Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

Abstract

Background Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients. Methods The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases). Results The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate). Conclusions In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.

Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis

“…3 Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength, 12,20 with a risk of adverse outcomes such as physical disability, poor quality of life, and death. 12,13,21 Muscle mass and strength were associated with developing geriatric conditions and poorer cognition at hospital admission, 22,23 and predictive for difficulties in performing activities of daily living, 24 falls, 25,26 and mortality 26 3 months after discharge. Sarcopenia is now recognized by the WHO as a muscle disease with an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis code M62.…”

Malnutrition at Admission Predicts In-Hospital Falls in Hospitalized Older Adults

“…In addition, patients admitted to acute care hospitals may develop malnutrition due to inflammation caused by acute or chronic illness [13], decreased activity [8], or decreased nutrition intake [14]. Malnutrition often results in low skeletal muscle mass and low muscle strength, which increases the risk of falling [15][16][17]. In turn, the risk of falling may be related to adverse effects on patient outcomes, quality of life, and increased medical costs.…”

Reduced Handgrip Strength in Hospital Admission Predicts Prolonged Hospital Stay and Death but Is Not Accurate to Identify Malnutrition: A Longitudinal Study of Reduced Handgrip Strength in Hospitalized Patients

“…The sample size calculation was performed according to the difference in the survivor and nonsurvivor HGS values in the study conducted by Reijnierse et al 23 (26.5 ± 6.06 vs 25.0 ± 5.66 kg), considering 80% power and 5% significance level, with an additional 20% for potential losses and adjustments in multivariate analysis, resulting in 480 patients.…”