Association between nutritional status (MNA®-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients

Abstract

Objective

This study aimed to explore the association between the impaired nutritional status and frailty in acute hospitalised elderly patients by using two tools, the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe).

Design

Cross-sectional study.

Setting

Acute hospitalised, community-dwelling elderly patients were recruited at internal medicine wards in Vienna, Austria.

Participants

133 men (39%) and women (61%) aged 74 (65–97) years.

Measurements

MNA®-SF was used to investigate malnutrition (<7 points) and patients at risk of malnutrition (8 to 11 points). By using the SHARE-FI, subjects were classified as frail, pre-frail or robust. A factor analysis was applied to identify overlaps between the MNA®-SF and SHARE-FI items. Internal consistency of different dimensions was assessed by using Cronbach’s Alpha.

Results

Malnutrition or risk of malnutrition was found in 76.7% of the total sample and in 46.8% of robust, in 69.0% of pre-frail, and in 93.0% of frail participants. Frailty or prefrailty was found in 75.9% of the total sample and in 45.1% of the subjects with no risk of malnutrition, in 80.9% of subjects at risk of malnutrition, and in 94.1% of malnourished patients. The two used tools show overlaps in three dimensions: (1) nutrition problems, (2) mobility problems and (3) anthropometric items with a moderate to strong internal consistency (Cronbach’s Alpha of 0.670, 0.834 and 0.946, respectively). 64.7% of the total sample (79.5% of frail and 87.9% of malnourished subjects) would participate in a home-based muscle training and nutritional intervention program.

Conclusions

This study underlines the association and the overlap between frailty and impaired nutritional status. There is a high readiness to participate in a program to tackle the problems associated with malnutrition and frailty, especially in those, who would benefit most from it.

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References

  1. 1.

    Soeters PB, Reijven PL, Van Bokhorst-De Van Der Schueren MA, Schols JM, Halfens RJ, Meijers JM, and Van Gemert WG. A rational approach to nutritional assessment. Clin Nutr 2008;27(5): 706–716.

    PubMed  Article  Google Scholar 

  2. 2.

    Soeters PB and Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care 2009;12(5): 487–494.

    PubMed  Article  Google Scholar 

  3. 3.

    Allison SP. Malnutrition, disease, and outcome. Nutrition 2000;16(7–8): 590–593.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Domer TE and Paeder A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 2012;155(1): 56–65.

    Google Scholar 

  5. 5.

    Domer TE, Schwarz F, Kranz A, Freidl W, Rieder A, and Gisinger C. Body mass index and the risk of infections in institutionalised geriatric patients. Br J Nutr 2010;103(12): 1830–1835.

    Article  Google Scholar 

  6. 6.

    Locher JL, Roth DL, Ritchie CS, Cox K, Sawyer P, Bodner EV, and Altaian RM. Body mass index, weight loss, and mortality in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2007;62(12): 1389–1392.

    PubMed Central  PubMed  Article  Google Scholar 

  7. 7.

    Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP, and Cardiovascular Study Research G Weight change in old age and its association with mortality. J Am Geriatr Soc 2001;49(10): 1309–1318.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Kondrup J, Allison SP, Elia M, Vellas B, and Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22(4): 415–421.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, and Sieber CC. The Mini Nutritional Assessment-its history, today’s practice, and future perspectives. Nutr Clin Pract 2008;23(4): 388–396.

    PubMed  Article  Google Scholar 

  10. 10.

    Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, and Garry P. Overview of the MNA-Its history and challenges. J Nutr Health Aging 2006;10(6): 456–463.

    CAS  PubMed  Google Scholar 

  11. 11.

    Espinoza SE and Fried LP. Risk Factors for Frailty in the Older Adult. Clin Geriatrics 2007;15: 37–44.

    Google Scholar 

  12. 12.

    Blaum CS, Xue QL, Michelon E, Semba RD, and Fried LP. The association between obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc 2005;53(6): 927–934.

    PubMed  Article  Google Scholar 

  13. 13.

    Villareal DT, Banks M, Siener C, Sinacore DR, and Klein S. Physical frailty and body composition in obese elderly men and women. Obes Res 2004;12(6): 913–920.

    PubMed  Article  Google Scholar 

  14. 14.

    Woods NF, Lacroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, and Newman AB. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005;53(8): 1321–1330.

    PubMed  Article  Google Scholar 

  15. 15.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, and Mcburnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3): M146–156.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Espinoza S and Walston JD. Frailty in older adults: insights and interventions. Cleve Clin J Med 2005;72(12): 1105–1112.

    PubMed  Article  Google Scholar 

  17. 17.

    Fried LP, Ferrucci L, Darer J, Williamson JD, and Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59(3): 255–263.

