Pre-fracture nutritional status is predictive of functional status at discharge during the acute phase with hip fracture patients: A multicenter prospective cohort study. Changes in nutritional and functional status in longer stay patients admitted to a geriatric evaluation and management unit The evolution of nutritional status of geriatric patients without cachexia is associated with food intake in sub-acute care Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery Hypovitaminosis D and 'functional hypoparathyroidism'-the NoNoF (Nottingham Neck of Femur) study. Hypoalbuminemia 3 months after hospital discharge: significance for long-term survival. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. Texture‐modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study Nutrition Screening in Geriatric Rehabilitation: Criterion (Concurrent and Predictive) Validity of the Malnutrition Screening Tool and the Mini Nutritional Assessment-Short Form. Evidence that albumin is not a suitable marker of body composition-related nutritional status in elderly patients. Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes. Protein Intake and Disability Trajectories in Very Old Adults: The Newcastle 85+ Study
BACKGROUND & AIMS Malnutrition is common in patients with hip fractures , and elderly patients with hip fractures lose functional independence and often fail to recover previous functional status . The aim of this study was to determine whether pre-fracture nutritional status predicts functional status of patients with hip fracture at discharge from acute hospitals . METHODS In the present multicenter prospect i ve cohort study , pre-fracture nutritional status was assessed using the  Mini Nutritional Assessment Short-Form ( MNA-SF ) . At discharge from acute hospitals , functional status was evaluated using a functional independent measurement instrument  ( FIM ) . Subsequently , multiple regression analyses were performed using FIM as the dependent variable and MNA-SF as the independent variable . RESULTS Among the 204 patients analyzed in the present study , the  mean length of hospital stay was 26.2 ± 12.6 days , and according to MNA-SF assessment s , 51 ( 25.0 % ) patients were malnourished , 98 ( 48.0 % ) were at risk of malnutrition , and 55 ( 27.0 % ) were well-nourished before fracture . At discharge , FIM scores were higher in patients who were well-nourished than in those who were malnourished or were at risk of malnutrition ( p < 0.01 ) . After adjustment for confounding factors , multiple regression analyses showed that MNA-SF was a significant independent predictor for FIM at discharge ( well-nourished vs. malnourished , β = -0.86 , p < 0.01 ) . CONCLUSIONS Pre-fracture nutritional status was a significant independent predictor for functional status at discharge during the acute phase , warranting early assessment of nutritional status and early intervention for successful postoperative rehabilitation Objectives Malnutrition and functional decline are common in older in patients admitted to subacute care setting s. However the association between changes in nutritional status and relevant functional outcomes remains under- research ed . This study examined changes in nutritional status , function and mobility in patients admitted to a Geriatric Evaluation and Management ( GEM ) unit who had a length of stay ( LOS ) longer than 21 days . Design A prospect i ve , observational study . Setting Two GEM units at St Vincent ’s Hospital Melbourne , Australia . Participants Patients admitted to the GEM units who stayed longer than 21 days were included in the study . Measurements Patients were assessed on admission and prior to discharge using the  Subjective Global Assessment ( SGA ) , Functional Independence Measure ( FIM ) motor domain and the Modified Elderly Mobility Scale ( MEMS ) . Results Fifty-nine patients ( Mean age 84.0 ± 7 years ) met the required length of stay and were included in the study . Fifty-four per cent ( n=32 ) were malnourished on admission ( SGA B/C ) and 44 % ( n=26 ) were malnourished on discharge . Twenty-two per cent ( n=13 ) improved SGA category , 75 % remained stable ( n=44 ) and 3 % deteriorated ( n=2 ) from admission to discharge . Total Motor FIM scores significantly increased from admission to discharge in both the improved ( p<0.001 ) and stable or deteriorated ( p<0.001 ) nutritional status groups . Subjects who improved in nutritional status had a significantly higher MEMS score at discharge ( p<0.001 ) . Conclusion On admission to the GEM unit , just over half the included patients were rated as malnourished defined by SGA category . Nearly one quarter of the sample had improved their nutritional status at the time of discharge . Improvement in nutritional status was associated with greater improvement in mobility scores . Further studies are required to investigate the effectiveness of nutrition interventions , which will inform models of care aim ing to optimise nutritional , functional , and associated clinical outcomes in patients admitted to GEM units Objectives To determine if changes in patients ’ nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for . Design Prospect i ve study .SubjectsA total of 32 non-cachectic patients ( 21 women ; 65–92y ) . Methods Nutritional status was evaluated at admission and discharge using the  Protein-Energy Malnutrition Index which includes BMI , % IBW , TS , MAC , albumin , hemoglobin and lymphocyte count . Food intake was assessed 3 meals/day every other day for an average of 46.2 ± 14.6 meals/participant . Results In all , 47 % of the study sample was malnourished at admission . Nutritional status improved in 73 % of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission . Total energy intake correlated with improvements in BMI , % IBW and total lymphocyte count ( all p < 0.04 ) . Improvement in PEMI score for the whole group was associated with functional status ( p < 0.05 ) . Controlling for this variable , energy ( kj/kg body weight ) and protein ( g/kg body weight ) intakes correlated positively with improvements in BMI , % IBW and MAC ( Energy : partial r = 0.644 , 0.624 , 0.466 respectively ; Protein : partial r = 0.582 , 0.554 , 0.433 respectively ; all p < 0.05 ) . Conclusions Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for , st and ard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay Purpose . To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models . Methods . Analytical cross-sectional study arising from baseline assessment s from 107 subjects drawn from a r and omised controlled trial of community rehabilitation service delivery models .  Setting . A community rehabilitation team based in Brisbane , Queensl and , Australia . Measures . Primary outcome variables include quality of life ( EQ-5D & VAS ) and Carer Strain Index . Predictor variables include participation in functional activities , history of falls , number of medications , number of co-morbidities , depression , environmental hazards , physical function and nutrition . Association between variables assessed using linear regression . Results . Major factors contributing to reduced quality of life were having reduced participation in daily activities , depression , and having poor vision . Having poor nutrition and no longer driving also contributed to poor quality of life . The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person . Conclusions . Community rehabilitation services working with older population s must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain BACKGROUND calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss , with an enhanced risk of osteoporotic fractures . Although hip fractures are a serious consequence , few therapeutic measures are given for primary or secondary prevention . A combination of calcium and vitamin D may not be the most effective treatment for all patients . OBJECTIVE to investigate the effects of hypovitaminosis D on the calcium-parathyroid hormone endocrine axis , bone mineral density and fracture type , and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients . DESIGN a population -based , prospect i ve cohort study . METHODS 150 elderly subjects were recruited from the fast-track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture . This ward accepts people who live at home and are independent in activities of daily living . All subjects had a baseline medical examination , biochemical tests ( parathyroid hormone ,  25-hydroxyvitamin D  and  1,25-dihydroxyvitamin D ) and were referred for bone densitometry . RESULTS at 68 % , the prevalence of hypovitaminosis D ( 25-hydroxyvitamin D<30 nmol/l ) was high . However , only half the patients had evidence of secondary hyperparathyroidism , the rest having a low to normal level of parathyroid hormone ( ' functional hypoparathyroidism ' ) . Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium , higher 1,25-dihydroxyvitamin D , lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ' functional hypoparathyroid ' group ( P<0.01 ) . CONCLUSION there is a high prevalence of hypovitaminosis D in active , elderly people living at home who present with a hip fracture . However , secondary hyperparathyroidism occurs in only half of these patients . This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover , leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures .  Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients , but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ' vitamin D-replete ' subjects needs further evaluation OBJECTIVES To determine change in albumin from hospital discharge to 3-month follow-up and the prognostic significance of persistent hypoalbuminemia in older veteran patients . DESIGN A prospect i ve cohort study . SETTING A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital . PARTICIPANTS The study population consisted of 282 subjects ( of 322 r and omly selected discharges who were free of cancer and terminal conditions ) that completed the 90-day postdischarge assessment ; most were older ( 75.4+/-8.6 ) , white ( 76 % ) , and male ( 99 % ) . MEASUREMENTS Each subject completed a comprehensive discharge assessment , had a repeat albumin an average of 94 days later , and was then tracked for 5 years . The strongest predictors of survival were identified using Cox proportional hazards regression analysis . RESULTS Between hospital discharge and the 3-month re assessment , albumins improved by more than 2 g/L in 122 subjects ( 43 % ) , stayed the same in 112 subjects ( 40 % ) , and deteriorated by more than 2 g/L in the rest . During follow-up , 190 subjects ( 67 % ) died . Of the 38 nutritional , functional , demographic , and illness severity variables evaluated , the 3-month postdischarge albumin was the strongest predictor of long-term mortality . Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater ( relative risk=2.6 , 95 % confidence interval=1.8 - 3.8 ) . After controlling for 3-month albumin , hospital-discharge albumin was not significantly associated with long-term mortality . CONCLUSION In older people , a low serum albumin 3 months after hospital discharge is associated with a poor long-term prognosis . It is not known whether this represents ongoing inflammation or inadequate nutrition OBJECTIVE To investigate the association between nutritional status and rehabilitation outcome in elderly in patients with hospital-associated deconditioning . DESIGN A prospect i ve cohort study . SUBJECTS/ PATIENTS One hundred sixty-nine consecutive elderly in patients diagnosed with hospital-associated deconditioning . METHODS Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center . Body mass index , haemoglobin , albumin , total lymphocyte count , C-reactive protein , cause of malnutrition , and feeding route were also investigated . Primary outcome was Barthel Index score at discharge . RESULTS A total of 148 patients ( 87.6 % ) were malnourished , and 21 were at risk for malnutrition . There were no patients with normal nutritional status . Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition . Chronic disease-related malnutrition , oral intake , and parenteral nutrition were associated with the Barthel Index score at discharge . There were significant correlations between the Barthel Index score at discharge and nutritional score , albumin , and total lymphocyte count . In multiple regression analysis , Mini Nutritional Assessment Short Form , albumin , and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge . CONCLUSION Most elderly in patients with hospital-associated deconditioning are malnourished . Nutritional status , albumin , and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning AIM Texture-modified diets ( TMD ) have significantly lower energy and protein content than normal diets . Therefore , TMD can cause malnutrition and loss of muscle mass . However , few studies have reported the relationship between TMD and decreased skeletal muscle mass . The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass . METHODS We review ed data of 188 older adult patients who were admitted to a rehabilitation hospital . TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation . The Mini Nutritional Assessment -Short Form was used to assess nutritional status ;  dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index , and the cut-off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia ; the Functional Independence Measure was used to evaluate activities of daily living . RESULTS The patients ' mean age was 80.6 ± 7.5 years , and 62 % were women . A total of 22 patients ( 11.7 % ) consumed TMD . A total of 104 patients ( 55.3 % ) had decreased skeletal muscle mass , and approximately 90 % of them consumed TMD . Decreased skeletal muscle mass index ( odds ratio 7.199 , 95 % confidence interval 1.489 - 34.805 , P ≤ 0.01 ) and Functional Independence Measure scores ( odds ratio 0.972 , 95 % confidence interval 0.952 - 0.992 , P ≤ 0.01 ) were independently related to TMD in the multivariate analysis . CONCLUSIONS The TMD group was associated with decreased skeletal muscle mass . Future , prospect i ve studies are necessary to investigate causality . Geriatr Gerontol Int 2018 ; 18 : 698 - 704 Background / Objectives : This study aim ed to assess the association between risk of malnutrition and 7-year mortality , controlling for functional ability , socio-demographics , lifestyle behavior and diseases , and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality . Subjects/ Methods : A longitudinal study on home-living and special-housing residents aged ⩾60 years was conducted . Of 2312 r and omly invited participants , 1402 responded and 1203 provided information on both nutritional status and functional ability . The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure ( BMI , MAC and CC ) below cut-off in addition to the presence of at least one subjective measure ( decreased food intake , weight loss and eating difficulty ) . Results : At baseline , 8.6 % of subjects were at risk of malnutrition and during the 7-year follow-up 34.6 % subjects died . The risk of malnutrition was independently associated with 7-year mortality ( hazard ratio ( HR ) 1.84 , 95 % confidence interval ( CI ) 1.28–2.65 ) . Additional independent predictors were dementia ( HR 2.76 , 95 % CI 1.85–4.10 ) , activity of daily living ( ADL ) dependence ( HR 2.08 , 95 % CI 1.62–2.67 ) , heart disease ( HR 1.44 , 95 % CI 1.16–1.78 ) , diabetes ( HR 1.41 , 95 % CI 1.03–1.93 ) and older age ( HR 1.09 , 95 % CI 1.07–1.10 ) . Moreover , the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate ( 18.7 % , P<0.001 ) . Conclusions : The risk of malnutrition significantly increases the risk of mortality in older people .  