Relationship between nutritional status and frailty in hospitalized older patients

Hong, Xiufang; Yan, Jing; Xu, Liyu; Shen, Shanshan; Zeng, Xingkun; Chen, Lingyan

doi:10.2147/cia.s189040

Cited by 63 publications

(57 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous studies showed that there was a close relationship between nutritional status and frailty. 31 Our study also found lower albumin which reflected nutritional status was independently associated with frailty. D-dimer is an important clinical assay for the detection of active coagulation and fibrinolysis.…”

Section: Associated Risk Factors Of Frailtysupporting

confidence: 69%

“…The overall prevalence of frailty in our study was consistent with previous published results which showed that 18% to 54% of elderly inpatients were frail among different regions in China. [15][16][17][18][19][20]31 However, no published results showed the data of frailty from different wards simultaneously, mostly only focusing on the department of geriatrics or only one type of disease. Our results revealed that non-surgical wards had the highest incidence of frailty and longest hospital length among the cardiac ward and surgical wards.…”

Section: Prevalence Of Frailty In Elderly Hospitalized Patientsmentioning

confidence: 99%

See 1 more Smart Citation

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

Liang¹,

Zhang²,

Liu³

et al. 2019

CIA

View full text Add to dashboard Cite

Objectives: To survey the difference of frailty prevalence in elderly inpatients amongdifferent wards; to compare the diagnostic performance of five frailty measurements (Clinical Frailty Scale [CFS], FRAIL, Fried, Edmonton, Frailty Index [FI]) in identifying frailty; and to explore the risk factors of frailty in elderly inpatients. Participants and methods: This was a cross-sectional study including 1000 inpatients (mean age 75.2±6.7 years, 51.5% male; 542, 229, and 229 patients from cardiology, nonsurgical, and surgical wards, respectively) in a tertiary hospital from September 2018 to February 2019. We applied the combined index to integrate the five frailty measurements mentioned above as the gold standard of frailty diagnosis. Multivariate logistic regression models were used to determine the independent risk factors of frailty. Results: Frailty prevalence was 32.3% (Fried), 36.2% (CFS), 19.2% (FRAIL), 25.2% (Edmonton), 35.1% (FI) in all patients. The frailty was more common in non-surgical wards, regardless of the frailty assessment tools used (non-surgical wards: 27.5% to 51.5%; cardiology ward: 14.9% to 29.3%; surgical wards: 18.8% to 41.9%). CFS≥5 showed a sensitivity of 94.1% and a specificity of 85.2% for all patients. FI≥0.25 showed a sensitivity of 94.8% and a specificity of 87.0% for all patients. Age [odds ratio (OR) = 1.089, P<0.001], education level (OR = 0.782, P=0.001), heart rate (OR = 1.025, P<0.001), albumin (OR = 0.911, P=0.002), log D-dimer (OR = 2.940, P<0.001), ≥5 comorbidities (OR = 2.164, P=0.002), and ≥5 medications (OR = 2.819, P<0.001) were independently associated with frailty in all participants. Conclusion: Frailty is common among elderly inpatients, especially in non-surgical wards. CFS is a preferred screening tool and FI may be an optimal assessment tool. Old age, low educational level, fast heart rate, low albumin, high D-dimer, ≥5 comorbidities, and polypharmacy are independent risk factors of frailty in elderly hospitalized patients.

show abstract

Section: Associated Risk Factors Of Frailtysupporting

confidence: 69%

Section: Prevalence Of Frailty In Elderly Hospitalized Patientsmentioning

confidence: 99%

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

Liang¹,

Zhang²,

Liu³

et al. 2019

CIA

View full text Add to dashboard Cite

show abstract

“…Increased Hb levels may be a protective factor for decreasing hospitalization rates and duration. Importantly, Hb could be an early indicator of the nutritional status of hospitalized elderly patients (30). The home care system in Taiwan made great efforts to advocate the avoidance of frequent admissions and provided phone consultation as required (13).…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

Chou

Tsou

Hwang

2019

Preprint

View full text Add to dashboard Cite

Backgrounds: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented elderly home care residents is increasing however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of elderly patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF).Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 39 required AHF and 130 NGF. All subjects were in a bedridden status 129 (76.3%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (47.7%) than in the AHF group (25.6%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia showed no significant difference in both groups (aOR = 2.20, 95% CI 0.92-5.30). One-year mortality rates in the AHF and NGF groups were 7.7% and 14.6%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38, 95% CI 0.58-9.70). There were no significant differences in hospitalization rate and duration.Conclusions: For elderly patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. However, aORs with the trend of increasing risk of in the NGF group were observed in measured outcomes. Therefore, the benefits of NGF are debatable in elderly patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on home healthcare would be required to support these results.3

show abstract

“…Higher Hb levels seemed to be a protective factor for decreasing hospitalization rates and duration of stay. Importantly, Hb could be an early indicator of nutritional status, related to hospitalized elderly patients (27). The home care system in my country made great efforts to advocate the avoidance of frequent admissions and provided phone consultation when needed (13).…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube feeding versus assisted hand feeding in-home health care older adults with severe dementia in Taiwan: a prognosis comparison

Chou

Tsou

Hwang

2019

Preprint

View full text Add to dashboard Cite

Backgrounds/Objectives All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented elderly home care residents is increasing, yet the tube feeding’s benefit in these groups is still unknown. We compared the clinical prognosis and mortality rate of demented elderly patients who received nasogastric tube feeding (NGF) or assisted hand feeding (AHF).Methods This retrospective observational study enrolled 202 participants aged over 60 years in the setting of home health care between January 1 and December 31, 2017. All subjects with documented severe dementia suffered from difficulty in oral intake and needed either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.Results A total of 202 subjects (61 males and 141 females, aged 85.7 ± 7.7 years) were analyzed. Of note, 61 had AHF, and 141 had NGF. Most subjects were in a bed-ridden status, with 83.7% on Eastern Cooperative Oncology Group (ECOG) scale 4 and 66.3% with a Barthel index less than score 10. Pneumonia risk was higher in NGF (46.8%) than in AHF (24.6%, p = 0.0031). Despite adjusting for multiple factors in the regression model, a higher incidence of pneumonia risk was still observed in the NGF group (aOR = 2.15, 95% CI 1.01–4.56). The one-year mortality rates in AHF and NGF were 8.3% and 14.2%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 1.20, 95% CI 0.37–3.90). No significant differences were observed in hospitalization rate and duration.Conclusions For in-home health care elderly demented patients, NGF is associated with a significantly higher pneumonia rate compared with AHF. Additionally, neither the mortality nor the hospitalization rates decreased in the NGF group. Therefore, on the basis of these findings, we should question the benefits of NGF for in-home health care elderly demented subjects. Continued careful hand feeding could be an alternative to tube feeding in severe dementia. Furthermore, we should consider the quality of life and make individualized decisions before deciding to use tube feeding.

show abstract

Relationship between nutritional status and frailty in hospitalized older patients

Cited by 63 publications

References 28 publications

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

Nasogastric tube feeding versus assisted hand feeding in-home health care older adults with severe dementia in Taiwan: a prognosis comparison

Contact Info

Product

Resources

About