No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients
... Exploratory factor analysis of this scale reproduced the three-factor model identified by the original authors. Regarding criterion validity, the Spanish instrument reflects a moderately strong and statistically significant inverse correlation with serum albumin (ALB), total protein, and transferrin (TRF) [22,23]. Moreover, there was a good inverse correlation with the Mini Nutritional Assessment (MNA) [22,23] score and a moderate inverse correlation with body mass index (BMI). ...
... Regarding criterion validity, the Spanish instrument reflects a moderately strong and statistically significant inverse correlation with serum albumin (ALB), total protein, and transferrin (TRF) [22,23]. Moreover, there was a good inverse correlation with the Mini Nutritional Assessment (MNA) [22,23] score and a moderate inverse correlation with body mass index (BMI). Higher EdFED values, which indicate a greater dependency on feeding, correlate with a greater risk of malnutrition and specifically with malnutrition identified by the MNA. ...
Background/Objectives: Patients with dementia present with feeding difficulties (FDs) since diagnosis, conditioning their progression. Early identification is vital for preventing deterioration due to nutritional problems. The Edinburgh Feeding Evaluation in Dementia Scale (EdFED) identifies the FDs of patients with dementia by studying their behaviours while eating or being fed. The aim of this study was to assess the responsiveness of the EdFED over time in older people with cognitive impairment and to compare its effectiveness in identifying malnutrition and risk with that of the gold standard Mini Nutritional Assessment (MNA) method. Methods: This was a multicentre, prospective, observational, longitudinal, analytic study with a follow-up period of 18 months (with patients participating in nursing homes and in the community). Sociodemographic and nutritional data (body mass index (BMI), MNA, forearm circumference (FC), calf circumference (CC), and a nutritional blood test) were collected; EdFED score was reported by nurses, nursing assistants, and family caregivers. Results: The total sample consisted of 359 individuals—60.7% residential participants and 39.3% community participants. In the last follow-up there were 149 remaining (41.5%). Malnutrition was more than 30%, and the risk was 40% at the three follow-ups. The results suggest that the EdFED scale is a useful tool for assessing feeding difficulties (FDs) in older persons with dementia. It demonstrated good sensitivity and specificity in detecting malnutrition, similar to the MNA, and, more importantly, detecting risk and also identifying changes in nutritional status over time. Conclusions: The EdFED scale provides a means of evaluating nutritional problems, making it possible to work on prevention.
... A two-step process uses a screening tool to identify individuals with high risk or probability of malnutrition, followed by a comprehensive clinical assessment to establish malnutrition diagnosis based on the GLIM criteria. Short of a 'gold standard' clinical assessment to diagnose malnutrition by a qualified health professional, 'hybrid' nutritional measurement tools, such as the Subjective Global Assessment (SGA) [6,7] or the Mini-Nutritional Assessment Full Form (MNA-FF) [8,9], which are able to provide more comprehensive information than mere screening tools, are often used as surrogate diagnostic tools. ...
... The reference 'gold standard' diagnosis of malnutrition was made using the Full Form of the MNA (MNA-FF), which has an additional 12 question items for those who score ≤11 points on the MNA-SF screening tool [8]. The additional questions include questions on the phenotypic manifestations (such as mid-arm and calf circumference and self-assesses nutritional and health status), risk factors (such as meal frequency, protein intake through dairy products, fish or meat, legumes, or eggs), and fruit and vegetable consumption. ...
Background: A minority of studies using the GLIM criteria for malnutrition diagnosis have performed formal empirical validation. Objectives: To evaluate the concurrent and predictive validity of GLIM criteria with and without prior screening among community-dwelling older adults in Singapore. Method: In the Singapore Longitudinal Aging Study (SLAS-2, n = 2477), malnutrition was diagnosed using single-step and two-step GLIM procedures using the Mini Nutritional Assessment Short Form (MNA-SF) and Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) for initial screening. Criterion validity was evaluated using MNA-Full Form (MNA-FF) as reference malnutrition diagnosis. Prognostic validity was evaluated using logistic and Cox regression analyses with respect to impaired quality of life (QoL) and 10-year mortality. Results: GLIM malnutrition with and without MNA-SF or ENIGMA screening showed significant associations with known clinical correlates; single-step GLIM malnutrition: sensitivity = 80%, specificity = 83%; two-step MNA-SF-GLIM malnutrition: sensitivity = 80%, specificity = 85%; two-step ENIGMA-GLIM malnutrition: sensitivity = 74%, specificity = 88%; positive predictive values of around 20% and negative predictive values above 98%. Cohen’s kappa values of agreement were uniformly low (0.26 to 0.32). All showed significant associations with about 50% increased odds of impaired QoL and 10-year mortality, adjusted for age, sex, ethnicity, education levels, and housing type, with the ENIGMA-GLIM malnutrition showing the highest risk estimates. Compared to MNA-FF malnutrition prevalence of 4.1%, GLIM-based malnutrition increased prevalence (14.6% to 19.7%) estimates. Conclusions: The GLIM criteria showed good construct and criterion validity. It increased the number of individuals diagnosed with malnutrition. The agreement between diagnoses of malnutrition was low. Diagnostic and prognostic accuracy vary with the screening instrument used. Early identification of malnutrition using appropriate tools can provide opportunities to delay or prevent the risk of important adverse outcomes such as impaired QoL and mortality.
... The MNA®-FF has twelve items in four groups (anthropometric, general, dietary, and subjective assessment). The resulting MNA®-FF score identifies nutritional status as with adequate nutrition (≥ 24 points), risk of malnutrition (17.5-23.5 points), and malnutrition (< 17 points) (11,12). ...
... with a positive predictive value of 97 %. The diagnostic accuracy of the MNA®-SF version is even higher, reaching 98 % sensitivity, 100 % specificity, with a diagnostic accuracy of 99 % for the screening of malnutrition risk(11).In Slovakia, in the care of elderly patients, complex geriatric assessment is considered the gold standard as a multidimensional, multidisciplinary procedure to diagnose somatic and mental health of older people, psychosocial status and functional abilities (or limitations), especially in frail or otherwise at-risk older people, and the MNA® tool is part of this diagnosis. Personalized medicine in this way is especially beneficial in the case of polymorbidity in conjunction with geriatric syndromes (such as malnutrition), when the priority of solutions may not always be clear and unambiguous(27). ...
... 19,20 The Mini Nutritional Assessment Short Form (MNA-SF) is a six-item PRO instrument that combines BMI and weight loss with additional questions about food intake, function, and comorbid conditions to screen for nutritional impairment. 21 It has confirmed validity as a nutritional impairment screening tool in studies conducted in a general population of older adults. 22,23 Quality of life (QOL) is an important outcome among older adults, who often prioritize preserving or improving QOL over length of life. ...
... 27 The MNA-SF assesses patients' food intake, weight loss in the past 3 months, BMI, mobility, psychological stress, acute disease, and cognitive impairment. 21 The MNA-SF is scored from 0 to 14 points, with scores ≤11 indicating nutritional impairment. 21,28 ...
Background
Nutritional impairment is associated with treatment toxicity and worse overall survival in patients with cancer. We aimed to (1) evaluate the association of nutritional impairment with psychological health and quality of life (QOL) and (2) examine which measures of nutrition had the strongest association with psychological health and QOL among older adults receiving cancer treatment with palliative intent.
Methods
This secondary analysis was performed on baseline data from a nationwide cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02107443; PI: Mohile). Adults age ≥70 with advanced cancer and ≥1 geriatric assessment (GA) impairment were enrolled from 2014 to 2017. In line with geriatric oncology standards, we defined nutritional impairment as Mini Nutritional Assessment Short Form (MNA‐SF) ≤11, body mass index (BMI) <21 kg/m², or >10% involuntary weight loss in the past 6 months. We conducted multivariable linear regressions to evaluate the association of nutritional impairment with each measure of psychological health and QOL: Geriatric Depression Scale (GDS‐15, range 0–15), Generalized Anxiety Disorder‐7 (GAD‐7, range 0–21), NCCN Distress Thermometer (NCCN DT, range 0–10), and Functional Assessment of Cancer Therapy‐General (FACT‐G, range 0–108). Analyses were adjusted for patient demographics, clinical characteristics, and GA.
