medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2020, Number 2

<< Back Next >>

Acta Ortop Mex 2020; 34 (2)

Effect of nutritional status on mortality and functional recovery in older adults with hip fracture

Roson, M; Benchimol, J; Rodota, L; Cabrera, P; Carabelli, GS; Barla, JD; Giunta, DH; Elizondo, MC; Boietti, BR

Language: Spanish
References: 25
Page: 96-102
PDF size: 177.86 Kb.


ABSTRACT

Introduction: Malnutrition is a common problem in the elderly population but has not been fully studied in elderly people with hip fractures. The goal is to estimate annual mortality based on nutrition in the elderly with hip fracture and compare motor functionality. Material and methods: Retrospective cohort of patients over 65 years of age with hip fracture included in the Institutional Register of The Elderly with Hip Fracture of a University Hospital, between July 2014 and July 2018. Nutritional status with Mini Nutritional Assessment Short-Form (MNA-SF) was assessed at hospital admission. Motor functional capacity was evaluated with Parker Scale (PS) basal, at three and 12 months. Results: 1,253 patients were included. 49.92% (CI95% 47.12-52.72) were malnourished. The annual mortality of the well-nourished (WN) was 9.45% (CI95% 7.23-12.30) against 21.52% (CI95% 18.12-25.45; p ≤ 0.001) of the malnourished (MN). The risk of death was associated with malnutrition HR 2.45 (CI95% 1.75-3.43; p ≤ 0.001). After adjusting it by age, sex, fragility, AVD, Charlson comorbility index and dementia, the risk remained HR 1.71 (CI95% 17-2.49; p = 0.005). With respect to functionality, the basal Parker Scale median (EP) for the WN group was 9 (RIC6-9) and for MN was 5 (RIC3-9) p ‹ 0.001, 6 months (RIC3-6) and 4 (RIC2-6) p ≤ 0.001 and 12 months 6 (RIC4-7) and 3 (RIC2-6) p ‹ 0.001. Conclusions: There is an association between the malnutrition of the elderly with hip fracture and its mortality with a year of evaluation; we also find a difference in motor functionality.


REFERENCES

  1. Shpata V, Ohri I, Nurka T, Prendushi X. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients. Clin Interv Aging. 2015; 10: 481-6.

  2.  2. Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr. 2016; 70: 393-8.

  3.  3. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop. 2014; 5: 402-11.

  4.  4. 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.

  5.  5. Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007; 55: 407-13.

  6.  6. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15: 116-22.

  7.  7. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross 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.

  8.  8. Helminen H, Luukkaala T, Saarnio J, Nuotio M. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes. Injury. 2017; 48: 903-8.

  9.  9. Mazzola P, Ward L, Zazzetta S, Broggini V, Anzuini A, Valcarcel B, et al. Association between preoperative malnutrition and postoperative delirium after hip fracture surgery in older adults. J Am Geriatr Soc. 2017; 65(6): 1222-8. doi: 10.1111/jgs.14764.

  10. Inoue T, Misu S, Tanaka T, Sakamoto H, Iwata K, Chuman Y, et al. Pre-fracture nutritional status is predictive of functional status at discharge during the acute phase with hip fracture patients: a multicenter prospective cohort study. Clin Nutr. 2017; 36(5): 1320-5. doi: 10.1016/j.clnu.2016.08.021.

  11. Benchimol J, Fiorentini F, Elizondo CM, Boietti BR, Carabelli G, Barla J, et al. Institutional registry of elderly patients with hip fracture in a community-based tertiary care hospital in Argentina (RIAFC). Geriatr Orthop Surg Rehabil. 2016; 7: 121-5.

  12. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001; 56: M366-72.

  13. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993; 75-B: 797-8.

  14. Mahoney FI, Barthel DW. Barthel Index [Internet]. PsycTESTS Dataset. 1965. doi: 10.1037/t02366-000.

  15. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9: 179-86.

  16. Huang SW, Lin JW, Liou TH, Lin HW. Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan. Int J Geriatr Psychiatry. 2015; 30: 695-701.

  17. 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(5): 555. doi: 10.3390/nu10050555.

  18. Drescher T, Singler K, Ulrich A, Koller M, Keller U, Christ-Crain M, et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients. Eur J Clin Nutr. 2010; 64: 887-93.

  19. Pérez DF, Ruiz LM, Bouzas PR, Martín-Lagos A. Nutritional status in elderly patients with a hip fracture. Nutr Hosp. 2010; 25: 676-81.

  20. Li HJ, Cheng HS, Liang J, Wu CC, Shyu YIL. Functional recovery of older people with hip fracture: does malnutrition make a difference? J Adv Nurs. 2013; 69: 1691-03.

  21. Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016; 16: 158.

  22. Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF. Older hip fracture patients: three groups with different needs. BMC Geriatr. 2010; 10: 65.

  23. Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg. 2016; 86: 157-61.

  24. Gumieiro DN, Rafacho BPM, Gonçalves AF, Tanni SE, Azevedo PS, Sakane DT, et al. Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture. Br J Nutr. 2013; 109: 1657-61.

  25. Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014; 99: 875-90.




2020     |     www.medigraphic.com