E. Schrader

Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients — independent of health status

ObjectivesThe aim of this study was to investigate the relationship between nutritional and functional status in acute geriatric patients including mobility and considering health status.DesignCross-sectional study.SettingHospital.Participants205 geriatric patients (median age 82.0 (IQR: 80–86) years, 69.3% women).MeasurementsNutritional status was determined by Mini Nutritional Assessment (MNA) and patients were categorized as well-nourished (≥ 24 points), at risk of malnutrition (17–23.5 points) or as malnourished (< 17 points). Functional status was determined by Barthel Index (BI) and Timed ‘Up and Go’ Test (TUG) and related to MNA categories. Using binary multiple logistic regression the impact of nutritional status on functional status was examined, adjusted for health status.Results60.3 % of the patients were at risk of malnutrition and 29.8 % were malnourished. Ability to perform basic activities of daily living (ADL) decreased with declining nutritional status. The proportion of patients unable to perform the TUG increased with worsening of nutritional status (45.0 % vs. 50.4 % vs. 77.0 %, p<0.01). After adjusting for age, gender, number of diagnoses, disease severity and cognitive function, a higher MNA score significantly lowered the risk of being dependent in ADL (OR 0.85, 95 % CI 0.77–0.94) and inability to perform the TUG (OR 0.90, 95 % CI 0.82–0.99).ConclusionNutritional status according to MNA was related to ADL as well as to mobility in acute geriatric patients. This association remained after adjusting for health status.

Dietary assessment methods for older persons: what is the best approach?

Purpose of reviewDue to the present worldwide demographic change and the close relation between nutrition and health up to old age, accurate dietary assessment in older persons gains in interest and importance. The purpose of this article is to give an overview of dietary assessment methods for this growing population group, with emphasis on recent findings, and to highlight future research needs. Recent findingsKnowledge on dietary assessment in older and especially in very old persons is limited and specific aspects were selectively examined in recent times. For use in epidemiological studies, short food frequency questionnaires were developed and validated, which seem to be promising to reduce the burden for respondents and interviewers. In the clinical setting estimation of dietary intake by plate diagrams was shown to be valid, and in different populations anorexia emerged as an important prognostic parameter. SummaryThe best approach for dietary assessment in older persons depends on the purpose of the assessment and the specific abilities and impairments of the sample or person under study. Research is needed to further develop existing methods in order to meet the needs of old and very old persons and to identify major modifiable prognostic nutritional characteristics.

Nutritional and functional status in geriatric day hospital patients–MNA short form versus full MNA

ObjectivesThe aims of this study were to determine the prevalence of malnutrition in patients of a geriatric day hospital using the Mini Nutritional Assessment short form (MNA-SF) and the full MNA, to compare both tools, and to examine the relationship between nutritional and functional status.DesignCross-sectional study.SettingGeriatric day hospital.Participants190 patients (72.1% female, median 80 years) aged 65 years or older.MeasurementsIn consecutively admitted geriatric day hospital patients nutritional status was assessed by MNA-SF and full MNA, and agreement between both tools calculated by Cohen’s kappa. Basic activities of daily living (ADL), instrumental activities of daily living (IADL) and short physical performance battery (SPPB) were determined and related to MNA categories (Chi2-test, Mann-Whitney-U-test).Results36.3 % and 44.7% of the patients were at risk of malnutrition, 8.9 % and 5.8 % were malnourished according to MNA-SF and full MNA, respectively. Agreement between both MNA forms was moderate (?=0.531). No significant associations between MNA-SF and ADL, IADL and SPPB, and between full MNA and SPPB were observed. According to full MNA, the proportion of patients with limitations in ADL and IADL significantly increased with declining nutritional status (ADL: 2.1 vs. 8.2 vs. 18.2 %, p=0.044; IADL: 25.5 vs. 47.1 vs. 54.5 %, p=0.005) with a simultaneous decrease of the proportion of patients without limitations. Well-nourished patients reached significantly higher ADL scores than patients at risk of malnutrition (95 (-100) vs. 95 (85- 100), p=0.005) and significantly higher IADL scores than patients at risk or malnourished (8 (6-8) vs. 7 (5-8) vs. 6 (4-8), p=0.004).ConclusionThe high prevalence of risk of malnutrition and the observed association between functional status and nutritional status according to full MNA call for routine nutritional screening using this tool in geriatric day hospital patients.

Varying Associations Between Body Mass Index and Physical and Cognitive Function in Three Samples of Older Adults Living in Different Settings

BACKGROUND The study investigates variations in the associations between body mass index (BMI) and (a) physical and (b) cognitive function across three samples of older adults living in different settings, and moreover determines if the association between BMI and physical function is confounded by cognitive abilities. METHODS One hundred ninety-five patients of a geriatric day hospital, 322 persons receiving home care (HC), and 183 nursing home (NH) residents were examined regarding BMI, cognitive (Mini-Mental State Examination), and physical function (Barthel Index for activities of daily living). Differences in Mini-Mental State Examination and activities of daily living scores between BMI groups (<22, 22-<25, 25-<30, 30-<35, ≥35kg/m(2)) were tested by analysis of covariance considering relevant confounders. RESULTS Activities of daily living and Mini-Mental State Examination impairments increased from the geriatric day hospital over the HC to the NH sample, whereas prevalence rates of obesity and severe obesity (35%, 33%, 25%) decreased. In geriatric day hospital patients cognitive and physical function did not differ between BMI groups. In the HC and NH samples, cognitive abilities were highest in obese and severely obese subjects. Unadjusted mean activities of daily living scores differed between BMI groups in HC receivers (51.6±32.2, 61.8±26.1, 67.5±28.3, 72.0±23.4, 66.2±24.2, p = .002) and NH residents (35.6±28.6, 48.1±25.7, 39.9±28.7, 50.8±24.0, 57.1±28.2, p = .029). In both samples significance was lost after adjustment indicating cognitive function as dominant confounder. CONCLUSIONS In older adults the associations between BMI and physical and cognitive function were dependent on the health and care status corresponding to the setting. In the HC and the NH samples, cognitive status, as measured by the Mini-Mental State Examination, emerged as an important confounder within the association between BMI and physical function.