Results
Among 541 patients, the mean age was 77 (range 70–96) and 60% had nutritional impairment. Mean baseline scores: GDS‐15 3.1 (SD 2.7), GAD‐7 2.9 (SD 4.0), NCCN DT 2.9 (SD 2.7), and FACT‐G 80 (SD 15). In the adjusted model, compared to those with no nutritional impairment, older adults with nutritional impairment had greater depression (β = 0.79, 95% CI 0.36–1.23) and anxiety severity (β = 0.86, 95% CI 0.19–1.53), and worse QOL (β = −6.31, 95% CI −8.62 to −4.00). Of the measures of nutrition, MNA‐SF ≤11 demonstrated the strongest associations with depression, anxiety, distress, and QOL.
Conclusion
Nutritional impairment is associated with impaired psychological health and worse QOL. Clinicians should use the MNA‐SF to screen older adults for nutritional impairment and offer tailored supportive interventions.
... Nutritional status was evaluated using the Mini Nutritional Assessment (MNA), a tool designed for comprehensive nutritional assessment in older adults (30). Based on their scores, participants were classified into three groups: normal nutrition, at-risk of malnutrition, and malnourished. ...
Introduction
The global aging population is rapidly increasing, with South Korea experiencing the fastest aging rate among the OECD countries. Consequently, the number of older adults living alone is sharply increasing, creating an urgent social issue that necessitates comprehensive and systematic care service policies. Frailty is a key indicator of the overall health status of older adults, and because oral health and nutrition are closely linked, continuous monitoring is essential in this population.
Methods
This study aimed to analyze the factors influencing oral frailty and nutritional status among older adults living alone in South Korea by using an oral frailty screening tool, which is one of the recently developed function-specific frailty screening tools. A survey of 606 adults aged 65 years and older examined their sociodemographic characteristics, health status, oral health, and nutritional status. Logistic regression analysis identified key factors affecting oral frailty and nutritional status.
Results
Results revealed a direct association between oral frailty and nutritional status, with loneliness emerging as a common factor influencing both variables.
Discussion
These findings highlight the importance of maintaining a balanced diet alongside proper oral hygiene and emphasize the need for integrated interventions including emotional support. Therefore, this study underscores the need for continuous care strategies to promote healthy aging and improve the quality of life of older adults.
... Frailty was assessed by the study physician using the Clinical Frailty Scale (CFS) (32). The study nurse carried out Mini Nutritional Assessment Short Form (MNA-SF) to assess baseline nutritional status (33). The categorization of the baseline variables is shown in Table 1. ...
Background Early mobilisation after hip fracture is a known predictor of short- and long-term outcomes. We investigated factors associated with reduced mobilisation in older patients with hip fracture. Methods The study population included 430 patients with hip fracture (70 years or older, 69% women and 61% with an intracapsular fracture) between September 2021 to January 2023. The degree of mobilisation was recorded during the early postoperative period using the Cumulated Ambulation Score (CAS). Multivariable logistic regression analyses were used according to the combined CAS scores of postoperative days 1, 1–2, and 1–3. Fracture type, delirium (4AT test), the Clinical Frailty Scale (CFS) scores, and nutritional status (Mini Nutritional Assessment Short Form (MNA-SF) adjusted for six confounding factors, were the explanatory variables. Results In all three postoperative CAS scores severe frailty (CFS7–9) versus CFS1-3 was associated with lower mobilisation (adjusted Odds Ratio, OR = 5.01, Confidence Interval, 95%CI, 1.61–15.63; OR = 24.92, 95%CI, 2.78-223.47, and OR = 62.88, 95%CI, 6.32–625.70, respectively), and mild-to-moderate frailty (CFS4–6) only in the 2-day CAS (OR = 2.14, 95%CI, 1.07, 4.26). Possible delirium (4AT > 3p) versus no delirium was associated with lower mobilisation in the 1-day CAS (OR = 2.45, 95%CI, 1.23–4.91) and in the 3-day CAS (OR = 2.85, 95%CI, 1.20–6.79). Malnutrition (MNA-SF) did not show association with mobilisation in any of the CAS scores. Conclusion Frailty and delirium were associated with lower postoperative mobilisation in patients with hip fracture. Frailty and prevention of delirium should be given specific attention in the perioperative care of older patients with hip fracture to improve their early ambulatory status. Trial registration The study has been registred locally by the Turku Clinical Research Center, Turku, Finland (study number T145/2021).
... MNA is a simple and brief method for the screening of nutritional status and assessment of nutritional status in elderly patients, surgical patients, and patients with chronic diseases [17]. It includes anthropometric measurements (weight, height, and weight loss), and six questions were related to lifestyle, medication, and mobility in the global assessment section. ...
Background
Hepatocellular carcinoma (HCC) patients are vulnerable to malnutrition. Despite its importance in enhancing clinical outcomes, management, and prognosis of HCC patients, few studies assessed their nutritional status. Our study aimed to evaluate the nutritional status of HCC patients using various nutritional assessment methods and their correlation with disease severity.
Patients and methods
This is a cross-sectional hospital-based study of 200 HCC patients who visited outpatient clinics at the National Liver Institute. Methods used for assessment of their nutritional status included body mass index (BMI), mid-arm circumference (MAC), mid muscle arm circumference (MMAC), calf circumference (CC), hand grip strength (HGS), adductor pollicis muscle (APM) thickness, subjective global assessment (SGA), and mini-nutritional assessment (MNA) questionnaire.
Results
The mean age of study participants was 61.51 ± 8.68 years. There was a wide variation in the diagnosis of malnutrition in HCC patients using different nutritional assessment methods. There was substantial agreement between MAC and MNA with SGA. There was a negative correlation between child class and MAC, MMAC, and MNA scores. There was a negative correlation between BCLC and MNA scores. SGA was positively correlated with both child class and BCLC staging.
Conclusions
There was a great variation in the prevalence of malnutrition in HCC patients using different nutritional assessment methods. MAC and MNA scores showed a substantial agreement with SGA. SGA, MNA, MAC, and MMAC correlated with disease severity. Assessing the nutritional status is necessary to improve patients’ clinical outcomes.
... The CGA was performed with validated tools administered by physicians with specific training in geriatrics. It included the assessment of cognitive capacities (Short Portable Mental Status Questionnaire [28]), mood (Geriatric Depression Scale [29]), nutritional status (Mini Nutritional Assessment [30]), risk of pressure ulcers (Exton-Smith scale [31]), and the extent of comorbidities (Comorbidity Index Rating Scale [32]) upon admission. It also included the assessment of the independence in basic and instrumental activities of daily living (BADL and IADL [33]), referred to the moment prior to the trauma that led to the hip fracture. ...
Background
Fragility fractures occur on porotic bones due to minor trauma and are associated with high rates of disability and mortality.
Aims
To evaluate the ability of handgrip strength to predict one-year mortality in elderly patients with fragility hip fracture.
Methods
We enrolled patients aged 65 years and older with fragility hip fractures admitted to an Italian orthopedic unit. They underwent a comprehensive geriatric assessment, including handgrip strength measurement, and all received surgical intervention.
