Depressive symptoms and nutritional status in the frail older adults

Chen, Chia Te; Tung, Heng Hsin; Chen, Yen‐Chin; Lee, Huan Fang; Wang, Chung Jen; Lin, Wei

doi:10.1016/j.archger.2019.03.023

Cited by 16 publications

(15 citation statements)

References 18 publications

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“…Comparatively, we hypothesized that the observed associations between comorbidity burden and malnutrition in many cross-sectional studies are driven through depression, thereby guiding the direction of arrows in our working DAG. This was supported by the results from a study in frail older adults, in which depression rather than comorbidity index was associated with malnutrition in multiple regression analyses [ 51 ]. This contrasts with earlier approaches which typically adjusted for comorbidities, admission diagnoses and length of hospital stay in examining the association between nutritional status and readmission, which in alternative analyses using the traditional approach for selection of variables would have nullified the association between malnutrition and 30-day readmission in our cohort.…”

Section: Discussionsupporting

confidence: 56%

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

2022

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Background Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods Consecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22–2.16), had poor oral intake (OR = 1.35, 95% CI 1.02–1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11–2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07–2.19), delirium (OR = 2.33, 95% CI 1.60–3.39) cognitive impairment (OR = 1.88, 95% CI 1.39–2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01–3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02–1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99–1.98). Conclusion The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Section: Discussionsupporting

confidence: 56%

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

2022

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“…Individuals in our study who were at risk of malnutrition had mild depressive symptoms in both countries, corroborating other ndings in Taiwan, which also signi cantly associated the risk of malnutrition with depressive symptoms, where similar scales were used to measure these aspects, however with elderly people considered fragile (39) . Our results may be associated with poor eating habits due to loss of appetite, which is aggravated by decreased food intake and lack of palatability and usually causes malnutrition with the risk of increased malnutrition when associated with depression (41) .…”

Section: Discussionsupporting

confidence: 90%

“…Portuguese individuals; of these, 16.5% exhibited food insecurity in association with the same variables (38) . Food insecurity is characterized as an individual who has a limited or uncertain possibility of acquiring food in a socially acceptable way or when the availability of food is compromised in relation to nutritional adequacy and safety (39) . Thus, these factors may have contributed to the highest percentage of participants with poor nutritional status found in the two groups in our study.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Nutritional Deficit and the Presence of Depressive Symptoms: Comparative Study Between Elderly Brazilians and Portuguese in Primary Health Care

Toscano¹,

Cavalcante²,

Torres³

et al. 2020

Preprint

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Background: Among the countless diseases that affect the world population, malnutrition has stood out in several social and demographic contexts; among them, there has been an exponential progression in elderly people, a population group that presents a strong tendency to develop depression and malnutrition. Data from the World Health Organization show that the worldwide prevalence of depressive disorders among elderly people is in the range of 10 to 20%. Similarly, the prevalence of depression, in turn, combined with chronic diseases, accounts for 50% of premature mortality.Objective: To compare the nutritional status and the level of depressive symptoms and to evaluate the correlation between both aspects in Brazilian and Portuguese elderly people assisted in Primary Health Care (PHC).Methods: A cross-sectional, comparative study with a quantitative approach conducted among PHC elderly people in Brazil and Portugal. The sociodemographic and health questionnaire, Mini-Mental State Examination (MMSE), Geriatric Depression scale (GDS-15) and Mini-Nutritional Assessment (MNA) were used.Results: We included 160 participants (110 Brazilians and 50 Portuguese) in the study. In this sample, 81.9% of participants had a risk of malnutrition or malnutrition and 45.0% of participants had mild depressive symptoms. There was a significant association and correlation in Brazil with the presence of a risk of malnutrition and mild symptoms of depression. Portugal also demonstrated a significant association, however, for the chance of not presenting alterations.Conclusion: Our research showed that the risk of malnutrition or the presence of malnutrition was associated with the presence of depressive symptoms in the studied sample. In the intergroup comparison, among Brazilians, those at risk of malnutrition were more likely to have changes associated with depression, while for participants in Portugal, the odds ratio tended to show no changes, as the majority were individuals without nutritional or depressive demands. Screening and prevention measures should be emphasized in PHC to avoid the progression of symptoms in order to refer patients with medium and high complexity since this segment of the public is susceptible to malnutrition and depression.

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“…Comparatively, we hypothesized that the observed associations between comorbidity burden and malnutrition in many cross-sectional studies are driven through depression, thereby guiding the direction of arrows in our working DAG. This was supported by the results from a study in frail older adults, in which depression rather than comorbidity index was associated with malnutrition in multiple regression analyses (43). This contrasts with earlier approaches which typically adjusted for comorbidities, admission diagnoses and length of hospital stay in examining the association between nutritional status and readmission, which in alternative analyses using the traditional approach for selection of variables would have nulli ed the association between malnutrition and 30-day readmission in our cohort.…”

Section: Discussionsupporting

confidence: 69%

Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

Tay

Chua

Ding

2022

Preprint

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Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Depressive symptoms and nutritional status in the frail older adults

Cited by 16 publications

References 18 publications

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

Correlation Between Nutritional Deficit and the Presence of Depressive Symptoms: Comparative Study Between Elderly Brazilians and Portuguese in Primary Health Care

Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

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