In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub “Malnutrition in the Elderly (MaNuEL),” a model of “ D eterminants o f M alnutrition in A ged P ersons” (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

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Aims To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. Design A secondary analysis of cross‐sectional data from the years 2012–2016. Methods The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. Results Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high‐risk group for the co‐occurrence of dysphagia and risk of malnutrition. Conclusions Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. Impact What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care.

Despite the significant impact of malnutrition in hospitalised patients, it is often not identified by clinical staff in daily practice. To improve nutritional support in hospitals, standardised routine nutritional screening is essential. The Graz Malnutrition Screening (GMS) tool was developed for the purpose of malnutrition risk screening in a large hospital setting involving different departments. It was the aim of the present study to validate the GMS against Nutritional Risk Screening (NRS) and Mini Nutritional Assessment-short form (MNA-sf) in a randomised blinded manner. A total of 404 randomly selected patients admitted to the internal, surgical and orthopaedic wards of the University Hospital Graz were screened in a blinded manner by different raters. Concurrent validity was determined by comparing the GMS with the NRS and in older patients (70+ years) with the MNA-sf additionally. According to GMS, 31·9 or 28·5 % of the admitted patients were categorised as at ‘risk of malnutrition’ (depending on the rater). According to the reference standard of NRS, 24·5 % of the patients suffered from malnutrition. Pearson’s r values of 0·78 compared with the NRS and 0·84 compared with the MNA showed strong positive correlations. Results of accuracy (0·85), sensitivity (0·94), specificity (0·77), positive predictive value (0·76) and negative predictive value (0·95) of GMS were also very high. Cohen’s κ for internal consistency of the GMS was 0·82. GMS proves to be a valid and reliable instrument for the detection of malnutrition in adult patients in acute-care hospitals.

This study demonstrates that a very strong association exists between dysphagia and malnutrition as well as high levels of care dependency and dependency in activities of daily living. Nearly one-quarter of the patients did not receive any nutritional intervention. Therefore, a potential for the improvement of nutritional therapy in older dysphagic hospitalized patients still exists.

Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review" found on pages 33-41, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the geriatric syndrome of sarcopenia. 2. Identify the outcome of the sarcopenia studies. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Sarcopenia is an important geriatric syndrome with high prevalence rates and one of the most common causes of reductions in mobility, quality of life, and increasing dependency on care. The current study examined the relationship between sarcopenia and nutritional status in adults 60 and older. A systematic literature search was conducted, and data from 33 publications were included. The currently available literature indicates that sarcopenia is correlated with poor nutritional status (e.g., low body mass index, unfavorable nutritional risk screening results, decreased nutritional laboratory parameters, anorexia). Comparison of the studies' results were complicated by the lack of a generally accepted definition for sarcopenia, as well as the use of many different instruments to detect sarcopenia. The co-occurrence of malnutrition and sarcopenia is of great relevance. Future scientific work should focus on the formation of consistent def...

Malnutrition risk screening is essential for the adequate identification and treatment of malnourished hospitalised patients. The aim of this study was to determine the effect of the use of an electronic malnutrition screening tool on the knowledge, attitudes and perceived practices (KAP) of a pool of nurses, nurses' aides and physicians. A controlled study using a pre-test-post-test design was carried out in two Austrian hospitals. The hospital that was assigned to the intervention group used the Graz malnutrition screening tool. The hospital that was assigned to the control group received no intervention. To collect data, a questionnaire was filled out by the study participants at baseline (T0) and 1 month after the implementation (T1) to assess KAP. All data were analysed using descriptive statistics, χ 2 tests, Wilcoxon signed-rank tests and Student's t tests. A total of 269 nurses, nurses' aides and physicians participated in the study and completed the questionnaires at T0, and 190 people at T1. The sum score for the KAP questionnaire changed significantly after the implementation of the malnutrition screening tool in the intervention group (P<0·001), but not in the control group. The use of a valid and reliable malnutrition screening tool effectively improved the KAP of healthcare staff. The KAP described here are essential for providing successful nutritional care in malnourished patients, and improving these factors may result in improved patient outcomes. To attain these outcomes, stakeholders, as well as members of all professions involved in multidisciplinary nutritional care, must invest significant efforts.