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Nutritional risk, functional status and mortality in newly institutionalised elderly

  • Emanuele Cereda (a1), Carlo Pedrolli (a2), Annunciata Zagami (a3), Alfredo Vanotti (a4), Silvano Piffer (a5), Milena Faliva (a6), Mariangela Rondanelli (a6) and Riccardo Caccialanza (a1)...
Abstract

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI < 92) and low (GNRI 92–98) nutritional risk were 36·1 and 30·6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P= 0·045), arm muscle area (P= 0·048), the number of co-morbidities (P= 0·027) and mainly with the GNRI (P< 0·001). During a median follow-up of 4·7 years (25th–75th percentile 3·7–6·2), 230 (66·5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95 % CI 1·32, 2·63; P< 0·001) and low nutritional risk (HR 1·52, 95 % CI 1·08, 2·14; P= 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI < 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95 % CI 1·28, 2·91; P< 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly.

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Corresponding author
*Corresponding author: E. Cereda, fax +39 382 502801, email e.cereda@smatteo.pv.it
References
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1Quinn, TJ, McArthur, K, Ellis, G, et al. (2011) Functional assessment in older people. BMJ 343, d4681.
2Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JM, et al. (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39, 412423.
3Salva, A, Coll-Planas, L, Bruce, S, et al. (2009) Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA. J Nutr Health Aging 13, 475483.
4Arvanitakis, M, Beck, A, Coppens, P, et al. (2008) Nutrition in care homes and home care: how to implement adequate strategies (report of the Brussels Forum (22–23 November 2007)). Clin Nutr 27, 481488.
5Cereda, E & Pedrolli, C (2009) The geriatric nutritional risk index. Curr Opin Clin Nutr Metab Care 12, 17(erratum in: Curr Opin Clin Nutr Metab Care 12, 683).
6Cereda, E, Pedrolli, C, Zagami, A, et al. (2011) Body mass index and mortality in institutionalized elderly. J Am Med Dir Assoc 12, 174178.
7Cereda, E, Valzolgher, L & Pedrolli, C (2008) Mini nutritional assessment is a good predictor of functional status in institutionalised elderly at risk of malnutrition. Clin Nutr 27, 700705.
8Cereda, E (2012) Mini nutritional assessment. Curr Opin Clin Nutr Metab Care 15, 2941.
9Kaiser, R, Winning, K, Uter, W, et al. (2010) Functionality and mortality in obese nursing home residents: an example of ‘risk factor paradox’? J Am Med Dir Assoc 11, 428435.
10Kondrup, J, Allison, SP, Elia, M, et al. (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22, 415421.
11Cereda, E, Pedrolli, C, Zagami, A, et al. (2011) Nutritional screening and mortality in newly institutionalised elderly: a comparison between the geriatric nutritional risk index and the mini nutritional assessment. Clin Nutr 30, 793798.
12Bouillanne, O, Morineau, G, Dupont, C, et al. (2005) Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82, 777783.
13Cereda, E, Pusani, C, Limonta, D, et al. (2009) The ability of the geriatric nutritional risk index to assess the nutritional status and predict the outcome of homecare resident elderly: a comparison with the mini nutritional assessment. Br J Nutr 102, 563570.
14Cereda, E & Vanotti, A (2008) Short dietary assessment improves muscle dysfunction identification by geriatric nutritional risk index in uncomplicated institutionalised patients over 70 years old. Clin Nutr 27, 126132.
15Cereda, E & Vanotti, A (2007) The new geriatric nutritional risk index is a good predictor of muscle dysfunction in institutionalized older patients. Clin Nutr 26, 7883.
16Cereda, E, Bertoli, S, Vanotti, A, et al. (2010) Estimated height from knee-height in Caucasian elderly: implications on nutritional status by mini nutritional assessment. J Nutr Health Aging 14, 1622.
17Cereda, E, Limonta, D, Pusani, C, et al. (2007) Feasible use of estimated height for predicting outcome by the geriatric nutritional risk index in long-term care resident elderly. Gerontology 53, 184186.
18World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854, 1452.
19Mahoney, FI & Barthel, DW (1965) Functional evaluation: the Barthel index. Med State Med J 14, 6165.
20Chobanian, AV, Bakris, GL, Black, HR, et al. (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42, 12061252.
21American Diabetes Association (2006) Diagnosis and classification of diabetes mellitus. Diabetes Care 29, Suppl. 1, S43S48.
22Cereda, E, Pedrolli, C, Zagami, A, et al. (2013) Alzheimer's disease and mortality in traditional long-term care facilities. Arch Gerontol Geriatr 56, 437441.
23Haynes, RB, Sackett, DL, Guyatt, GH, et al. (2006) Clinical Epidemiology: How to Do Clinical Practice Research, 3rd ed.Philadelphia, PA: Lippincott Williams & Wilkins.
24Cereda, E, Zagami, A, Vanotti, A, et al. (2008) Geriatric nutritional risk index and overall-cause mortality prediction in institutionalised elderly: a 3-year survival analysis. Clin Nutr 27, 717723.
25Bahat, G, Saka, B, Tufan, F, et al. (2010) Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey. Aging Male 13, 211214.
26Ballmer, PE (2001) Causes and mechanisms of hypoalbuminaemia. Clin Nutr 20, 271e3.
27Volpato, S, Romagnoni, F, Soattin, L, et al. (2004) Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. J Am Geriatr Soc 52, 886891.
28Cooper, R, Kuh, D, Hardy, R, et al. (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 341, c4467.
29Huybrechts, KF & Caro, JJ (2007) The Barthel index and modified Rankin scale as prognostic tools for long-term outcomes after stroke: a qualitative review of the literature. Curr Med Res Opin 23, 16271636.
30Bellelli, G, Magnifico, F & Trabucchi, M (2008) Outcomes at 12 months in a population of elderly patients discharged from a rehabilitation unit. J Am Med Dir Assoc 9, 5564.
31Espaulella, J, Arnau, A, Cubí, D, et al. (2007) Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care. Age Ageing 36, 407413.
32Baztán, JJ, Gálvez, CP & Socorro, A (2009) Recovery of functional impairment after acute illness and mortality: one-year follow-up study. Gerontology 55, 269274.
33Avraham, Y, Hao, S, Mendelson, S, et al. (2002) Hypothalamic–pituitary–adrenal responses to weight loss in mice following diet restriction, activity or separation stress: effects of tyrosine. Nutr Neurosci 5, 327335.
34Venihaki, M, Dikkes, P, Carrigan, A, et al. (2001) Corticotropin-releasing hormone regulates IL-6 expression during inflammation. J Clin Invest 108, 11591166.
35Yeh, SS & Schuster, MW (1999) Geriatric cachexia: the role of cytokines. Am J Clin Nutr 70, 183197.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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