Muscle Measures and Nutritional Status at Hospital Admission Predict Survival and Independent Living of Older Patients - the EMPOWER Study

OBJECTIVES: Older adults with sarcopenia and malnutrition are at risk for co-morbidities, hospitalization, institutionalization, and mortality. In case of hospitalization, risks may be further increased, especially in case of suboptimal dietary intake. The aim of our study was to assess whether muscle mass, muscle strength, functional performance, and nutritional status at hospital admission were associated with survival and independent living among older patients three months after discharge. DESIGN, SETTING, PARTICIPANTS: The EMPOWER study was an observational, prospective and longitudinal inception cohort of patients older than 70 years admitted to the VU University Medical Centre in Amsterdam, the Netherlands. MEASUREMENTS: Patients were assessed for demographic and clinical characteristics, measurements of muscle mass (by bioelectrical impedance analysis), handgrip strength (by dynamometry), functional performance (self-reported ability to walk), and screened for risk of malnutrition (by SNAQ). Three months after hospital discharge, survival and living situation were assessed by a follow-up telephone interview. RESULTS: The majority of the 378 patients enrolled were living independently at the time of hospitalization (90%) and three months post-discharge (83%). Fifty-two patients died in the period from hospital admission to three months after discharge (survival rate 86%). Higher absolute muscle mass measures and not being malnourished at admission were significantly associated with the likelihood of survival. Handgrip strength and self-reported ability to walk were positively associated with a higher chance of living independently three months after discharge, but not with survival. CONCLUSIONS: Older patients with greater muscle mass and without malnutrition at hospital admission had a higher survival rate, while measures of muscle strength and functional performance were predictive for living independently three months after hospital discharge. Different components of muscle health relate to different relevant outcomes and therefore require investigation of specifically targeted interventions in the hospitalized older population

High risk of malnutrition is associated with low muscle mass in older hospitalized patients - a prospective cohort study

BACKGROUND: Malnutrition, low muscle strength and muscle mass are highly prevalent in older hospitalized patients and associated with adverse outcomes. Malnutrition may be a risk factor for developing low muscle mass. We aimed to investigate the association between the risk of malnutrition and 1) muscle strength and muscle mass at admission and 2) the change of muscle strength and muscle mass during hospitalization in older patients. METHODS: The EMPOWER study included 378 patients aged seventy years or older who were acutely or electively admitted to four different wards of an academic teaching hospital in Amsterdam. Patients were grouped into low risk of malnutrition and high risk of malnutrition based on the Short Nutritional Assessment Questionnaire (SNAQ) score and were assessed for hand grip strength and muscle mass using hand held dynamometry respectively bioelectrical impedance analysis (BIA) within 48 h after admission and at day seven, or earlier at the day of discharge. Muscle mass was expressed as skeletal muscle mass, appendicular lean mass, fat free mass and the skeletal muscle index. RESULTS: The mean age of the patients was 79.7 years (SD 6.39), 48.9% were female. At admission, being at high risk of malnutrition was significantly associated with lower muscle mass (Odds Ratio, 95% CI, 0.90, 0.85-0.96), but not with muscle strength. Muscle strength and muscle mass did not change significantly during hospitalization in both groups. CONCLUSION: In older hospitalized patients, a high risk of malnutrition is associated with lower muscle mass at admission, but not with muscle strength nor with change of either muscle strength or muscle mass during hospitalization

High risk of malnutrition is associated with low muscle mass in older hospitalized patients - a prospective cohort study

10.1186/s12877-017-0505-5BMC GERIATRICS17

Muscle Strength and Muscle Mass in Older Patients during Hospitalization: The EMPOWER Study

BACKGROUND: Low muscle strength and muscle mass are associated with an increased length of hospital stay and higher mortality rate in inpatients. To what extent hospitalization affects muscle strength and muscle mass is unclear. OBJECTIVE: We aimed to assess muscle strength and muscle mass at admission and during hospitalization in older patients and its relation with being at risk of geriatric conditions. METHODS: The EMPOWER study included patients aged 70 years and older, admitted to 4 wards of the VU University Medical Center in the Netherlands between April and December 2015. At admission, patients were screened for being at risk of 4 geriatric conditions: delirium, falls, malnutrition, and functional disability. At admission and at discharge, muscle strength and muscle mass were assessed. RESULTS: A total of 373 patients (mean age, standard deviation [SD]: 79.6, 6.38 years) were included at admission, and 224 patients (mean age, SD: 80.1, 6.32 years) at discharge. At admission, lower muscle strength in both female and male patients and low muscle mass in male patients were associated with being at risk of a higher cumulative number of geriatric conditions. Muscle strength increased during hospitalization, but no change in muscle mass was observed. Changes in muscle measures were not associated with being at risk of geriatric conditions. DISCUSSION: Older patients with lower muscle strength and muscle mass at admission were at risk of a higher cumulative number of geriatric conditions. However, being at risk of geriatric conditions did not forecast further decrease in muscle strength and muscle mass during hospitalization