Results
Among the 322 enrolled patients (median age: 84 years; 75.2% women), the one-year mortality rate was 15.5%. According to the European Working Group on Sarcopenia in Older People 2 guidelines, 235 subjects (73.0%) exhibited low handgrip strength. This group revealed HR: 2.36 (95%CI: 1.06–5.24) for one-year mortality compared to the group with adequate handgrip strength (p = 0.036). After adjusting for age and risk of adverse event, through Multidimensional Prognostic Index, the HR decreased to 1.31 (95%CI: 0.56–3.07), with a lower validity.
Discussion
Our study found a slightly lower one-year mortality than other studies with similar samples, probably due to the co-management of orthopedic and geriatric teams. As for the main outcome, low handgrip strength was significantly associated with one-year mortality. However, the significance diminished when considering possible confounding variables, despite a lower precision of the model.
Conclusions
Low handgrip strength predicts one-year mortality in elderly people with fragility hip fractures. Further studies are needed to explore the possible influence of confounders.
... Disability was defined as loss of 2 or more ADLs [23]. At admission, nutritional status was assessed with the mini nutritional assessment (MNA) [24]. The number of all the medications regularly taken at home was available at admission not considering the over the counter (OTC) medications. ...
Background
Psychoactive drugs represent a major contributor to falls in older people. This study aims to evaluate the prescribing practice of psychoactive drugs in older people hospitalized for hip fracture (HF) and to explore independent correlates of deprescribing.
Methods
Multicenter prospective observational study including patients with HF admitted to 13 Orthogeriatric wards of the Italian Group of Orthogeriatrics (July 2019-August 2022). Patients underwent a comprehensive geriatric assessment. The use of psychoactive drugs associated with a higher risk of falls was assessed using a dedicated checklist. Deprescribing was defined as any reduction in the number of psychoactive drugs upon discharge, and independent correlates of deprescribing were explored using logistic regression analyses. Cluster analysis by Partitioning around Medoids was also performed in the hypothesis that selected clusters of characteristics could be associated with deprescribing.
Results
One thousand eight hundred fifty-four older individuals (mean age 84 years, 77% females) were studied; 1190 (64%) were not prescribed any psychoactive drug, while 474 (26%), 129 (7%), and 61 (3%) took 1, 2, 3 or more psychoactive drugs, respectively.
Among 664 patients on psychoactive drugs on admission, 177 (27%) had fewer prescriptions at discharge, mainly anxiolytics from 89 to 10 (50–6%), antipsychotics from 49 to 12 (28–7%) and antidepressants from 98 to 28 (55–16%). On the other count, 51 (8%) were prescribed more psychoactive drugs, mostly antidepressants from 25 to 45 (49–88%) and antipsychotics from 7 to 17 (14–17%). Functional autonomy (ADL aOR 0.87 [95%CI 0.78–0.97] p < 0.001), polipharmacy (aOR 1.15 [95%CI 1.03–1.29] p < 0.001) and the occurrence of post-operative delirium (aOR 1.71 [95%CI 1.09–2.66] p < 0.017) were independent correlates of deprescribing. More specifically, the clustering procedure could not improve the characterization of deprescribing; conversely, the deprescribing propensity significantly depended upon the center-specific prescriptive practice, not explained by other clinical-epidemiological factors.
Conclusion
Only a small proportion of patients hospitalized for HF undergoes deprescribing of psychoactive drugs, with considerable heterogeneity among centers, suggesting that the physician’s attitude rather than patient-related factors affects deprescribing.
... Psychosocial factors include feelings of loneliness and depression [10][11][12]. Various tools are available for assessing the risk of malnutrition; however, the Mini Nutritional Assessment (MNA) is specifically recommended for older adults [13]. ...
Background/Objectives: Addressing the risk of malnutrition at an early stage is crucial to preventing its development, which can have a detrimental impact on physical and mental health status. This study investigates the potential role of biochemical biomarkers such as sirtuin 1 (SIRT-1), melatonin, cholecystokinin-8 (CCK-8), and total antioxidant capacity (TAC) in identifying the risk of malnutrition. Methods: This cross-sectional study assessed malnutrition risk in 153 community-dwelling older adults using the Mini Nutritional Assessment (MNA). Serum levels of SIRT-1, melatonin, and CCK-8 were analyzed with enzyme-linked immunosorbent assay (ELISA), and total antioxidant capacity (TAC) was measured using the ferric reducing ability of plasma (FRAP) method. Results: Serum levels of TAC and CCK-8 were significantly positively correlated with grip strength and visceral adipose tissue, with TAC levels also showing associations with appendicular skeletal muscle mass index (ASMI), total body water, total energy expenditure, fat-free mass index, and fat mass index (p < 0.001). CCK-8 emerged as a strong predictor of malnutrition risk (AUC = 0.58 in females, AUC = 0.64 in males), whereas SIRT-1 (AUC = 0.57 for both sexes), melatonin (AUC = 0.46 for females, AUC = 0.51 for males), and TAC (AUC = 0.42 for females, AUC = 0.54 for males) exhibited weaker predictive abilities. A multivariate model incorporating CCK-8 demonstrated excellent predictive accuracy (AUC = 0.84, 95% CI: 0.77–0.90) and indicated a potential association between elevated CCK-8 levels and a higher risk of malnutrition. Conclusions: In conclusion, this study highlights the effectiveness of a multi-parameter model incorporating CCK-8 as a reliable approach for assessing malnutrition risk in older adults, offering a comprehensive evaluation of the condition. However, further research is needed to confirm its applicability and accuracy in diverse elderly populations and clinical settings.
... The Mini Nutritional Assessment (MNA) has been recently developed and validated as a swift, comprehensive tool for evaluating nutritional status across various healthcare settings, including clinics, hospitals, and nursing homes [23,24]. A substantial body of evidence from both retrospective and prospective studies supports the MNA as the gold standard for screening and assessing malnutrition in OA [25]. ...
Background
Quality of life (QoL) is a key indicator of well-being in older adults (OAs) and several factors, including nutrition, physical fitness, and dwelling place, can influence QoL. OA residing in institutional settings, such as nursing homes (NH), often can exhibit different QoL outcomes, nutrition status and physical fitness compared to those living independently in age-in-place (AIP) environments. This study seeks to compare the QoL, and physical activity levels of OA residing in NH with those AIP and to evaluate their dietary quality.
Methods
This cross-sectional study included a total of 400 voluntary OAs, residing either in Narlıdere Nursing Home and Aged Care Rehabilitation Centre (n = 200) or aging in place (n = 200) in İzmir, Turkey. Participants were recruited between May 2023 and December 2023. Data collection involved face-to-face interviews using a questionnaire that covered demographic and anthropometric measurements, Mini Nutritional Assessment (MNA), Older People’s Quality of Life (OPQOL-brief), Physical Fitness and Exercise Activity Levels of Older Adults Scale (PFES), and a 24-hour dietary recall. Nutritional status was further assessed using the Healthy Eating Index for Older Adults (HEI-OA).
Results
Mean age of OAs was 77.8 ± 6.5 years and BMI was 25.8 ± 3.9 kg/m². HEI scores were not differed between groups (NH: 42.8 ± 8.1, AIP: 42.2 ± 11.0, p < 0.542), but AIP residents had lower poor diet quality (NH: 40.4 ± 5.9, AIP: 37.5 ± 7.9, p < 0.001). NH residence had higher OPQOL scores (NH: 54.8 ± 7.8, AIP: 47.6 ± 10.4, p < 0.001), and higher MNA scores (NH: 25.6 ± 2.7, AIP: 22.4 ± 5.5, p < 0.001). NH group had lower PFES scores, indicating reduced physical fitness compared to AIP participants (NH: 67.3 ± 6.3, AIP: 74.7 ± 7.7, p < 0.001). Nutrient intake analysis revealed that NH residents consumed more daily water, protein, and micronutrients than AIP participants, with statistically significant differences in protein, MUFA, and SFA intake (p < 0.001). A significant relationship between MNA and QoL total score in NH (r = 0.157, p = 0.027) and AIP (r = 0.619, p < 0.001) was found.
