Evaluating the nutritional condition in complex diagnostics and management of geriatric frailty


Authors: T. Klbíková;  E. Topinková
Published in: Geriatrie a Gerontologie 2018, 7, č. 1: 33-39
Category:

Overview

Ageing is a complex process, which involves both anatomical and physiological changes to organs, including lowered organ function reserves. The dynamics of these changes can be variable. Chronic diseases or acute illnesses can accelerate these processes and lead to geriatric frailty – multicausal lowered health potential.

One of the key factors accelerating the development of geriatric frailty is lack of proper nutrition, both in quantitative and qualitative sense. Nutrition issues are very common among the elderly and past 80 years of age, some degree of malnutrition is present in practically all geriatric patients. In most at-risk patients admitted into a hospital their malnutrition progresses further unless it is diagnosed early on. In frail seniors this can be lethal.

The goal of the presented article is to document the nutritional and general condition/frailty of patients aged over 60, evaluated by the SPPB tests and to verify the relationship between geriatric frailty and nutritional condition.

Methodology:
For analysis data from commonly used screening tests within the framework of comprehensive geriatric assessment (CGA) – self-sufficiency (ADL) and physical fitness (SPPB), cognitive function (MMSE) and nutritional assessment (MNA-SF) were used.

Results:
The study included a total of 200 patients, of whom 46 (23%) were male and 154 (77%) were female with the mean age of 81±8 (range 60–101 years). Very low physical fitness and geriatric frailty were found in 119 (59.5%, SPPB <6 points), 59 patients (29.5%) were classified as „pre-frail“ (SPPB 7–9 points) and 22 (11%, SPPB 10-12 points) as robust. Malnutrition was diagnosed in 31 (15.5%, MNA-SF ≤ 7 points) patients and another 75 (37.5%, MNA-SF 8–11 points) were at risk of developing malnutrition. 91.5% of patients with nutritional disorders (high-risk or already suffering from malnutrition) were also frail or „pre-frail“. 94 (47 %, MNA-SF 12–14 points) were well-nourished.

In correlation analysis the total SPPB score correlated with the MNA-SF score, a significant positive correlation was found for the whole group (ρ = 0,503, p < 0,001), but SPPB scores correlated also with ADL andMMSE respectively (ρ = 0,372 and ρ = 0,499, p < 0,001 for both tests).

Conclusion:
In the sample of 200 patients, we demonstrated a strong correlation between geriatric frailty and nutritional status. Of significance to clinical practice is the finding that malnutrition can be both an indicator and a key factor influencing the development of geriatric frailty and also of disability. Although several well validated screening tools for the early detection of people at risk of eating disorders are available they are not sufficiently used in practice.

Keywords:
geriatric frailty – malnutrition – geriatric patient – self-sufficiency


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