Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture

Han, Thang S.; Yeong, Keefai; Lisk, Radcliffe; Fluck, David; Fry, Christopher

doi:10.1038/s41430-020-00774-5

Cited by 22 publications

(18 citation statements)

References 39 publications

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“…The Mini Nutritional Assessment-Short Form (MNA-SF) [11][12][13][14][15] and the Mini Nutritional Assessment-Full Form (MNA-FF) [12,[16][17][18][19] are the most commonly used tools for evaluating nutritional status in patients with hip fracture. The Malnutrition Screening Tool (MST) [20], Controlling Nutritional Status (CONUT) [21,22], Geriatric Nutritional Risk Index (GNRI) [22,23], Malnutrition Universal Screening Tool (MUST) [24], body mass index (BMI) [25,26], serum albumin [12,16,26,27], prealbumin [27], total protein [27], vitamin D [23,27] and lymphocyte count [16] are also used. These evaluation tools are useful for assessing the nutritional status of patients with hip fracture.…”

Section: Prevalence Of Undernutritionmentioning

confidence: 99%

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

et al. 2020

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Geriatric patients with hip fractures often experience overlap in problems related to nutrition, including undernutrition, sarcopenia, and frailty. Such problems are powerful predictors of adverse responses, although few healthcare professionals are aware of them and therefore do not implement effective interventions. This review aimed to summarize the impact of undernutrition, sarcopenia, and frailty on clinical outcomes in elderly individuals with hip fractures and identify successful strategies that integrate nutrition and rehabilitation. We searched PubMed (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant literature published over the last 10 years and found that advanced interventions targeting the aforementioned conditions helped to significantly improve postoperative outcomes among these patients. Going forward, protocols from advanced interventions for detecting, diagnosing, and treating nutrition problems in geriatric patients with hip fractures should become standard practice in healthcare settings.

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Section: Prevalence Of Undernutritionmentioning

confidence: 99%

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

et al. 2020

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“…Hip fracture is a common condition in older people, sharing the largest proportion of hospital admissions amongst all types of fractures [1]. Patients with a hip fracture have increased risk of many adverse outcomes in hospital including prolonged hospitalisation, malnutrition, pressure ulcers, mortality and requirement for higher levels of care [2][3][4][5][6]. Consequently, the personal and social costs of hip fractures are enormous [7,8].…”

Section: Introductionmentioning

confidence: 99%

Changes in Characteristics and Outcomes of Patients Undergoing Surgery for Hip Fractures Following the Initiation of Orthogeriatric Service: Temporal Trend Analysis

et al. 2021

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The Blue Book published by the British Orthopaedic Association and British Geriatrics Society, together with the introduction of National Hip Fracture Database Audit and Best Practice Tariff, have been influential in improving hip fracture care. We examined ten-year (2009–2019) changes in hip fracture outcomes after establishing an orthogeriatric service based on these initiatives, in 1081 men and 2891 women (mean age = 83.5 ± 9.1 years). Temporal trends in the annual percentage change (APC) of outcomes were identified using the Joinpoint Regression Program v4.7.0.0. The proportions of patients operated beyond 36 h of admission fell sharply during the first two years: APC = − 53.7% (95% CI − 68.3, − 5.2, P = 0.003), followed by a small rise thereafter: APC = 5.8% (95% CI 0.5, 11.3, P = 0.036). Hip surgery increased progressively in patients > 90 years old: APC = 3.3 (95% CI 1.0, 5.8, P = 0.011) and those with American Society of Anaesthesiologists grade ≥ 3: APC = 12.4 (95% CI 8.8, 16.1, P < 0.001). There was a significant decline in pressure ulcers amongst patients < 90 years old: APC = − 17.9 (95% CI − 32.7, 0.0, P = 0.050) and also a significant decline in mortality amongst those > 90 years old: APC = − 7.1 (95% CI − 12.6, − 1.3, P = 0.024). Prolonged length of stay (> 23 days) declined from 2013: APC = − 24.6% (95% CI − 31.2, − 17.4, P < 0.001). New discharge to nursing care declined moderately over 2009–2016 (APC = − 10.6, 95% CI − 17.2, − 2.7, P = 0.017) and sharply thereafter (APC = − 47.5%, 95%CI − 71.7, − 2.7, P = 0.043). The rate of patients returning home was decreasing (APC = − 2.9, 95% CI − 5.1, − 0.7, P = 0.016), whilst new discharge to rehabilitation was increasing (APC = 8.4, 95% CI 4.0, 13.0; P = 0.002). In conclusion, the establishment of an orthogeriatric service was associated with a reduction of elapsed time to hip surgery, a progressive increase in surgery carried out on high-risk adults and a decline in adverse outcomes.

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“…Osteoporosis was detected as risk factor of HAPUs possibly as a result of poor nutrition. Furthermore, osteoporosis is a main cause of FNF especially among the elderly, and these factors are found to be associated with HAPUs as mentioned above [37].…”

Section: Discussionmentioning

confidence: 92%

Incidence and Risk Factors of Hospital-Acquired Pressure Ulcers Following Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Yang

Wang

Shi

et al. 2021

Preprint

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BackgroundThe occurrence of hospital-acquired pressure ulcers (HAPUs) is disturbing and costly, leading to a variety of adverse effects. The objective of this study was to examine the incidence and risk factors of HAPUs following total hip arthroplasty (THA) using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed.ResultsA total of 592,174 THAs were captured from the NIS database. The general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance compared to the nonaffected individuals. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors of HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n≥3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Both elective admission and Private insurance were detected as protective factors. ConclusionsIt is beneficial to study the risk factors of HAPUs after THA to ensure the preventive management and optimize consequences although a really low incidence was identified.

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Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture

Abstract: Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture. European Journal of Clinical Nutrition.

Cited by 22 publications

References 39 publications

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

Changes in Characteristics and Outcomes of Patients Undergoing Surgery for Hip Fractures Following the Initiation of Orthogeriatric Service: Temporal Trend Analysis

Incidence and Risk Factors of Hospital-Acquired Pressure Ulcers Following Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

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