Conclusion
The findings of this study revealed the potential influence of nutritional status on QoL, in enhancing QoL outcomes.
... We used the MNA-SF to evaluate the nutritional statuses of our patients. The MNA is used to identify individuals with MN and those at risk of MN among older adults [21]. Accordingly, ESPEN recommends using the full or short form of the MNA to screen nutritional status in older adults [22]. ...
Objectives: Malnutrition (MN) is prevalent in older adults and closely related to sarcopenia, frailty, morbidity, mortality, and decreased quality of life. In this study, we aimed to evaluate the effects of a personalized diet combined with planned physical exercise on nutritional status, physical performance, and quality of life (QoL) in malnourished older adult patients. Methods: In this prospective study, 20 older adults with MN risk according to the Mini Nutritional Assessment—Short Form (MNA-SF) were randomized into (i) personalized diet (PD) and (ii) personalized diet with physical exercise (PDE) groups, and followed up with for 12 weeks. The physical exercise included warm-up, strengthening, balance, and cooldown phases, with a frequency of 3–4 days per week. Anthropometric measurements, physical performance, and quality of life were assessed using standardized tools at baseline and at the 4th, 8th, and 12th weeks. QoL was measured using the EQ–5D index and EQ–5D visual analog scale (VAS) scores. Results: A total of 20 patients (55% male) participated in the study. During the study, BMIs, MNA-SF scores, and hand grip strength were increased, and the patients’ average duration on the Timed Up and Go (TUG) test decreased significantly in both groups. The EQ–5D index score of the PD group and the EQ–5D VAS scores of both groups were increased. Conclusions: A personalized diet with or without physical exercise therapy was associated with improved nutritional status, physical performance, and QoL.
... A avaliação do estado nutricional foi realizada também através de métodos subjetivos: ASG proposta por Detsky et al 20 para os pacientes adultos e a MAN para os idosos Guigoz et al. 21 . A NRS foi aplicada para pacientes adultos e idosos 9 . ...
... To perform the nutritional assessment, the Mini Nutritional Assessment (MNA) [27] and Mini Nutritional Assessment Short Form (MNA-SF) [28] scales were used. These tools reveal the current nutritional status of each participant. ...
Background/Objectives: Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess the associations between malnutrition and its determinants in a group of institutionalized older people via the Mini Nutritional Assessment–Short Form (MNA-SF) and the full MNA. Methods: The MNA-SF was compared with the full MNA to evaluate the nutritional status of 207 older people. A multinomial logistic regression analysis was performed. Results: The data revealed that institutionalized older people with cognitive impairment, frailty syndrome, dysphagia, a low BMI, a high duration of institutionalization, and a low educational level are more likely to be malnourished or at risk of malnutrition. Conclusions: The results reveal that the MNA or MNA-SF may not identify common determinants of malnutrition or nutritional risk. The identified determinants depend on the test. Therefore, the data obtained determine the need to use adequate nutritional screening tools to control the presence of malnutrition. Nutritional screening is essential to decrease public costs, hospitalizations, rates of disability, dependence, morbidity, and even mortality among institutionalized older people.
... 5 It has also been emphasized that nutritional management can have a direct and positive impact on muscle recovery, particularly in patients with moderate to severe levels of undernutrition. [6][7][8] The significant improvements in biomarkers between T0 and T6 indicate a marked recovery in patients' nutritional status. Mean albumin increased to 35.9 g/L, reflecting improved protein reserve. ...
This study examined the morphometric and clinical aspects as well as the nutritional and dietary management of undernourished adult patients in the Marrakech Tensift Al Haouz region, Morocco. It highlighted the specific challenges faced by these patients, in particular the significant differences in nutritional requirements and management strategies. Our results showed a significant increase in caloric intake from 19.97±0.64 kcal/kg/d to 27.23±0.12 kcal/kg/d for all patients. Muscle mass increased from 16.71±4.76 kg to 18.75±3.58 kg. The mean albumin increased to 35.9 g/L, indicating an improved protein reserve. Similarly, pre-albumin increased to 186.3 mg/dL, suggesting a rapid response to nutritional intake. At the same time, C-reactive protein levels fell, indicating a reduction in systemic inflammation. In addition, it is important to note that body mass index differed between the sexes, with women tending to gain muscle mass more slowly than men. The results highlight the urgent need to adopt a personalized approach to improving the health and well-being of undernourished patients by adjusting nutritional and dietary interventions to the specific needs of each individual.
... Dependence in ADLs was assessed by questioning the informal caregiver or care staff by using the Lawton and Brody scales containing six P-ADL and eight I-ADL domains [44,45] and the motor domain of Functional Independence Measure (FIM) [46,47]. Nutritional status according to Mini Nutritional Assessment (MNA, 0-30) [48] including body mass index (kg/m 2 ), was assessed. Neuropsychiatric symptoms were assessed by questioning the informal primary caregiver or care staff, using the Neuropsychiatric Inventory, (NPI) [49]. ...
Background
A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.
Methods
Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.
Results
Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.
Conclusions
The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.
Trial registration
The study protocol, ISRCTN59155421, was registered online 4/11/2015.
... Nutritional status was evaluated through body mass index (BMI), unintentional weight loss within the past 3 months and the Mini-Nutritional Assessment [19]. Individuals were classified as having poor nutrition if their BMI was less than 18.5 kg/m 2 , their unintended weight loss was more than 10%, or their Mini-Nutritional Assessment (MNA) score was less than 24 [20]. ...
Aim
To evaluate the prognostic impact of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) on overall survival (OS) among Indian older patients with cancer.
Methods
This observational study was conducted in the geriatric oncology clinic of Tata Memorial Hospital (India). We included all patients who underwent a geriatric assessment (GA) and had a complete blood count available for analysis. The NLR was dichotomized at 3.5, PLR and LMR at the median. Our primary study outcome was OS.
Results
Between June 2018 and November 2021, 786 patients were enrolled (median age: 69 years). The most common primary tumour was lung (308, 39.5%), followed by gastrointestinal (261, 33.5%). Metastatic disease was present in 54.3% of patients. Univariate analysis revealed that patients with NLR >3.5 had shorter OS (9.1 months) than NLR <3.5 (15.7 months) (HR: 1.56). Similarly, patients with PLR >183.5 had reduced OS (9.3 months) compared to PLR <183.5 (16.6 months) (HR: 1.56). Conversely, patients with LMR >3.1 showed better OS (14.2) compared to LMR <3.1 (9.8 months) (HR: 0.74). After adjusting for age, performance status, primary tumour, metastatic status and GA-derived factors (function, nutrition and cognition), NLR (HR: 1.25, 95%CI: 1.03–1.52), PLR (HR: 1.34, 95%CI: 1.11–1.63) and LMR (HR: 0.79, 95%CI: 0.65–0.95) were associated with OS.
Conclusion
In our study of older cancer patients, we identified three key inflammatory markers (NLR >3.5, PLR >183.5, LMR <3.1) as strong predictors of poor OS. These markers remain predictive even after accounting for traditional prognostic factors and GA-derived scales.
... Nutritional status was evaluated using the mini nutritional assessment-long form (MNA-LF), which involved direct questioning of patients [70]. The assessment comprised 18 items, including anthropometric measurements and questions pertaining to dietary intake, appetite, general health, and disability status. ...
Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60–0.78) and 0.62 (95% CI: 0.54–0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77–0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.
... Mid-arm circumference (MAC) and calf circumference (CC) measurements were performed on nondominant limbs. According to the Mini Nutritional Assessment (MNA), MAC < 22 cm and CC < 31 cm were considered indicative of reduced muscle mass [37]. ...
Chronic kidney disease (CKD) is linked to an elevated risk of malnutrition and sarcopenia, contributing to the intricate network of CKD-related metabolic disorders. Adipokines and myokines are markers and effectors of sarcopenia and nutritional status. The aim of this study was to assess whether the adipokine–myokine signature in patients on kidney replacement therapy could help identify malnutrition and sarcopenia. The study involved three groups: 84 hemodialysis (HD) patients, 44 peritoneal dialysis (PD) patients, and 52 kidney transplant recipients (KTR). Mean age was 56.1 ± 16.3 years. Malnutrition was defined using the 7-Point Subjective Global Assessment (SGA) and the Malnutrition-Inflammation Score (MIS). Sarcopenia was diagnosed based on reduced handgrip strength (HGS) and diminished muscle mass. Concentrations of adipokines and myokines were determined using the enzyme-linked immunosorbent assay (ELISA). 32.8% of all study participants were identified as malnourished and 20.6% had sarcopenia. For malnutrition, assessed using the 7-Point SGA, in ROC analysis albumin (area under the curve (AUC) 0.67 was the best single biomarker identified. In dialysis patients, myostatin (AUC 0.79) and IL-6 (AUC 0.67) had a high discrimination value for sarcopenia, and we were able to develop a prediction model for sarcopenia, including age, albumin, adiponectin, and myostatin levels, with an AUC of 0.806 (95% CI: 0.721–0.891). Adipokines and myokines appear to be useful laboratory markers for assessing malnutrition and sarcopenia. The formula we propose could contribute to a better understanding of sarcopenia and potentially lead to more effective interventions and management strategies for dialysis patients.
... Each patient's actual nutritional status was assessed on admission by the Burn Unit dietitian, using the Subjective Global Assessment (SGA) [11] and Mini-Nutritional Assessment (MNA) [12], both validated for use with older persons [13]. The SGA includes a physical examination to assess the presence and extent of muscle wasting, loss of subcutaneous fat stores and oedema. ...
... El EN al ingreso se determinó a partir del Mini Nutritional Assessment (MNA), en las primeras 24-48 horas del ingreso hospitalario. Se consideró malnutrición cuando el puntaje fue <17, riesgo de malnutrición entre 17 y 23,5, y normal >24 (16) . En caso de no poder realizarse la evaluación del MNA (versión larga), se utilizó su herramienta de cribaje: malnutrición/riesgo de malnutrición/normal. ...
Introducción: la desnutrición (DN) en la persona mayor (PM) al ingreso hospi- talario alcanza el 60,00 %. Las hospitalizaciones de más de ocho días muestran una reducción significativa de la masa muscular (MM) y la fuerza muscular (FM). Objetivo: determinar el efecto de los primeros 10 días de hospitalización sobre la evolución de la MM, según la circunferencia de la pantorrilla (CP), la circunferencia muscular del brazo (CMB), el espesor del músculo aductor del pulgar (EMAP) y la FM. Métodos: estudio descriptivo y longi- tudinal. Los datos se obtuvieron mediante la Mini Nutritional Assessment (MNA) y las mediciones antropométricas (peso, talla, CP, CMB, EMAP y FM) se realizaron a las 24-48 horas del ingreso del paciente, y a los 10 días. Resultados: la muestra quedó conformada por 49 PM. Predominó el sexo feme- nino (57,00 %; n = 28). La media de edad fuede77±8,2años(IC:95%=75,2-80 años) y un rango de 65 a 96 años. El índice de masa corporal (IMC) promedio fue de 24,6 ± 4,3 kg/m2 (IC: 95 % = 23,4-25,8) y un rango de 17,3 a 34,6 kg/m2. La prevalencia de evolución desfavorable de la MM fue del 67,30 %, 55,10 % y 51,00 %, según CP, CMB y EMAP, respectivamente. Para la FM, la evolución favorable predominó en un 53,10 %. Conclusión: la hospitalización empeora la evolución de la MM, sin poder confirmar lo mismo para la FM. La MM, según el EMAP, fue la que presentó mayor dispersión.
... Improving the nutritional status of older persons play an important role in improving their health and reducing deaths caused by complications of chronic diseases in them [12]. Brief assessment of nutritional status in elderly (MNA) is a useful tool for rapid assessment of nutritional status in elderly and people to be able to identify early intervention is appropriate [13,14]. has been Arzaby reliability of these instruments in several studies [15,16]. ...
Due to physiological changes in the elderly, elderly nutritional status in developing countries is an important issue that has received little attention. Nutritional factors on mortality, morbidity and quality of life are effective. Through epidemiological diseases, increased life expectancy and an increase in the number of old age, and consequently the number of elderly who need medical services will be added. Studies show that the turnout at the world's largest nutritional status, play a prominent role in health and disease and people 65 years and older for many low-income elderly and the poor, the most important factor. Known dietary factors, including chronic diseases, oral health problems, lack of emotional functioning, social isolation, taking multiple medications, socioeconomic status / F physical disability, sedentary lifestyle, depression and dementia, and reduced production gastric acid. The cognitive factors that make a person vulnerable to severe illnesses exhausted physical condition of the body and finally admitted to the hospital. Studies have shown that malnutrition is an independent risk factor for hospital admission in the elderly. Materials and Methods This study is a cross-sectional descriptive study population included all elderly men and women living in nursing homes has been a city of Sabzevar. 120 samples were randomly selected (60 males and 60 females). Collect data using observation and questionnaires were used. Anthropometric values weighing, measuring height, weight, body mass index (BMI) was calculated. Standard questionnaire MNA (Mini Nutritional Assessment) that was used for grading the nutritional condition of the elderly. Results Mother in a nursing home survey data show that 5 people suffer from malnutrition, 31 people were at risk of malnutrition and 14 normal powers. In the process of absorption of nutrients that are in trouble and have not enjoyed the life of a healthy lifestyle and diet has been previously Condition risk factors.
... This form allows the assessment of the risk of malnutrition among individuals aged 60 and over. It includes 18 questions addressing anthropometric measurements, global assessment, dietary questionnaire, and self-perception of health and nutrition 24 . The maximum global score for MNA-SF is 30 points, with the following classification: a normal nutritional status indicated by a score of 24 to 30, risk of malnutrition with scores between 17 and 23.5, and malnutrition indicated by a score less than 17 points 18 . ...
Introduction: With aging, there is an increased risk of suffering from different chronic diseases, including high blood pressure. Hypertension management must be carried out by health professionals, whether or not treatment involves medication. By controlling drug treatment, especially adherence, serious health problems for older people can be avoided. Objective: To determine the factors associated with adherence to arterial hypertension treatment in older adults who live at home. Materials and Methods: A quantitative and cross-sectional study was conducted in La Libertad Region, Peru, with 342 older adults living at home. For data collection, a sociodemographic profile form, anthropometric measurements, blood pressure measurements, the Mini-mental State Examination (MMSE) test, the Geriatric Depression Scale (GDS), and the Morisky Green Levine (MGL) adherence scale were used. In addition, descriptive and analytical statistics were used. Result: 57.60% of the participants did not adhere to the pharmacological treatment, and, in most of the sociodemographic variables examined, they did not adhere to pharmacological treatment in most cases. Likewise, a relationship between retirement in older adults and the MGL adherence scale score was identified. The study showed evidence linking treatment adherence and age (p=0.01), retirement status (p=0.05), and history of stroke (p=0.004). Discussion: Treatment adherence depends on sociodemographic and health factors for disease control and a healthy lifestyle. Conclusion: Older adults and their caregivers need guidance and education to improve adherence to pharmacological treatments.
... The Mini Nutritional Assessment (MNA) score for the screening of malnutrition was recorded. An MNA total score of <17 was indicative of malnutrition and a score of 17-23 was indicative of risk of malnutrition [18]. ...
