Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture

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Abstract

Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture.

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ESPEN Guidelines on Enteral Nutrition: Geriatrics.

T Cederholm, S. Schneider, B Herbst … (2006)

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

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Impact of hip fracture on hospital care costs: a population-based study

J Leal, A. Gray, D. Prieto-Alhambra … (2015)

Summary Using a large cohort of hip fracture patients, we estimated hospital costs to be £14,163 and £2139 in the first and second year following fracture, respectively. Second hip and non-hip fractures were major cost drivers. There is a strong economic incentive to identify cost-effective approaches for hip fracture prevention. Introduction The purpose of this study was to estimate hospital costs of hip fracture up to 2 years post-fracture and compare costs before and after the index fracture. Methods A cohort of patients aged over 60 years admitted with a hip fracture in a UK region between 2003 and 2013 were identified from hospital records and followed until death or administrative censoring. All hospital records were valued using 2012/2013 unit costs, and non-parametric censoring methods were used to adjust for censoring when estimating average annual costs. A generalised linear model examined the main predictors of hospital costs. Results A cohort of 33,152 patients with a hip fracture was identified (mean age 83 years (SD 8.2). The mean censor-adjusted 1- and 2-year hospital costs after index hip fracture were £14,163 (95 % confidence interval (CI) £14,008 to £14,317) and £16,302 (95 % CI £16,097 to £16,515), respectively. Index admission accounted for 61 % (£8613; 95 % CI £8565 to £8661) of total 1-year hospital costs which were £10,964 higher compared to the year pre-event (p < 0.001). The main predictors of 1-year hospital costs were second hip fracture, other non-hip fragility fractures requiring hospitalisation and hip fracture-related complications. Total UK annual hospital costs associated with incident hip fractures were estimated at £1.1 billion. Conclusions Hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture. Experiencing a second hip fracture after the index fracture accounted for much of the increase in costs. There is a strong economic incentive to prioritise research funds towards identifying the best approaches to prevent both index and subsequent hip fractures.

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Sarcopenia in the elderly: diagnosis, physiopathology and treatment.

Vincenzo Malafarina, Francisco Uriz-Otano, Raquel Iniesta … (2012)

Sarcopenia, defined as a syndrome rather than as a pathology, is the loss of muscle mass and function associated with age. Sarcopenia is an enigma for medicine, and despite the numerous publications available in the literature and the number of papers currently being published, there is no agreement about its definition, and even less about its root causes. One salient aspect that proves the lack of consensus is the fact that different working groups are still debating about the right name for this syndrome (which is associated with the loss of muscle mass and strength in the elderly). In hospitalized patients, sarcopenia has been shown to raise the risk of complications such as infections, pressure ulcers, loss of autonomy, institutionalization and poor quality of life, as well as to increase mortality. The factors that contribute to the development of sarcopenia in the elderly are: the state of chronic inflammation, atrophy of motoneurons, reduced protein intake (secondary among others to the condition defined as geriatric anorexia), and immobility. There is ongoing debate about the causes of sarcopenia, but the aspect that generates most interest today is the quest to achieve repeatable and clinically useful diagnostic criteria for its diagnosis, prevention and treatment. The aim of this narrative review is to summarise the abundant information available in the literature and to draw useful conclusions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 30 April 2018

Publication date Collection: May 2018

Volume: 10

Issue: 5

Electronic Location Identifier: 555

Affiliations

[1 ]Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain; jalfmtz@ 123456unav.es (J.A.M.); mazulet@ 123456unav.es (M.A.Z.)

[2 ]Geriatric Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain

[3 ]Department of Public Health, Epidemiology and Health Economics, University of Liège, CHUB23, 4000, Liège, Belgium; jyr.ch@ 123456bluewin.ch (J.-Y.R.); olivier.bruyere@ 123456ulg.ac.be (O.B.)

[4 ]WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium

[5 ]King Saud University, 11692 Riyadh, Kingdom of Saudi Arabia

[6 ]Dietician Researcher; 08025 Barcelona, Spain, sonia.abril51@ 123456gmail.com

[7 ]Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK; w.j.pontefract@ 123456sheffield.ac.uk

[8 ]Institute for Health and Aging, Catholic University of Australia, Fitzroy VIC 3065 Melbourne, Australia

[9 ]Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain

[10 ]CIBERobn, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain

[11 ]Centre for Nutrition Research, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain

[12 ]IMDEA Food, Research Institute on Food & Health Sciences, 28049 Madrid, Spain.

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[* ]Correspondence: vmalafarina@ 123456gmail.com ; Tel.: +34-94-842-5600 (ext. 6317); Fax: +34-94-842-5740

Author information

Vincenzo Malafarina https://orcid.org/0000-0001-6748-1556

J. Alfredo Martinez https://orcid.org/0000-0001-5218-6941

Article

Publisher ID: nutrients-10-00555

DOI: 10.3390/nu10050555

PMC ID: 5986435

PubMed ID: 29710860

SO-VID: 281e5758-4872-4f4e-9210-53031cae8309

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

History

Date received : 31 January 2018

Date accepted : 25 April 2018

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Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture

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Karger: Nutrition and Dietetics

Most cited references 67

ESPEN Guidelines on Enteral Nutrition: Geriatrics.

Impact of hip fracture on hospital care costs: a population-based study

Sarcopenia in the elderly: diagnosis, physiopathology and treatment.

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