and aging 2016; 5(4): 208–213.
4. Fried LP, Tangen CM, Walston J,et al. Frailty in older adults: Evidence for a phenotype. Journals of Gerontology Series – A Biological Sciences and Medical Sciences 2001; 56(3): 146–156.
5. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J. Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2009; 64(6): 675–681.
6. Collard RM, Boter H, Schoevers RA, Voshaar RCO. Prevalence of Frailty in Community-Dwelling Older Persons: A Systematic Review. Journal of the American Geriatrics Society 2012; 60(8): 1487–1492.
7. Gale CR, Cooper C, Sayer AA. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age and Ageing 2015; 44(1):162–165.
8. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Age and Ageing 2010; 39(4): 412–423.
9. Topinková E. Využití standardizovaných škál pro hodnocení stavu výživy u starších nemocných. Česká geriatrická revue 2003; 1(1): 6–11.
10. Berková M, Topinková E, Mádlová P a kol. Krátká baterie pro testování fyzické zdatnosti seniorů – pilotní studie a validizace testu u starších osob v České republice. Vnitřní lékařství 2013; 59(4): 256–263.
11. Guralnik JM, Simonsick EM, Ferrucci, et al. A short physical performance battery assessing lower-extremity function – association with self-reported disability and prediction of mortality and nursing-home admission. Journals of Gerontology 1994; 49(2): 85–94.
12. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutrition reviews 1996; 54(1): 59–65.
13. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research 1975; 12(3): 189–198.
14. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland state medical journal 1965; 14: 61–65.
15. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2007; 62(7): 722–727.
16. Chernoff R. Geriatric nutrition 2013. Jones & Bartlett publishers.
17. Sobotka L, Allison SP (Eds.). Basics in clinical nutrition, 2011.
18. Kunesová M. Životní styl a obezita – longitudinální epidemiologická studie prevalence obezity v ČR. Česká obezitologická společnost ČLS JEP 2006.
19. Zamboni M, Mazzali G, Zoico E,et al.Health consequences of obesity in the elderly: a review of four unresolved questions. International Journal of Obesity 2005; 29(9): 1011–1029.
20. Štěpánková H, Höschl C, Vidovicová L. Gerontologie: současné otázky z pohledu biomedicíny a společenských věd. Univerzita Karlova: Karolinum Press 2015.
21. Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences. Current Opinion in Clinical Nutrition and Metabolic Care 2008; 11(6): 693–700.
22. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice developing the short-form mininutritional assessment (MNA-SF). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001; 56(6): 366–372.
23. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature – What does it tell us? Journal of Nutrition Health & Aging 2006; 10(6): 466–485.
24. Volkert D, Berner YN, Berry, E, et al. (2006). ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutrition 2006; 25(2): 330–360.
25. Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci 2003; 58(2): 159–164.
26. Artaza-Artabe I, Sáez-López P, Sánchez-Hernández N, et al.The relationship between nutrition and frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review. Maturitas 2016; 93: 89–99.
Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
![Issue 1](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/fc8cffdf1a65d2bd2c397bde78e8e399.jpeg)
2018 Issue 1
Most read in this issue
- Hyponatremia in older patients, specifics in diagnostics and treatment
- Renal function and older age patients
- Nephropathy induced by contrast agent: do we know everything?
- Indapamide induced hyponatremia in an 83 year old patient