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

Abstract

Malnutrition leads to poor prognoses, including a predisposition to falls. Few studies have investigated the relationship between malnutrition and falls during hospitalization. This study aimed to determine malnutrition’s association with falls during hospitalization. A retrospective observational study was conducted. Patients aged ≥65 years that were admitted to and discharged from a university hospital between April 2018 and March 2019 were examined. Patients with independent basic activities of daily living were included. Diagnosis of malnutrition was based on the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria at admission. Disease information such as the Charlson Comorbidity Index (CCI) and reasons for hospitalization were reviewed. Kaplan–Meier curve and multivariate Cox regression analyses were performed. Data from 6081 patients (mean age: 74.4 ± 6.1 years; males: 58.1%) were analyzed. The mean CCI was 2.3 ± 2.8 points. Malnutrition was detected in 668 (11.0%) and falls occurred in 55 (0.9%) patients. Malnourished patients experienced a higher fall rate than those without malnutrition (2.4% vs. 0.7%, log-rank test p < 0.001). In multivariate analysis, malnutrition had the highest hazard ratio for falls among covariates (hazard ratio 2.78, 95% confidence interval 1.51–5.00, p = 0.001). In conclusion, malnutrition at the time of admission to hospital predicts in-hospital falls.

Nutritional Status Is Associated with Function, Physical Performance and Falls in Older Adults Admitted to Geriatric Rehabilitation: A Retrospective Cohort Study

“…A lower MNA-SF score at admission was also associated with increased risk of being a faller in orthogeriatric patients. Our results also confirm the relationship between nutritional status and falls in orthogeriatric patients in other clinical settings [ 28 , 29 ]. A fall represents an adverse outcome that could influence the rehabilitation process with worse functional recovery, increasing the length of stay and reducing the probability of being discharged at home [ 52 ].…”

“…Malnutrition is also related to higher incidence of falls and risk of falling in hospitalized and community-dwelling older adults [ 28 , 29 ]. These events can lead to many adverse consequences in this population, such as functional decline, increased morbidity and even death [ 30 , 31 ].…”

Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management

“…In particular, the risk of falls increases up to 8.4% and 6.2% in geriatric and internal medicine wards, respectively, and the global fall rate rises up to 31.6% up to 39.5% in patients ≥80 years [65]. Old patients with malnutrition and independent activities of daily living (ADL) were recently reported with a 2.7 higher risk of in-hospital falls [66]. In a 5-year observational study, malnourished patients showed an 8-times higher risk of harmful falls during hospitalization as compared to well-nourished patients [67].…”

Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan

“…2,26 Although many clinical studies in Japanese individuals have reported an association of ESPEN criterion malnutrition with clinical outcomes, no report has examined whether the cut-offs for BMI and lean body mass index, components of the ESPEN criterion malnutrition diagnosis, are optimal cut-offs for Japanese people. [27][28][29] GLIM-defined malnutrition requires the presence of phenotypic and etiologic criteria, whereas ESPEN-defined malnutrition does not involve etiologic factors. Further studies must be carried out to determine the validity of GNRI <96 points in diagnosing GLIM-defined malnutrition.…”

“…Second, we only used the ESPEN criteria in diagnosing malnutrition, although the latest diagnostic criteria from GLIM had been published 2,26 . Although many clinical studies in Japanese individuals have reported an association of ESPEN criterion malnutrition with clinical outcomes, no report has examined whether the cut‐offs for BMI and lean body mass index, components of the ESPEN criterion malnutrition diagnosis, are optimal cut‐offs for Japanese people 27–29 . GLIM‐defined malnutrition requires the presence of phenotypic and etiologic criteria, whereas ESPEN‐defined malnutrition does not involve etiologic factors.…”