    PubMed  Article  Google Scholar 

  18. 18.

    Abellan Van Kan G and Vellas B. Is the Mini Nutritional Assessment an appropriate tool to assess frailty in older adults? J Nutr Health Aging 2011;15(3): 159–161.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, Sieber CC, and Bauer JM. Nutritional Status According to the Mini Nutritional Assessment (MNA(R)) and Frailty in Community Dwelling Older Persons: A Close Relationship. J Nutr Health Aging 2013;17(4): 351–356.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Dale O and Salo M. The Helsinki Declaration, research guidelines and regulations: present and future editorial aspects. Acta Anaesthesiol Scand 1996;40(7): 771–772.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC, and Group MN-I. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009;13(9): 782–788.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Rubenstein LZ, Harker JO, Salva A, Guigoz Y, and 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(6): M366–372.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Ranhoff AH, Gjoen AU, and Mowe M. Screening for malnutrition in elderly acute medical patients: the usefulness of MNA-SF. J Nutr Health Aging 2005;9(4): 221–225.

    CAS  PubMed  Google Scholar 

  24. 24.

    Romero-Ortuno R, Walsh CD, Lawlor BA, and Kenny RA. A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010;10: 57.

    PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    Romero-Ortuno R. The Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe predicts mortality similarly to a frailty index based on comprehensive geriatric assessment. Geriatr Gerontol Int 2013;13(2): 497–504.

    PubMed  Article  Google Scholar 

  26. 26.

    Andela RM, Dijkstra A, Slaets JP, and Sanderman R. Prevalence of frailty on clinical wards: description and implications. Int J Nurs Pract 2010;6(1): 14–19.

    Google Scholar 

  27. 27.

    Santos-Eggimann B, Cuenoud P, Spagnoli J, and Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009;64(6): 675–681.

    PubMed  Article  Google Scholar 

  28. 28.

    Calvo I, Olivar J, Martinez E, Rico A, Diaz J, and Gimena M. MNA(R) Mini Nutritional Assessment as a nutritional screening tool for hospitalized older adults; rationales and feasibility. Nutr Hosp 2012;27(5): 1619–1625.

    CAS  PubMed  Google Scholar 

  29. 29.

    Johansson Y, Bachrach-Lindstrom M, Carstensen J, and Ek AC. Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study. J Clin Nurs 2009;18(9): 1354–1364.

    PubMed  Article  Google Scholar 

  30. 30.

    Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature-What does it tell us? J Nutr Health Aging 2006;10(6): 466–485.

    CAS  PubMed  Google Scholar 

  31. 31.

    Morley JE. Anorexia of aging: a true geriatric syndrome. J Nutr Health Aging 2012;16(5): 422–425.

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Morley JE Anorexia, weight loss, and frailty. J Am Med Dir Assoc 2010;11(4): 225–228.

    PubMed  Article  Google Scholar 

  33. 33.

    Montero-Odasso M, Muir S, Hall M, Doherty T, Kloseck M, Beauchet O, and Speechley M. Gait variability is associated with frailty in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2011;66(5): 568–576.

    PubMed  Article  Google Scholar 

  34. 34.

    Chevalier S, Saoud F, Gray-Donald K, and Morals JA. The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status. J Nutr Health Aging 2008;12(10): 721–726.

    CAS  PubMed  Google Scholar 

  35. 35.

    Schroll M. Aging, food patterns and disability. Forum Nutr 2003;56:256–258.

    PubMed  Google Scholar 

  36. 36.

    Rosenberg IH. Sarcopenia: origins and clinical relevance. Clin Geriatr Med 2011;27(3): 337–339.

    PubMed  Google Scholar 

  37. 37.

    Neelemaat F. Post-discharge nutritional support in malnourished ill elderly patients -effectiveness and cost-effectiveness. Departments of Nutrition and Dietetics, Internal Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 2012.

    Google Scholar 

  38. 38.

    Lackinger C, Haider S, Luger E, Kapan A, Schindler K, and Dorner T. Gesundheitsförderung via Trainings- und Ernährungsintervention durch “Buddies” bei älteren und hochbetagten Personen mit Malnutrition und/oder Frailty im extramuralen Bereich. In 16. Wissenschaftliche Tagung der ÖGPH, Österreichische Gesellschaft für Public Health, St. Pölten, Austria, 2013.

    Google Scholar 

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Correspondence to Eva Luger.

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Dorner, T.E., Luger, E., Tschinderle, J. et al. Association between nutritional status (MNA®-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients. J Nutr Health Aging 18, 264–269 (2014). https://doi.org/10.1007/s12603-013-0406-z

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Key words

  • Screening
  • malnutrition
  • frailty
  • elderly
  • hospital