Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Trevisan, Caterina; Crippa, Alessio; Ek, Stina; Welmer, Anna-Karin; Sergi, Giuseppe; Maggi, Stefania; Manzato, Enzo; Bea, Jennifer W.; Cauley, Jane A.; Decullier, Évelyne; Hirani, Vasant; LaMonte, Michael J.; Lewis, Cora E.; Schott, Anne-Marie; Orsini, Nicola; Rizzuto, Debora

doi:10.1016/j.jamda.2018.10.027

Cited by 75 publications

(66 citation statements)

References 70 publications

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“…This means that hospitalized patients who are aged ≥80 years and at risk of malnutrition have a two‐fold higher chance of experiencing a fall during their hospital stay than older hospitalized patients who are not at risk of malnutrition. Hence, the results of our study provide evidence that an impaired nutritional status is not only associated with falls in the community or falls in the nursing home but also in the hospital. Our results also showed that a low BMI was significantly associated with hospital‐acquired falls in very old patients.…”

Section: Discussionsupporting

confidence: 50%

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

Eglseer

Hoedl

Schoberer

2020

Geriatrics Gerontology Int

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Aim To assess the relationship of malnutrition risk and in‐hospital falls in a patient group of older hospitalized patients (65–79 and ≥80 years). Methods A cross‐sectional, multicenter, point‐prevalence study was conducted in 68 Austrian hospitals with 3702 hospitalized older patients. The relationship between malnutrition risk and falls was analyzed using univariate and multivariate binary logistic regression analyses. Data were analyzed separately for two age groups, patients were aged 65–79 years (n = 2320) and ≥80 years (n = 1382). Results Prevalence of hospital‐acquired falls was 5.2%, and prevalence of risk of malnutrition was 24.3% (Malnutrition Universal Screening Tool) and 16.2% (definition using body mass index and weight loss). The univariate analysis showed significant associations of malnutrition risk and in‐hospital falls for patients aged ≥80 years (odds ratio 2.1; 95% confidence interval 1.2–3.6) but not for patients aged 65–79 years. The multivariate logistic regression analysis did not show significant associations between malnutrition risk and hospital‐acquired falls. Conclusions The results of this study show that malnutrition risk is a predictor for in‐hospital falls in very old patients (≥80 years). In this patient group, the screening and assessment of nutritional status as well as nutritional interventions for the prevention/treatment of malnutrition risk should be considered as one important factor for successful fall prevention. Studies are necessary to assess the effect of nutritional interventions as part of a multifaceted fall‐prevention program. Geriatr Gerontol Int 2020; 20: 348–353.

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Section: Discussionsupporting

confidence: 50%

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

Eglseer

Hoedl

Schoberer

2020

Geriatrics Gerontology Int

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“…The aim of this systematic literature review and metaanalysis was to present an overview of the nutritional status on admission and its association with functional parameters in geriatric rehabilitation patients. The pooled prevalence (95% CI) for MNA (nine studies) demonstrated that malnutrition and risk of malnutrition were present in 13% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and 47% (40-54) of the geriatric rehabilitation population, whereas the pooled estimate (95% CI) of BMI (n = 45) was 23.8 kg/m 2 (23.2-24.5). The ranges of the values and heterogeneity were high among the individual studies of the respective pooled estimates.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalence of obesity was not reported in any study. This would have been highly relevant information in this population, as obesity also has a relevant impact on functionality [7]. However, the high prevalence of malnutrition and risk of malnutrition combined with an average normal to high BMI indicates that a BMI is not a good proxy for malnutrition, and that screening for malnutrition with a validated screening tool should be used to identify those with malnutrition, and treat accordingly.…”

Section: Discussionmentioning

confidence: 99%

“…Malnutrition and weight loss, body mass index (BMI) values lower than 20 kg/m 2 , reduced food intake in general and reduced protein intake specifically are established independent factors which negatively influence functional parameters in older people [3,4]. While nutritional status and its association with functionality has been well examined in community-dwelling older individuals [5][6][7], in older hospital patients [2,8] and in nursing home residents [9,10], only scarce information is available in geriatric rehabilitation. The majority of patients in a geriatric rehabilitation setting is significantly older than 70 years, multimorbid and has a reduced functional status, which necessitates nursing care for activities of daily living [11].…”

Section: Introductionmentioning

confidence: 99%

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Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

et al. 2020

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Aim This systematic review and meta-analysis aims to characterize the nutritional status of geriatric rehabilitation patients and its association with functional parameters. Findings Malnutrition is prevalent in a relevant percentage of geriatric rehabilitation patients, whereas body mass index (BMI) is in the normal to overweight range. Furthermore, data suggest that protein and energy intake is reduced and vitamin D deficiency is prevalent in this population. Decreased physical function is associated with malnutrition according to Mini-Nutritional Assessment (MNA) and MNA short form, whereas BMI did not show any clear association. Message Nutritional status is reduced in a relevant percentage of geriatric rehabilitation patients and associated with decreased physical function which emphasizes the need for screening and targeted interventions.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Cited by 75 publications

References 70 publications

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

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

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