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Health issues and nutrition in the elderly

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

European Journal of Clinical Nutrition volume 75, pages 645–652 (2021)Cite this article

Subjects

Abstract

Background/objectives

Major causes of hip fractures are osteoporosis and falls, both of which are determined by nutrition. Information on the nutritional status of patients admitted to hospital with a hip fracture is lacking. In this study, we assessed determinants and adverse outcomes associated with malnutrition and malnourishment.

Methods

Nutritional status, assessed using the Malnutrition Universal Screening Tool protocol, was compared to age and residency prior to admission, and outcomes during hospital stay and at discharge.

Results

A total of 1239 patients admitted with a hip fracture (349 men, 890 women), aged 60–100 years. Compared with well-nourished individuals, the prevalences of malnutrition risk or malnourishment were higher in older age groups and those from residential or nursing care. Those with risk of malnutrition or malnourishment stayed in hospital longer by 3.0 days (95% confidence interval (CI), 1.5–4.5 days; p < 0.001) and 3.1 days (95% CI, 0.7–5.5 days; p = 0.011), respectively. Compared with the well-nourished group, malnourished individuals had increased: (1) risk for failure to mobilise within 1 day of surgery (rates = 17.9 versus 27.0%; odds ratio (OR) = 1.6 (95% CI, 1.0–2.7), p = 0.045); (2) pressure ulcers (rates = 1.0% versus 5.0%; OR = 5.5 (95% CI, 1.8–17.1), p = 0.006); (3) in-patient mortality (rates = 4.5% versus 10.1%; OR = 2.3 (95% CI, 1.1–4.8) p = 0.033) and (4) discharge to residential/nursing care: rates = 4.3% versus 11.1%; OR = 2.8 (95% CI, 1.2–6.6), p = 0.022.

Conclusions

Inadequate nutrition is common in patients admitted to hospital with a hip fracture, which in turn predisposes them to a number of complications. More research on nutritional support should be directed to this group to prevent or minimise hip fractures.

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Fig. 1: Distribution of patients throughout the study.
Fig. 2: Nutritional status in relation to age and pre-admission residency.
Fig. 3: Nutritional status in relation outcomes.
Fig. 4: Nutritional status in relation to length of stay.

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References

  1. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49:1458–60.

    PubMed  Google Scholar 

  2. Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures. Z Gerontol Geriatr. 2019;52:10–6.

    PubMed  Google Scholar 

  3. Hagen G, Magnussen J, Tell G, Omsland T. Estimating the future burden of hip fractures in Norway. A NOREPOS study. Bone. 2020;131:115156.

    PubMed  Google Scholar 

  4. Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM. Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med. 1998;104:539–45.

    CAS  PubMed  Google Scholar 

  5. Gregg EW, Pereira MA, Caspersen CJ. Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc. 2000;48:883–93.

    CAS  PubMed  Google Scholar 

  6. Cannarella R, Barbagallo F, Condorelli RA, Aversa A, La Vignera S, Calogero AE. Osteoporosis from an endocrine perspective: the role of hormonal changes in the elderly. J Clin Med. 2019;8:1564.

    CAS  PubMed Central  Google Scholar 

  7. Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc. 2009;57:492–8.

    PubMed  PubMed Central  Google Scholar 

  8. Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community‐dwelling women: the Randwick falls and fractures study. Aust J Public Health. 1993;17:240–5.

    CAS  PubMed  Google Scholar 

  9. Buchner DM, Larson EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA. 1987;257:1492–5.

    CAS  PubMed  Google Scholar 

  10. Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips PT. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Min Res. 1998;13:1932–9.

    CAS  Google Scholar 

  11. Rhoads J, Clayman A, Nelson S. The relationship of urinary tract infections and falls in a nursing home. Director. 2007;15:22–6.

    PubMed  Google Scholar 

  12. Pigłowska M, Kostka J, Kostka T. Association between respiratory tract infections and incidence of falls in nursing home residents. Pol Arch Med Wewn. 2013;123:371–7.

    PubMed  Google Scholar 

  13. Verlaan S, Ligthart-Melis GC, Wijers SL, Cederholm T, Maier AB, de van der Schueren MA. High prevalence of physical frailty among community-dwelling malnourished older adults–a systematic review and meta-analysis. J Am Med Dir Assoc. 2017;18:374–82.

    PubMed  Google Scholar 

  14. Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, et al. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients 2018;10:555.

    PubMed Central  Google Scholar 

  15. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S, et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr. 2012;31:917–21.

    PubMed  Google Scholar 

  16. Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, et al. Malnutrition according to mini nutritional assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc. 2015;16:661–7.

    PubMed  Google Scholar 

  17. Lisk R, Uddin M, Parbhoo A, Yeong K, Fluck D, Sharma P, et al. Predictive model of length of stay in hospital among older patients. Aging Clin Exp Res. 2019;31:993–9.

    PubMed  Google Scholar 

  18. Lisk R, Yeong K, Enwere P, Jenkinson J, Robin J, Irvin-Sellers M, et al. Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures. Age Ageing. 2020;49:411–7.

    PubMed  Google Scholar 

  19. Royal College of Physicians. National Hip Fracture Database annual report 2017. London: RCP; 2017. http://www.nhfd.co.uk/. Accessed 1 Feb 2019.

  20. Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A. National Hip Fracture Database National report 2013. Prepared on behalf of the Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians. https://www.nhfd.co.uk/20/hipfractureR.nsf/945b5efcb3f9117580257ebb0069c820/566c6709d04a865780257bdb00591cda/$FILE/onlineNHFDreport.pdf.