Background: Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. Methods: This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were compared with a historical control group of 11 patients. The nutritional treatment consisted of standard oral (ON) or artificial nutrition (AN). Traditional measurements, including bioimpedance-derived body composition and volumetric reconstruction of the posterior paraspinal muscles at the C3 level based on magnetic resonance imaging (MRI-C3), were obtained in 16 patients to investigate sarcopenia. Results: The patients were categorized according to TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 90.9% in the control group (P
... There is, however, no "gold standard" for the assessment of malnutrition. However, nutritional assessments help in the evaluation of feeding problems that lead to clinical complications [6]. In a Turkish and Portuguese nutritional study of elderly populations, authors describe differences in terms of malnutrition related to sociodemographic factors [7]. ...
There are many nutritional changes that come with aging, mostly as consequences of health regression. Malnutrition and overweight often start with inadequate food consumption, followed by alterations in biochemical indices and body composition. In our study, we aimed to analyze the feeding habits and energy and nutrient intake of a Hungarian elderly population, focusing on macronutrient, water, fruit, and vegetable consumption while searching for possible nutritional factors leading to NCD and many other chronic diseases in this population. Two questionnaires were used. These were the Mini Nutritional Assessment (MNA) and one asking about nutritional habits, and a 3-day feeding diary was also filled. Subjects (n = 179, 111; females (F), 68 males (M), older than 50 years were recruited. Based on MNA results, 78 adults (43.57% of the studied population) were malnourished or at risk of malnutrition, although, according to BMI categories, 69% were overweight and 7.3% were obese among M, while 42.3% were overweight among F. The average daily meal number was diverse. The amount of people consuming fruit (11.7%) and vegetables (8.93%) several times a day was extremely low (15.3% of F and 4.4% of M). Daily fruit consumption in the whole sample was 79.3%. Overall, 36.3% consumed 1 L of liquid and 0.5 L of consumption was found in 15.1% of participants. A significant gender difference was found in water consumption, with F drinking more than M (p ≤ 0.01). In our sample, 27.93% of the respondents took dietary supplements. Further analysis and research are needed to explore the specific health implications of and reasons behind these findings.
Purpose
Malnutrition among elderly nursing home residents represents a critical public health challenge, particularly in rapidly aging societies such as China. This study aimed to develop and validate a predictive model for malnutrition risk tailored to this vulnerable population.
Methods
We analyzed clinical data from 1,023 elderly individuals (aged ≥ 65 years) across 26: nursing homes in Wuhan, China (March–October 2023). Participants were randomly divided into model-building (70%, n = 716) and internal validation cohorts (30%, n = 307). LASSO regression and logistic regression identified key predictors, and a nomogram was constructed. Model performance was assessed via AUC, calibration curves, and decision curve analysis (DCA).
Results
The malnutrition incidence was 46.37%. Five predictors were significant: feeding method (OR = 2.89, 95% CI: 1.75–4.76), dental status (OR = 0.56, 95% CI: 0.37–0.86), physical inactivity (OR = 1.75, 95% CI: 1.09–2.80), Barthel Index (OR = 0.96 per 10-point decrease), and anemia (OR = 1.91, 95% CI: 1.10–3.30). The model showed excellent discrimination (AUC = 0.90, 95% CI: 0.85–0.94) and calibration (mean absolute error = 0.026). DCA indicated clinical utility across threshold probabilities (2–97%).
Conclusion
This nomogram provides a robust tool for malnutrition risk stratification in nursing homes. Future studies should validate its generalizability across diverse populations and regions.
Introdução: Os idosos representam um grupo etário de risco a deficiências nutricionais e doenças crônicas, em função do modo de vida e dos hábitos alimentares. Objetivo: Relatar as experiências do Projeto de Extensão “Acompanhamento e Orientação em Alimentação e Nutrição para a Universidade Aberta à Terceira Idade” desenvolvidas por meio de aulas na disciplina de Nutrição. Metodologia: Foram utilizadas diversas metodologias de ensino, de acordo com a temática a ser desenvolvida, como palestras, jogos, aulas expositivas dialogadas, oficinas práticas, aplicação de questionários e avaliação nutricional. Resultados: A partir das aulas e convivência com os idosos participantes houve o aprimoramento dos conhecimentos sobre nutrição, observou-se mudanças nos hábitos alimentares, estilo de vida e maior conscientização, partindo dos princípios do que foi abordado nas aulas. Conclusão: A educação alimentar e nutricional nesta população visaram à melhoria das práticas alimentares, da qualidade de vida, prevenção, tratamento e controle de doenças.
Introduction
Accidental falls are a common geriatric syndrome that hinders healthy ageing in older adults. Older adults who live in nursing homes (NHs) are at a greater risk of accidental falls than those who reside in communities. Intrinsic capacity (IC) decline has been shown to be an independent influencing factor for fall risk. Moreover, healthy behaviour is a prerequisite for IC. Therefore, this study considers IC as a starting point, with an aim of developing, implementing and evaluating a low-administration-cost multidomain fall risk management intervention programme based on the Health Action Process Approach.
Methods and analysis
The target population includes older adults with declining IC in Chinese NHs. A random lottery method will be adopted to divide the 100 participants into the control group and intervention group. The project will be conducted in three parts over 24 weeks. In the first part, a fall risk management intervention pathway and programme will be developed with the theoretical and IC framework, which will be refined via the Delphi method. In the second part, a randomised controlled trial will be implemented. The control group will receive usual care and health education, and the intervention group will complete a three-stage process to complete fall risk management behaviour intention and behaviour maintenance. In the third part, follow-up will be conducted to clarify the maintenance effectiveness of the programme in fall risk management. Behaviour change techniques and an interactive handbook will be used to increase the feasibility of the programme. The primary outcomes will include the IC composite score (cognition, locomotion, vitality, sensation and psychology) and fall risk. The secondary outcomes will include gait and balance, strength, fall efficacy, fall prevention self-management, fall management behaviour stages and healthy ageing. The outcomes will be assessed at baseline, and then after 4 weeks, 16 weeks and 24 weeks in both groups. The effectiveness of the intervention will be analysed via linear mixed models on a range of outcomes.
Ethics and dissemination
The trial was approved by the Huzhou University Committee (No.2023-06-06). The results will be submitted for publication in a peer-reviewed journal and presented at conferences.
Trial registration number
NCT05891782 .
La población anciana cada vez es más longeva, siendo el grupo etario con mayor crecimiento el de ancianos >80 años. Con el envejecimiento se presentan muy frecuentemente enfermedades crónicas, deterioro cognitivo, funcional y/o nutricional que requieren una complejidad de cuidados, siendo el motivo fundamental de ingreso en residencias. Sin embargo, existen escasos estudios que evalúen la prevalencia de fragilidad en ancianos institucionalizados. En este sentido, es importante realizar un diagnóstico precoz de estas situaciones adversas, que pueden originar discapacidad o dependencia, manifestándose en la fragilidad del anciano. Objetivos: evaluar la influencia del ingreso en residencia de ancianos sobre la evolución de los factores que determinan la fragilidad. Validar un método de valoración de la fragilidad para estas personas, que pueda ser utilizado por todo el personal sanitario. Determinar la prevalencia de fragilidad atendiendo a los criterios del nuevo método.
