Low Body Mass Index and Low Serum Albumin Are Predictive Factors for Short-Term Mortality in Elderly Japanese Requiring Home Care

Abstract

Japan has a rapidly growing elderly population. The proportion of citizens aged 65 years and over was 22.1% in 2008, and is projected to as high as 27% by 2015 (Health and Welfare Statistics Association 2009). In accordance, elderly individuals requiring care are also increasing. To cope with this situation, the long term care service system was implemented in Japan in 2000. Since then, the number of elderly requiring care doubled from 2.2 to 4.4 million (Health and Welfare Statistics Association 2008).One of the important challenges for people requiring care is how to prevent a decrease in activities of daily living (ADL). To address this issue, we initiated the Yamato Study, a population-based study of individuals utilizing the long term care service system, to develop preventive methods for diminishing ADL levels (Nishiwaki et al. 2005(Nishiwaki et al. , 2007.Another critical risk for people requiring care is increased mortality. Kuzuya et al. (2006) demonstrated that decreased ADL is associated with higher mortality rates while Takeda (2004) showed that higher requisite care levels are associated with higher mortality rates. These studies suggest that ADL level is an important predictor of mortality in elderly requiring care. A number of studies targeting independent elderly people in the community have also indicated that body stature (Grabowski and Ellis 2001;Al Snih et al. 2007), muscle strength (Al Snih et al. 2002), and serum albumin levels (Sahyoun et al. 1996;Okamura et al. 2008) are significant predictors of mortality. To date, however, only a few studies have explored risk factors for mortality other than ADL in elderly people requiring care to date (Enoki et al. 2007a(Enoki et al. , 2007b. This study aimed to clarify multiple risk factors for two-year mortality through follow-up of the Yamato Study elderly cohort who utilize the long term care service system.

Ten-year all-cause mortality in hospitalized non-surgical patients based on nutritional status screening

“…Nevertheless, hypoalbuminaemia in our study was found to be associated with mortality as an independent predictor of death; each decrease in albumin by 1·0 g/l was associated with a 3 % increase in mortality (20) . Similar data have been shown in studies of patients with end-stage renal disease (21) , after hip fracture (22) or in frail elderly patients (23) . Malnutrition is commonly associated with certain diseases (24,25) , so we explored the prevalence of malnutrition estimated by SGA among the co-morbidities.…”

Serum albumin and health in older people: Review and meta analysis

“…In the elderly living in the community there is a clear association between albumin levels and long-term mortality (between 3 and 12 years) [13,33,[58][59][60][61]. However, in the elderly living in care homes albumin was associated to short-term mortality (1 year) but not to long-term mortality [13].…”

Association Between Activities of Daily Living and Mortality Among Institutionalized Elderly Adults in Japan

“…3 – 6 In Japan, several research groups have reported that low ADL levels are associated with high mortality in elderly populations. 3 , 7 – 12 However, these studies were conducted exclusively in community settings and not in institutional settings.…”