  21. Kondrup JE, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.

    CAS  PubMed  Google Scholar 

  22. National Institute for Health and Care Excellence Hip fracture in adults. Manchester: NICE; 2012. NICE quality standard No 16.

  23. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6:14–7.

    PubMed  PubMed Central  Google Scholar 

  24. Kiesswetter E, Pohlhausen S, Uhlig K, Diekmann R, Lesser S, Heseker H, et al. Malnutrition is related to functional impairment in older adults receiving home care. J Nutr Health Aging. 2013;17:345–50.

    CAS  PubMed  Google Scholar 

  25. Söderström L, Rosenblad A, Adolfsson ET, Bergkvist L. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr. 2017;117:532–40.

    PubMed  Google Scholar 

  26. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58:1734–8.

    PubMed  Google Scholar 

  27. Chavarro-Carvajal D, Reyes-Ortiz C, Samper-Ternent R, Arciniegas AJ, Gutierrez CC. Nutritional assessment and factors associated to malnutrition in older adults: a cross-sectional study in Bogotá, Colombia. J Aging Health. 2015;27:304–19.

    PubMed  Google Scholar 

  28. Neumann SA, Miller MD, Daniels L, Crotty M. Nutritional status and clinical outcomes of older patients in rehabilitation. J Hum Nutr Diet. 2005;18:129–36.

    CAS  PubMed  Google Scholar 

  29. Galivanche AR, Kebaish KJ, Adrados M, Ottesen TD, Varthi AG, Rubin LE, et al. Postoperative pressure ulcers after geriatric hip fracture surgery are predicted by defined preoperative comorbidities and postoperative complications. J Am Acad Orthop Surg. 2020;28:342–51.

    PubMed  Google Scholar 

  30. Lindholm C, Sterner E, Romanelli M, Pina E, Torra y Bou J, Hietanen H, et al. Hip fracture and pressure ulcers—the Pan‐European Pressure Ulcer Study—intrinsic and extrinsic risk factors. Int Wound J. 2008;5:315–28.

    PubMed  Google Scholar 

  31. Jones A, Pope J, Anguah KO, Erickson D. Mini Nutritional Assessment Score as a potential predictor of pressure ulcers in elderly nursing home patients with dementia. Top Clin Nutr. 2020;35:42–9.

    Google Scholar 

  32. Hedström M, Ljungqvist O, Cederholm T. Metabolism and catabolism in hip fracture patients nutritional and anabolic intervention—a review. Acta Orthopaedica. 2006;77:741–7.

    PubMed  Google Scholar 

  33. Bell JJ, Bauer JD, Capra S, Pulle RC. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients—results of a pragmatic intervention. Clin Nutr. 2014;33:1101–7.

    PubMed  Google Scholar 

  34. Li HJ, Cheng HS, Liang J, Wu CC, Shyu YI. Functional recovery of older people with hip fracture: does malnutrition make a difference? J Adv Nurs. 2013;69:1691–703.

    PubMed  Google Scholar 

  35. Gunnarsson AK, Lönn K, Gunningberg L. Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation? J Clin Nurs. 2009;18:1325–33.

    PubMed  Google Scholar 

  36. Houwing RH, Rozendaal M, Wouters-Wesseling W, Beulens JW, Buskens E, Haalboom JR. A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Clin Nutr. 2003;22:401–5.

    CAS  PubMed  Google Scholar 

  37. Espaulella J, Guyer H, Diaz-Escriu F, Mellado-Navas JA, Castells MO, Pladevall MA. Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Age Ageing. 2000;29:425–31.

    CAS  PubMed  Google Scholar 

  38. Bruce D, Laurance I, McGuiness M, Ridley M, Goldswain P. Nutritional supplements after hip fracture: poor compliance limits effectiveness. Clin Nutr. 2003;22:497–500.

    CAS  PubMed  Google Scholar 

  39. Lawson RM, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Clin Nutr. 2000;19:171–5.

    CAS  PubMed  Google Scholar 

  40. Philipson TJ, Snider JT, Lakdawalla DN, Stryckman B, Goldman DP. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19:121–8.

    PubMed  Google Scholar 

  41. Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 2004;125:1446–57.

    PubMed  Google Scholar 

  42. Han TS, Lean ME, Fluck D, Affley B, Gulli G, Patel T, et al. Impact of delay in early swallow screening on pneumonia, length of stay in hospital, disability and mortality in acute stroke patients. Eur J Clin Nutr. 2018;72:1548–54.

    PubMed  Google Scholar 

  43. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308:945–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Nevo RF, et al. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr. 2016;35:1053–8.

    PubMed  Google Scholar 

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Acknowledgements

We are grateful to all patients who participated in this NHFD Audit Programme and hospital staff who provided clinical care and support to patients throughout their hospital stay.

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Authors and Affiliations

  1. Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK

    Thang S. Han

  2. Department of Orthogeriatrics, Ashford and St Peter’s NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK

    Keefai Yeong & Radcliffe Lisk

  3. Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK

    David Fluck

  4. School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK

    Christopher H. Fry

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Contributions

TSH reviewed the topic related literature and conceived the original idea. KY and RL performed the study coordination and data collection. TSH wrote the first draft, analysed, interpreted the data and revised the paper. CHF and DF edited the paper. All authors checked, interpreted the results and approved the final version.

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Correspondence to Thang S. Han.

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Han, T.S., Yeong, K., Lisk, R. et al. Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture. Eur J Clin Nutr 75, 645–652 (2021). https://doi.org/10.1038/s41430-020-00774-5

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