13 research outputs found
Risk Factors for Mortality in Nursing Home Residents: An Observational Study
Purpose: Identifying mortality risk factors in people living in nursing homes could
help healthcare professionals to individualize or develop specific plans for predicting future care
demands and plan end-of-life care in this population. This study aims to identify mortality risk
factors in elderly nursing home (NH) residents, based on variables adapted to this environment,
routinely collected and easily accessible to their healthcare professionals. Methods: A prospective,
longitudinal, observational study of NH residents aged 65 years and older was carried out collecting
sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other
health variables. These variables were analyzed as mortality risk factors by Cox proportional
hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6))
were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment,
84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality
(hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those
with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002),
respectively). Male gender (HR = 1.88; p < 0.001), age 80 years (HR = 1.73; p = 0.034), hypertension
(HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of
pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and
male gender (due to the higher prevalence of associated comorbidity in these two variables),
certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional
and cognitive impairment, and frequency of medical emergency service care increased the risk of
mortality in our study. Given their importance and their easy identification by healthcare professionals
in nursing homes, these clinical variables should be used for planning care in institutionalized
older adults.Grupo Ballesol (Valencia, Spain) provided financial support for conducting the research and publishing the article. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptEnfermerí
Validation of score in mna scale like nutritional risk factor in institutionalized geriatric patients with moderate and severe cognitive impairment
Introducción: La valoración geriátrica integral incluye
el examen del apartado nutricional debido a la alta prevalencia de desnutrición en este tipo de pacientes; especialmente en los pacientes con deterioro cognitivo asociado.
Las escalas de cribado del estado nutricional presentan
preguntas de autopercepción subjetiva de difícil respuesta en pacientes mayores con demencia.
Objetivo: Estudiar la especificidad, el valor predictivo
positivo y la sensibilidad de la escala MNA para la detección
de malnutrición en pacientes diagnosticados de enfermedad
de Alzheimer con deterioro cognitivo avanzado.
Material y métodos: Se diseñó un estudio descriptivo
poblacional con una muestra de 52 pacientes mayores de
70 años, institucionalizados, con enfermedad de Alzheimer grado moderado y severo. Se estudió la sensibilidad,
especificidad y valor predictivo positivo de la escala MNA
respecto a los parámetros de malnutrición del American
Institute of Nutrition (AIN).
Resultados: Los valores de sensibilidad, especificidad y
valor predictivo positivo son 60%, 94,7% y 93,8% respectivamente. Existe una correlación significativa (p < 0,001)
ente la puntuación obtenida en la escala MNA y la escala de
riesgo de caídas Tinneti (r = 0,577), de función Barthel (r =
0,742), de valoración cognitiva MEC (r = 0,651) y los niveles
de creatinina (r = 0,402). Más del 50% de la muestra presentó al menos un parámetro de malnutrición AIN alterado.
Conclusiones: La escala MNA presenta una menor
sensibilidad y especificidad en estos pacientes. El diseño
de una escala de valoración nutricional sin valoraciones
subjetivas y sólo con parámetros objetivos podría mejorar la eficacia de la misma en ancianos institucionalizados
con deterioro cognitivo moderado y severo.Introduction: comprehensive geriatric assessment
includes examination of the nutritional status given the
high prevalence of hyponutrition in this kind of patients,
particularly in patients with associated cognitive impairment. Scales for screening the nutritional status include
questions on self-perception difficult to answer by
demented elder patients.
Objective: To study the specificity, the positive predictive value, and the sensitivity of the MNA scale to detect
malnutrition in patients diagnosed with Alzheimer’s disease with advanced cognitive impairment.
Material and methods: a population-based descriptive
study with a sample of 52 patients older than 70 years,
institutionalized, and with moderate-severe Alzheimer’s
disease was designed. The sensitivity, specificity, and positive predictive value of MNA scale were studied regarding the parameters on malnutrition of the American
Institute of Nutrition (AIN).
Results: the sensitivity, specificity, and positive predictive values were 60%, 94.7%, and 93.8%, respectively.
There was a significant correlation (p < 0.001) between
the score obtained with the MNA Scale and the Tinneti’s
Risk of Fall Scale (r = 0.577), the Barthel’s function (r =
0.742), the MCT cognitive assessment (r = 0.651), and creatinine levels (r = 0.402). More than 50% of the sample
presented at least one malnutrition parameter altered.
Conclusions: the MNA Scale presents lower sensitivity
and specificity in these patients. Designing a nutritional
assessment scale without subjective evaluations and only
with objective parameters might improve its efficiency in
institutionalized elderly patients with moderate-severe
cognitive impairment.Nutrición humana y dietétic
Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS®) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery
Background: The aim of this study was to determine whether the inclusion of older patients undergoing elective colorectal cancer resection in the Enhanced Recovery After Surgery (ERAS®) programme could improve clinical outcomes during hospital admission. Methods: A before-and-after study in ≥70-year-old patients electively admitted for colorectal cancer resection was designed. In total, 213 patients were included in the ERAS® group, and 158 were included in the control group. Results: The average age was 77.9 years old (SD 5.31) and 57.14% of them were men, with a Charlson Index score of 3.42 (SD 3.32). The ERAS® group presented a lower transfusion rate of 42 (19.7%), compared to 75 (47.5%) in the control group (p < 0.001). The crude odds ratio (OR) for transfusion was 0.27 (95% CI 0.17–0.43; p < 0.001), and the adjusted odds ratio was 0.26 (95% CI 0.14–0.48; p < 0.001). The ERAS® group had a lower percentage of patients with moderate–severe malnutrition on admission, at 23.4% (37 patients) against 36.2% in the control group (42 patients) (p = 0.023), with an OR of 0.47 (95% CI 0.29–0.75; p < 0.002) and an adjusted OR of 0.48 (95% CI 0.29–0.78; p = 0.003). The number of patients who required admission to the intensive care unit (ICU) was also markedly lower: 54 from the ERAS® group (25.4%) versus 71 from the control group (44.9%) (p < 0.001). Conclusions: The inclusion of ≥70-year-old adults in the ERAS® programme resulted in a decrease in transfusions, number of erythrocyte concentrates transfused, and number of ICU admissions, along with improved nutritional status
Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort
Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative perio
Risk Factors for Mortality in Nursing Home Residents: An Observational Study
Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults