Increased Association With Malnutrition and Malnourishment in Older Adults Admitted With Hip Fractures Who Have Cognitive Impairment and Delirium, as Assessed by 4AT.
cognitive dysfunction
delirium
hip fractures
malnutrition
nutrition assessment
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
ISSN: 1941-2452
Titre abrégé: Nutr Clin Pract
Pays: United States
ID NLM: 8606733
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
28
08
2020
accepted:
16
11
2020
pubmed:
29
12
2020
medline:
30
9
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
The Royal College of Physicians recently introduced the 4AT (Alertness, Abbreviated Mental Test-4, Attention, and Acute change or fluctuating course) for screening cognitive impairment and delirium. Here, we examined the association of the 4AT with nutrition status in patients admitted to a hospital with hip fractures between January 1, 2016, and June 6, 2019. Nutrition status was assessed using the Malnutrition Universal Screening Tool, and the 4AT was assessed within 1 day after hip surgery. χ From 1082 patients aged 60-103 years, categorized into 4AT scores of 0, 1-3, or ≥4, the prevalence of malnutrition risk was 15.5%, 27.3%, and 39.6% and malnourishment was 4.1%, 13.2%, and 11.3%, respectively. Compared with the 4AT = 0 cohort, a 4AT score = 1-3 was associated with an increased malnutrition risk (odds ratio [OR], 2.3; 95% CI, 1.6-3.1) or malnourishment (OR, 3.6; 95% CI, 2.1-6.3). For a 4AT score ≥4, corresponding ORs were 4.0 (95% CI, 2.8-5.9) and 3.6 (95% CI, 1.9-6.8). Overall, there was a significant positive association: as 4AT scores increased, so did malnutrition risk. Among older adults admitted with hip fractures, high 4AT scores, which are suggestive of cognitive impairment and delirium, identified patients at increased malnutrition risk. These findings lend further support for the use of 4AT to identify patients who are at increased health risk.
Sections du résumé
BACKGROUND
BACKGROUND
The Royal College of Physicians recently introduced the 4AT (Alertness, Abbreviated Mental Test-4, Attention, and Acute change or fluctuating course) for screening cognitive impairment and delirium. Here, we examined the association of the 4AT with nutrition status in patients admitted to a hospital with hip fractures between January 1, 2016, and June 6, 2019.
METHODS
METHODS
Nutrition status was assessed using the Malnutrition Universal Screening Tool, and the 4AT was assessed within 1 day after hip surgery. χ
RESULTS
RESULTS
From 1082 patients aged 60-103 years, categorized into 4AT scores of 0, 1-3, or ≥4, the prevalence of malnutrition risk was 15.5%, 27.3%, and 39.6% and malnourishment was 4.1%, 13.2%, and 11.3%, respectively. Compared with the 4AT = 0 cohort, a 4AT score = 1-3 was associated with an increased malnutrition risk (odds ratio [OR], 2.3; 95% CI, 1.6-3.1) or malnourishment (OR, 3.6; 95% CI, 2.1-6.3). For a 4AT score ≥4, corresponding ORs were 4.0 (95% CI, 2.8-5.9) and 3.6 (95% CI, 1.9-6.8). Overall, there was a significant positive association: as 4AT scores increased, so did malnutrition risk.
CONCLUSIONS
CONCLUSIONS
Among older adults admitted with hip fractures, high 4AT scores, which are suggestive of cognitive impairment and delirium, identified patients at increased malnutrition risk. These findings lend further support for the use of 4AT to identify patients who are at increased health risk.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1053-1058Informations de copyright
© 2020 American Society for Parenteral and Enteral Nutrition.
Références
MacLullich A. The 4AT - a rapid assessment test for delirium. Accessed June 15, 2020. http://www.the4at.com/
Bellelli G, Morandi A, Di Santo SG, et al. “Delirium Day”, a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med. 2016;14:1, 106.
Johansen Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A. National Hip Fracture Database National Report 201. 2013. Accessed August 1, 2020. https://www.nhfd.co.uk/20/hipfractureR.nsf/0/CA920122A244F2ED802579C900553993/$file/NHFD%20Report%202013.pdf
Royal College of Physicians. National Hip Fracture Database Annual Report 2017. 2017. Accessed August 1, 2020. https://www.nhfd.co.uk/files/2017ReportFiles/NHFD-AnnualReport2017.pdf
Lisk R, Yeong K, Enwere P, 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;49:3, 411-417.
Landi F, Liperoti R, Russo A, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31:5, 652-658.
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;17:3, 240-245.
Rhoads J, Clayman A, Nelson S. The relationship of urinary tract infections and falls in a nursing home. Director. 2007;15(1):22-26.
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(7-8):371-377.
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;48:8, 883-893.
Buchner DM & Larson EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA. 1987;257:11, 1492-1495.
Cederholm T, Barazzoni RO, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36:1, 49-64.
Sobotka L, ed. Basics in Clinical Nutrition. 4th ed. Rome: Galen; 2012.
Pirlich M, Schütz T, Kemps M, et al. Social risk factors for hospital malnutrition. Nutrition. 2005;21:3, 295e300.
Arvanitakis M, Beck A, Coppens P, et al. Nutrition in care homes and home care: how to implement adequate strategies (report of the Brussels Forum (22-23 November 2007)) Clin Nutr. 2008;27:4, 481-488.
Verlaan S, Ligthart-Melis GC, Wijers SL, et al. High prevalence of physical frailty among community-dwelling malnourished older adults-a systematic review and meta-analysis. J Am Med Dir Assoc. 2017;18:5, 374-382.
Lisk R, Uddin M, Parbhoo A, et al. Predictive model of length of stay in hospital among older patients. Aging Clin Exp Res. 2019;31:7, 993-999.
World Health Organization. International Statistical Classification of Diseases and Related Health Problems: Instruction Manual. Geneva: World Health Organization; 2004.
Kondrup JE, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:4, 415-421.
Boustani MA, Campbell NL, Munger S, Maidment I, Fox GC. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4, 311-320.
UK Department of Health. UK Chief Medical Officers' Alcohol Guidelines Review (2016) Summary of the proposed new guidelines. January 2016. Accessed July 2020. http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf
Rosted E, Prokofieva T, Sanders S, et al. Serious consequences of malnutrition and delirium in frail older patients. J Nutr Gerontol Geriatr. 2018;37:2, 105-116.
Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. Eur J Clin Nutr. 2000;54:7, 555-562.
Pérez Durillo FT, Ruiz López M, Bouzas PR, Martín-Lagos A. Estado nutricional en ancianos con fractura de cadera. Nutr Hosp. 2010;25(4):676-681.
Drevet S, Bioteau C, Maziere S, et al. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res. 2014;100:6, 669-674.
Goisser S, Schrader E, Singler K, 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;16:8, 661-667.
Koren-Hakim T, Weiss A, Hershkovitz A, et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity, and outcome. Clin Nutr. 2012;31:6, 917-921.
Inoue T, Misu S, Tanaka T, 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, 1320-1325.
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;48:4, 903-908.
Mazzola P, Ward L, Zazzetta S, et al. Association between preoperative malnutrition and postoperative delirium after hip fracture surgery in older adults. J Am Geriatr Soc. 2017;65:6, 1222-1228.
Han TS, Yeong K, Lisk R, Fluck D, Fry CH. Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture. Eur J Clin Nutr. Accepted manuscript. Published online October 7, 2020. https://doi.org/10.1038/s41430-020-00774-5
Lorenzl S, Füsgen I, Noachtar S. Acute confusional states in the elderly-diagnosis and treatment. Dtsch Arztebl Int. 2012;109(21):391-399.
Fagerström C, Palmqvist R, Carlsson J, Hellström Y. Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study. Int J Nurs Stud. 2011;48:7, 863-871.
Gunstad J, Sanborn V, Hawkins M. Cognitive dysfunction is a risk factor for overeating and obesity. Am Psychol. 2020;75:2, 219-234.
Philipson TJ, Snider JT, Lakdawalla DN, et al. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19:121-128.
Barr J, Hecht M, Flavin KE, et al. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 2004;125:4, 1446-1457.
Han TS, Lean ME, Fluck D, 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;72:11, 1548-1554.
Vanderwee K, Clays E, Bocquaert I, et al. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-center study. Clin Nutr. 2010;29:4, 469-476.
Roque M, Salva A, Vellas B. Malnutrition in community-dwelling adults with dementia (NutriAlz Trial). J Nutr Health Aging. 2013;17:4, 295-299.
Meijers JM, Schols JM, Halfens RJ. Malnutrition in care home residents with dementia. J Nutr Health Aging. 2014;18:6, 595-600.
Webb P, Stordalen GA, Singh S, et al. Hunger and malnutrition in the 21st century. BMJ. 2018;361:k2238.
Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014;43:4, 496-502.
Hendry K, Quinn TJ, Evans J, et al. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016;45:6, 832-837.
O'Sullivan D, Brady N, Manning E, et al. Validation of the 6- item cognitive impairment test and the 4AT test for combined delirium and dementia screening in older emergency department attendees. Age Ageing. 2018;47:1, 61-68.
De J, Wand AP, Smerdely PI, et al. Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population. Int J Geriatr Psychiatry. 2017;32:12, 1322-1329.
Gagné AJ, Voyer P, Boucher V, et al. Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. CJEM. 2018;20(6):903-910.