An overview is given on the range of direct and indirect treatment interventions for swallowing problems. The therapist’s role in planning dysphagia interventions, screening, assessment, behavioural treatment and evaluation is elucidated. With emphasis on the multidisciplinary team, tasks and responsibilities of the phoniatrician are described. Basic principles of drug treatment in dysphagia are introduced, addressing pharmacological intervention for swallowing problems in degenerative neurological diseases and medications that potentially affect swallowing function. Botulinum toxin is presented as a treatment option of isolated cricopharyngeal dysfunction or upper oesophageal sphincter spasm. Oral, enteral and parenteral nutrition management in dysphagic patients is introduced in two parts. After a short overview on oral, enteral and parenteral nutrition management in dysphagic patients, the refeeding syndrome is described. Challenges in the production of texture-modified food in oropharyngeal dysphagia are presented in detail. Indications for surgical procedures in dysphagia are introduced, addressing specific organ structures, severe aspiration, swallowing disorders after radio-chemotherapy and percutaneous endoscopic gastrostomy (PEG). Indications and contra-indications of PEG and ethical issues are discussed. Tracheal tube management is described with a stepwise approach to rehabilitation of voice and swallowing. Complications of tracheal cannula usage are described. Causes and predictors of dysphagia in non-surgically treated patients with head and neck cancer are introduced, addressing inter alia the toxicity of radiotherapy. The incidence of aspiration and aspiration pneumonia, dysphagia stages according to swallowing phases and the multidisciplinary management of swallowing in this patient group are given. Prognostic aspects are discussed, considering oropharyngeal dysphagia in neurological disorders, after radio-chemotherapy for, or primarily surgically treated, ENT malignancies and other disorders.
Amaç: Yaşlı popülasyonun gün geçtikçe artış göstermesi birçok sorunu da beraberinde getirmektedir. Bu çalışmanın amacı huzurevinde yaşayan yaşlılarda bu sorunlardan biri olan sarkopeni riski ve malnütrisyon durumunu incelemek ve etkileyen faktörleri belirlemektir. Gereç ve Yöntem: Tanımlayıcı ve kesitsel tipte yapılan araştırma Haziran 2023-Ocak 2024 tarihleri arasında bir huzurevinde yaşayan 115 yaşlı ile yapıldı. Veriler yüz yüze görüşme tekniği ile Kişisel Bilgi formu, Mini Nütrisyonel Araştırma Formu Kısa ve Uzun Form (MNA), Sarkopeni Teşhisi İçin Basit Hızlı Anket (SARC-F)kullanılarak toplandı. Görüşmeler yaklaşık 30 dakika sürdü. Bulgular: Yaşlıların yaş ortalamasının 75,03±6,86 ve büyük çoğunluğunun erkek olduğu (%67,8) tespit edildi. Yaşlıların MNA kısa forma göre %51,3’ünün; MNA uzun forma göre %47,8’inin malnütrisyon riski veya malnütrisyonu olduğu; %63,5’inin ise sarkopeni açısından riskli olduğu belirlendi. Kronik hastalığı bulunan yaşlıların MNA kısa form puanı 10,75±2,32 iken kronik hastalığı bulunmayanların puanı 11,57±2,72 olarak tespit edildi (p
In the current era of immune therapy, lenvatinib (LEN) continues to be vital for treating unresectable hepatocellular carcinoma (uHCC) patients. This study investigates the importance of nutritional status in the prognosis of uHCC patients receiving LEN and evaluates a new prognostic scoring system that combines the geriatric nutritional risk index (GNRI) and systemic inflammatory response. From 2018 to 2022, 484 uHCC patients treated with LEN (384 males, median age 73). Prognostic value was compared between GNRI and C-reactive protein (CRP) scoring (GNRI-C score), GNRI, and neo-Glasgow prognostic score (neo-GPS). Evaluation was based on the Akaike information criterion (AIC) and concordance index(c-index). Median progression-free survival (mPFS) was 9.3/6.8/4.6 months for GNRI no-risk/low-risk/moderate-to-major risk (p < 0.01, AIC 4742.4/c-index 0.585). Median overall survival (mOS) was 27.8/15.2/9.5 months (p < 0.01, AIC 3433.34/c-index 0.639). For GNRI-C score, mPFS was 10.8/7.1/5.6/4.0 months (score 0/1/2/3) (p < 0.01, AIC 4732.82/c-index 0.6), while neo-GPS showed mPFS of 8.5/5.1/5.2 months (p < 0.01, AIC 4745.89/c-index 0.562). For mOS, GNRI-C score demonstrated 28.6/20.0/10.1/8.4 months (score 0/1/2/3) (p < 0.01, AIC 3420.27/c-index 0.652), while neo-GPS indicated 21.0/12.4/4.5 months (p < 0.01, AIC 3468.84/c-index 0.564). The newly devised GNRI-C score, incorporating nutritional and inflammatory markers, could offer improved prognostic predictions for uHCC patients treated with LEN.
There is growing recognition of the importance of managing sleep disorders in the elderly, particularly given their complexity within a multidimensional framework. The aim of the present study is to investigate whether sleep quality and daytime sleepiness are associated with the risk of falls in older adults.
This study included patients aged 75 years or older who were consecutively evaluated at the Geriatric Service, University Hospital of Monserrato, Cagliari, Italy. Participants underwent geriatric assessment, including sleep analysis using the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), as well as an assessment of risk of falls with Performance Oriented Mobility Assessment (POMA).
The study included 206 subjects, of whom 70.4% were women, with a median age of 83 years. A total of 141 participants (68.4%) had poor sleep quality, and 43 (20.9%) had excessive daytime sleepiness (EDS). Among people at high risk of falls, 85 participants had bad sleep quality, and 24 a satisfying one (χ2: 8.23, p = 0.0029); additionally, 77 participants did not exhibit daytime sleepiness, while 32 did (χ2: 9.03, p = 0.0027). To further explore these results, we designed logistic regressions, considering dichotomized PSQI and dichotomized ESS as independent variables, and dichotomized POMA as the dependent variable, and finally adjusted them for confounders. The adjusted model for PSQI yielded OR: 2.04 (95%CI 1.02–4.10), and the adjusted model for ESS yielded OR: 2.56 (95%CI 1.17–5.91).
Our study demonstrated that an increased estimated risk of falling is associated with poor sleep quality and EDS in older adults, independently of the confounders.
The rising burden of dementia calls for high-quality data on cognitive decline and dementia onset. The second wave of the Harmonized Diagnostic Assessment for the Longitudinal Aging Study in India (LASI-DAD) was designed to provide longitudinal assessments of cognition and dementia in India. All Wave 1 participants were recruited for a follow-up interview, and a refresher sample was drawn from the Longitudinal Aging Study in India, a nationally representative cohort of Indians aged 45 and older. Respondents underwent a battery of cognitive tests, geriatric assessments, and venous blood collection. Their health and cognitive status were also assessed through an interview with a close family member or friend. Clinical consensus diagnosis was made based on the Clinical Dementia Rating ® , and comprehensive data on risk factors of dementia were collected, including neurodegenerative biomarkers, sensory function, and environmental exposures. A total of 4635 participants were recruited between 2022 and 2024 from 22 states and union territories of India, accounting for 97.9% of the population in India. The response rate was 84.0%, and 71.5% of the participants provided venous blood specimen. LASI-DAD provides rich new data to study cognition, dementia, and their risk factors longitudinally in a nationally representative sample of older adults in India. Longitudinal cognitive data, together with longitudinally assessed biomarker data and novel data on sensory function and environmental exposures, provide a unique opportunity to establish associations between risk factors and biologically defined cognitive aging phenotypes.
Older adults make up about 1% of the population in the USA but represent nearly 40% of hospitalized adults and almost 50% of all health care dollars spent on hospitalization. The hospital is a very important setting for geriatrics teaching given that hospitalization is a high-risk time for older adults. For many older adults, hospitalization often results in complications, including functional, physical, and cognitive decline (Creditor, Ann Intern Med 118(3):219–223, 1993), that are unrelated to the inciting problem prompting hospital admission. The care that older adults receive during a relatively short hospital stay often have long-term impacts. This chapter addresses key teaching topics in the care for hospitalized older adults, including delirium, immobility, hospital-associated disability, pressure injuries, adverse drug events and medication errors, sleep disturbances, urinary retention and incontinence, constipation, malnutrition and dehydration, goals of care discussions, and discharge planning. Teaching rationale, concepts, and clinical teaching pearls during daily bedside rounds are provided.