Moreover , risk of malnutrition and ADL dependence together explain a significantly poorer survival rate ; however , the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality BACKGROUND Nutrition screening is required for early identification and treatment of patients at risk for malnutrition so that clinical outcomes can be improved and health care costs reduced . OBJECTIVE To determine the criterion ( concurrent and predictive ) validity of the Malnutrition Screening Tool ( MST ) and Mini Nutritional Assessment -Short Form ( MNA-SF ) in older adults admitted to inpatient rehabilitation facilities . DESIGN Observational , prospect i ve cohort . PARTICIPANTS / SETTING Participants were 57 adults aged 65 years and older ( mean±st and ard deviation age=79.1±7.3 years ) from two rural rehabilitation units in New South Wales , Australia . MAIN OUTCOME MEASUREMENTS MST ; MNA-SF ; International Statistical Classification of Diseases and Health Related Problems , 10th revision , Australian Modification ( ICD-10-AM ) classification of malnutrition ; rehospitalization ; admission to a residential aged care facility ( institutionalization ) ; and discharge location . STATISTICAL ANALYSIS PERFORMED Measures of diagnostic accuracy with 95 % CIs generated from a contingency table , Mann-Whitney U test , and χ(2 ) test . RESULTS When compared with the ICD-10-AM criteria , the MST showed stronger diagnostic accuracy ( sensitivity 80.8 % , specificity 67.7 % ) than the MNA-SF ( sensitivity 100 % , specificity 22.6 % ) . Neither the MST nor the MNA-SF was able to predict rehospitalization , institutionalization , or discharge location . CONCLUSIONS The MST showed good concurrent validity and can be considered an appropriate nutrition screening tool in geriatric rehabilitation . The MNA-SF may overestimate the risk of malnutrition in this population . The predictive validity could not be established for either screening tool OBJECTIVE Serum albumin has long been used in clinical practice as a marker of protein-energy undernutrition , but very few studies have focused on its relation with dual-energy X-ray absorptiometry-assessed lean mass measurements , which is the current reference method in routine for body composition-related nutritional status . Serum albumin concentration is also affected by non-nutrition-related factors , and there is published evidence on the relation between serum albumin concentration and morbidity/mortality in the elderly . This study was design ed to examine the relationship between serum albumin and lean mass and nutrition-related risk of morbidity/mortality in geriatric patients . Our objective was to clarify whether serum albumin in geriatric patients is a marker of body composition-related nutritional status , risk of morbidity/mortality , neither , or both . METHODS This prospect i ve study enrolled 125 elderly patients hospitalized in a rehabilitation unit [ 83.8 ( SD 7.7 ) y ] . Subjects were evaluated for  serum albumin concentration and nutritional status at admission [ body mass index , lean mass , appendicular skeletal muscle mass index , and body cell mass index ( calculated as the ratio of the mass to the square of the height ) , evaluated by dual-energy X-ray absorptiometry combined with bioelectrical impedance analysis ] . Outcome scores were assessed 6 mo later , taking into account complications ( pressure ulcers and /or infections ) and 6-mo mortality . RESULTS Serum albumin concentration was not correlated with the lean mass , appendicular skeletal muscle mass , or body cell mass indexes . Serum albumin concentration was , however , correlated with outcome score ( r = 0.22 , P = 0.02 ) . CONCLUSION This study clearly demonstrates that albumin is not suitable as a marker of body composition in elderly patients Purpose : To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture . Method : Prospect i ve study in a hospital geriatric rehabilitation unit . Sixty-one consecutive patients were studied : 28 with cognitive impairment ( age 87.6 ± 7.2 years , Mini Mental State Examination ( MMSE ) score 11.25 ± 5.9 ) , 23 with possible cognitive impairment ( age 83.9 ± 6.8 years , MMSE 22.65 ± 1.6 ) and 10 without cognitive impairment ( age 77.6 ± 7.4 years , MMSE 29.5 ± 0.9 ) . Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure ( FIM ) . Functional gain was calculated by absolute FIM gain ( admission FIM minus discharge FIM ) , relative ( to maximum potential ) FIM gain with the Montebello Rehabilitation Factor Score ( MRFS ) and analysis of covariance of the FIM ( ANCOVA ) . Results : Patients without cognitive impairment had significantly higher admission FIM and discharge FIM . Cognitive status was not significantly associated with absolute functional gain . The adjusted ( age , gender , sensory impairment , nutritional status , comorbidity and treatment ) MRFS score of cognitively impaired patients was significantly lower ( p < 0.03 ) . However , the functional gain related to baseline functional status ( ANCOVA ) was not significantly different between the groups . Conclusions : In spite of cognitive impairment , elderly patients with hip fracture can benefit from participation in rehabilitation programmes OBJECTIVES To determine the prevalence of under-nutrition using brief screening methods and to determine the relation between these results and ( 1 ) those of a more st and ard nutritional assessment and ( 2 ) discharge outcomes . DESIGN Prospect i ve study . SUBJECTS 65 ( 21 males ) patients older than 65 years . SETTING Sub-acute care facility . MEASUREMENTS The  Mini Nutritional Assessment , st and ard nutritional assessment , ' rapid screen ' and discharge outcome .  RESULTS The prevalence of under-nutrition was high , ranging from 35.4 % to 43.1 % , depending on the screening method used . Compared to the st and ard nutritional assessment the ' rapid screen ' consisting of ( 1 ) body mass index < 22 kg/m(2 ) ; and /or ( 2 ) reported weight loss of > 7.5 % over the previous 3 months and the two-tiered Mini Nutritional Assessment process ( at risk subjects ( 46 % of total ) further evaluated using st and ard nutritional assessment ) had sensitivities of 78.6 and 89.5 % and specificities of 97.3 and 87.5 % respectively in diagnosing under-nutrition . Under-nourished patients  as identified by the st and ard nutritional assessment ( 50.0 % ( under-nourished ) versus 21.6 % ( nourished ) ; P = 0.017 ) , the two-tiered Mini Nutritional Assessment process ( 50.0 % ( under-nourished ) versus 21.6 % ( nourished ) ; P = 0.017 ) and the rapid screen ( 56.5 % ( under-nourished ) versus 21.4 % ( nourished ) ; P = 0.004 ) were more likely to be discharged to an acute hospital or an accommodation with increased support ( poor discharge outcomes ) than nourished patients . CONCLUSION All screening methods identified patients more likely to have a poor discharge outcome . The highly specific but less sensitive ' rapid screen ' may be the best method in facilities with limited re sources as it can be easily incorporated into nursing/medical admissions and avoids biochemical investigations in all patients . The more sensitive two-tiered Mini Nutritional Assessment is better if re sources permit Objectives To determine whether protein intake is associated with  better disability trajectories in the oldest adults ( ≥85 ) and whether muscle mass and muscle strength would partially mediate this . Design Prospect i ve cohort study . Setting Newcastle‐upon‐Tyne and North Tyneside , United Kingdom . Participants Community‐dwelling older adults aged 85 at baseline ( N=722 ) . Methods Protein intake was estimated using two 24‐hour multiple‐pass recalls at baseline . Disability was measured as difficulty performing 17 activities of daily living at baseline and 18 , 36 , and 60 months . Trajectories were derived using mortality‐adjusted group‐based trajectory modelling . The effect of protein intake  ( g/kg of adjusted body weight (aBW)/d ) on disability trajectories was examined using multinomial logistic regression . Results Participants had 4 distinct disability trajectories ( between the ages of 85 and 90 : constant very low ( AT1 ) , mild ( AT2 ) , moderate ( AT3 ) , and severe ( AT4 ) . Each unit increase in protein ( g ) per kg of aBW/d was associated with greater odds of AT1 ( odds ratio ( OR=7.97 , 95 % confidence interval (CI)=1.96–32.43 , p = .004 ) and AT2 ( OR=3.28 , 95 % CI=1.09–9.87 , p = .03 ) than of AT4 over 5 years in models adjusted for selected covariates . Participants with protein intake of 1.0 g/kg aBW/d or more were more likely to belong to AT1 ( OR=3.65 , 95 % CI=1.59–8.38 , p = .009 ) and AT2 ( OR=2.12 , 95 % CI=1.16–3.90 , p = .01 ) than to AT4 . Conclusion  Higher  protein intake , especially 1.0 g/kg aBW/d or more , was associated with better disability trajectories in the oldest adults . These findings will inform new dietary strategies to support active , healthy ageing . J Am Geriatr Soc 67:50–56 , 2019
This systematic review and meta- analysis aims to characterize the nutritional status of  geriatric rehabilitation patients and its association with functional parameters .
Malnutrition is prevalent in a relevant percentage of geriatric rehabilitation patients , whereas body mass index ( BMI ) is in the normal to overweight range .
Furthermore , data suggest that protein and energy intake is reduced and vitamin D deficiency is prevalent in this population .
Nutritional status is reduced in a relevant percentage of geriatric rehabilitation patients and associated with decreased physical function which emphasizes the need for screening and targeted interventions .
Since there is only limited evidence available for geriatric rehabilitation patients , this systematic review and meta- analysis aims to characterize the nutritional status in this population and its relationship with functionality .