Introduction
malnutrition and micronutrient deficiencies are pressing health concerns, particularly among the elderly. As this population is vulnerable to nutritional imbalances, understanding the prevalence and contributing factors is crucial for designing targeted interventions. This pilot study focuses on assessing the extent of these issues among elderly people attending a geriatric center in the University College Hospital, Ibadan.
Methods
this study employs a cross-sectional design, involving a sample of elderly individuals attending a geriatric center at the University College Hospital, Ibadan. Anthropometric measurements and dietary assessments were conducted using the Mini Nutritional Assessment (MNA) tool. A structured questionnaire was used to gather information on socio-demographic factors and other medical parameters. Continuous and categorical variables were compared respectively by Student’s t-test or Chi-square test respectively.
Results
in this study, findings indicated that none of the participants exhibited malnutrition. Instead, 72.7% demonstrated a normal nutritional status, while 27.3% were identified as being at risk of malnutrition. A lesser fraction had deficiency of vitamins A (10%) and D (1%). Furthermore, males aged 60-69 years and those above 80 years showed a higher likelihood of a favorable nutritional assessment compared to females.
Conclusion
the study revealed an absence of malnutrition among the elderly individuals attending the geriatric center in the University College Hospital, Ibadan. Notably, females had a higher probability of malnutrition compared to males. These findings underscore the importance of targeted nutritional interventions, especially among at-risk groups, to promote the overall well-being of this population.
Background and aims
Patients undergoing pancreatic resection are commonly malnourished. It is still unclear whether nutritional scores reliably predict postoperative outcomes after pancreatic resection. This study evaluated whether five commonly used preoperative nutritional screening scores predicted severe complications and length of stay.
Methods
Patients scheduled for pancreatic resection (pancreatoduodenectomy, distal and total pancreatectomy) at a national referral center for pancreatic surgery from September 2022 to June 2023 were prospectively screened for malnutrition with MNA, MUST, SGA, SNAQ, and NRS2002 scores. Postoperative complications were classified using the Clavien-Dindo classification. #NCT05608538.
Results
Three hundred patients were enrolled, including 168 pancreatoduodenectomies (56%), 102 distal pancreatectomies (34%), and 30 total pancreatectomies (10%). Final pathology revealed malignancy in 203 cases (67.7%). When applying the scores, the proportion of patients malnourished or at risk of malnutrition ranged from 21.7% for SGA to 79.3% for NRS2002. After adjusting for selected confounders, only an MNA <17 was associated with severe postoperative complications (OR 8.39, 95%CI[1.95 – 32.31], p=0.01). MNA, SGA, and SNAQ predicted the length of stay (all p<0.01), while MNA and SGA also correlated with a higher probability of having a greater heterogeneity in the length of stay (p=0.04 and 0.002, respectively).
Discussion
We promote using MNA to detect malnourished patients at risk of severe postoperative complications and longer hospitalization after pancreatic surgery. SGA and SNAQ may also have value in predicting patients who will be hospitalized longer. More prospective studies will be needed to corroborate these findings
Objectives
We aimed to evaluate clinical characteristics and outcomes of patients with head and neck squamous cell cancers (HNSCC) planned for chemoradiation enrolled in our geriatric clinic and the role of geriatric assessment (GA) in treatment decision-making.
Methods
Patients aged over 60 years with locally advanced HNSCC planned for chemoradiation referred to the geriatric clinic from 2018 to 2023 were identified from the clinic database.
Results
Of 164 patients identified, 36/148 (24.3%) patients were vulnerable in the domain of function and falls, 41/84 (48.8%) in comorbidities, 88/148 (55.4%) in nutrition, 35.148 (23.6%) in psychological, 6/87 (6.9%) in cognition, 25 (11.8%) in polypharmacy and 8 (5.4%) in social domains. 76 (51.4%) were frail, with 2 or more vulnerabilities.
35 (21.3%) patients were planned for radiotherapy alone, and 117 (71.3%) patients ultimately received chemoradiation. Decision on chemotherapy regimen was made awaiting GA in 99 (84.6%) patients. Among them, tentative chemotherapy regimen was changed after GA in 13 (13.1%) patients. 24-month OS was 64.7% (95% CI: 52.2%-80.3%). Factors significantly associated with poorer overall status (OS) were Eastern Cooperative Oncology Group performance status (PS) >=2 (hazard ratio (HR) 5.38, CI 2.39-12.1), vulnerability in nutrition (HR 2.52, CI 1.17-5.39), higher CARG score (HR 9.92, CI 3.91-25.16) and frailty (HR 10.51, CI 2.89-38.22). Factors impacting grade 3/4 toxicity included vulnerability in nutrition, higher CARG score and PS >=2.
Conclusion
71.3% patients planned for chemoradiation went on to receive concurrent chemotherapy after GA, with vulnerabilities in nutrition, frailty, performance status and CARG score being predictive for OS.
In 1979, 304 healthy elderly individuals in New Mexico were recruited for a longitudinal study of nutrition and aging. Repeat measurements on a yearly basis of commonly requested clinical chemistry analytes allowed the calculation of reference intervals, between and within-subject variance components, and percentiles for change in concentration between two yearly measurements. The latter was further divided into analytical and biological variance components. The upper 95th percentile for the difference between two yearly measurements, expressed as a percent of the population mean, ranged from 4% for Na+ to approximately 20% for total cholesterol and to greater than 90% for ferritin. Year-to-year differences attributable to the biological component ranged from a low of 2% of the population mean for Na+ to 70% for gamma-glutamyltransferase.
Nutritional assessment is a technique by which malnutrition can be identified. The importance of identifying malnourished patients has greatly increased in the recent past because of our increased ability to alter the nutritional state. Significant malnutrition remains a term which is difficult to define because it implies that nutritional intervention is mandated to improve clinical outcome.
The population of older Americans over 65, and particularly over 75 and 85 years of age, when daily activities affecting eating and food-getting are often compromised, is growing rapidly. Screening to identify risk factors to nutritional and general health, and further assessment and intervention for those who are found to be at risk is essential. The Nutrition Screening Initiative is a voluntary effort of several major health professional organizations focused on promoting better nutrition screening and nutritional care for our nation's elderly. This article describes some of the nutrition-related problems faced by older Americans. The progress of the Nutrition Screening Initiative is reviewed, and some simple steps to implement the Initiative's recommendations in physician offices and other health care settings serving older Americans are provided. By adopting and using the simple screening and assessment tools that are provided, or by developing individualized tools, the practicing physician can incorporate these essential components of comprehensive geriatric assessment into office practice. This will do much to alleviate remediable problems early, and to control or ameliorate those that cannot be prevented. Some useful supportive continuing medical education efforts, resources available, and measures that are being taken at the community level are summarized. A case study of some potential problems and how they might be alleviated is provided. Finally, some potential avenues in both the health and social services system for more effective interventions to deal with problems are identified.
In the search for a clinically useful nutritional index for use in a European context, we have translated an American nutritional assessment index - Subjective Global Assessment (SGA), and tested the modified translated version for validity and reliability in a Swedish setting. Judgements by an expert panel resulted in a mean agreement of 71% for clarity, 80% for content validity and 65% for internal consistency. Construct validity was demonstrated by the use of contrasting patient-groups (n = 20) and by 90% agreement with a medical expert as 'gold standard' for unknown patients (n = 20). Inter-rater reliability showed 75% agreement by 3 Registered Nurses (RNs) (n = 20). The individual Kappas for the raters varied from 0.68 to 0.89. The study showed difficulties experienced by raters in relating certain aspects in the SGA-index to normality. However, we concluded that a modified SGA-index translated from one language to another, with all the problems of cultural and idiomatic differences, can be of value for assessing and documenting pre-operative nutritional status of patients undergoing gastrointestinal surgery in a Swedish setting.