Relationship of Frailty and Nutritional Status with Laboratory Parameters in Older Adults Admitted to the Emergency Department

Year 2024, Volume: 77 Issue: 4, 381 - 388, 29.12.2024

Yaşar Çatal

Abstract

Objectives: Frailty and malnutrition in older adults are associated with many adverse outcomes. Our study aimed to compare malnutrition and
frailty scales and laboratory test results in older adults admitted to the emergency department

Materials and Methods: This single-center cross-sectional study was conducted in the emergency department of a university hospital. The frailty
status of the patients was evaluated with the clinical frailty scale (CFS), and the patients were grouped as frail and non-frail. Mini nutritional
assessment-short form (MNA-SF) evaluated malnutrition status. The patients were grouped as malnourished, malnutrition risky, and normal
nutritional status. In addition to the basic biochemical parameters of the patients, prealbumin, iron, fasting insulin, hemoglobin a1c, vitamin B12,
and parathyroid hormone levels were measured. The relationship between laboratory results and CFS and MNA-SF results was analyzed statistically.

Results: One hundred-six patients were included in the study. Sixty-six patients were female, and the mean age was 78.1±7.43 years. According to
the CFS scale, 87.7% of the patients were found to be frail. According to MNA-SF, the rate of patients was 18.9% malnourished and 47.2% at risk of
malnutrition. When the scales and laboratory results were compared, frail patients had lower levels of prealbumin, iron, total protein, hemoglobin,
and sodium, which was statistically significant. In malnourished patients, prealbumin, fasting insulin, total protein, albumin, hemoglobin, and
calcium levels were lower.

Keywords

Frailty , malnutrition , older adults , emergency medicine

Ethical Statement

This study was approved by the Local Ethics Committee of Ankara University Faculty of Medicine (decision no.: İ07-424-22, date: 04.08.2024) and this study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Supporting Institution

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Project Number

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Thanks

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Acil Servise Başvuran Yaşlılarda Kırılganlık ve Beslenme Durumunun Laboratuvar Parametreleri ile İlişkisi

Abstract

Amaç: Yaşlı yetişkinlerde kırılganlık ve yetersiz beslenme birçok olumsuz sonuçla ilişkilidir. Çalışmamızda acil servise başvuran yaşlı yetişkinlerde
malnütrisyon ve kırılganlık ölçekleri ile laboratuvar test sonuçlarının karşılaştırılması amaçlandı.

Gereç ve Yöntem: Bu tek merkezli kesitsel çalışma bir üniversite hastanesinin acil servisinde gerçekleştirildi. Hastaların kırılganlık durumu klinik
kırılganlık ölçeği (CFS) ile değerlendirildi ve hastalar kırılgan ve kırılgan olmayan olarak gruplandırıldı. Mini beslenme değerlendirmesi-kısa formu
(MNA-SF) yetersiz beslenme durumunu değerlendirdi. Hastalar malnütrisyonlu, malnütrisyon riskli ve beslenme durumu normal olarak gruplandırıldı.
Hastaların temel biyokimyasal parametrelerinin yanı sıra prealbümin, demir, açlık insülini, hemoglobin a1c, B12 vitamini ve paratiroid hormon
düzeyleri ölçüldü. Laboratuvar sonuçları ile CFS ve MNA-SF sonuçları arasındaki ilişki istatistiksel olarak analiz edildi.

Bulgular: Çalışmaya 106 hasta dahil edildi. Hastaların 66’sı kadındı ve yaş ortalaması 78,1±7,43 yıldı. CFS skalasına göre hastaların %87,7’sinin
kırılgan olduğu belirlendi. MNA-SF’ye göre yetersiz beslenen hastaların oranı %18,9, yetersiz beslenme riski taşıyanların oranı ise %47,2 oldu. Ölçekler
ve laboratuvar sonuçları karşılaştırıldığında, kırılgan hastalarda prealbümin, demir, total protein, hemoglobin ve sodyum düzeyleri istatistiksel olarak
anlamlı derecede düşüktü. Yetersiz beslenen hastalarda prealbümin, açlık insülini, toplam protein, albümin, hemoglobin ve kalsiyum düzeyleri daha
düşüktü.

Sonuç: Çalışmamızda laboratuvar parametrelerinin kırılganlık ve malnütrisyonun erken teşhisinde yardımcı olabileceğini düşünüyoruz

Keywords

Kırılganlık , malnütrisyon , yaşlılar , acil tıp

Ethical Statement

This study was approved by the Local Ethics Committee of Ankara University Faculty of Medicine (decision no.: İ07-424-22, date: 04.08.2024) and this study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Orimo H. [Reviewing the definition of elderly]. Nihon Ronen Igakkai Zasshi. 2006;43:27-34. Japanese.
• 2. Lim SC, Doshi V, Castasus B, et al. Factors causing delay in discharge of elderly patients in an acute care hospital. Ann Acad Med Singap. 2006;35:27-32.
• 3. Inouye SK, Studenski S, Tinetti ME, et al. Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept. J Am Geriatr Soc. 2007;55:780-791.
• 4. Yang YC, Lin MH, Wang CS, et al. Geriatric syndromes and quality of life in older adults with diabetes. Geriatr Gerontol Int. 2019;19:518-524.
• 5. Magnuson A, Sattar S, Nightingale G, et al. A practical guide to geriatric syndromes in older adults with cancer: a focus on falls, cognition, polypharmacy, and depression. Am Soc Clin Oncol Educ Book. 2019;39:e96-e109.
• 6. Patel KV, Brennan KL, Brennan ML, et al. Association of a modified frailty index with mortality after femoral neck fracture in patients aged 60 years and older. Clin Orthop Relat Res. 2014;472:1010-1017.
• 7. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381:752-762.
• 8. Xu L, Zhang J, Shen S, et al. Clinical frailty scale and biomarkers for assessing frailty in elder inpatients in China. J Nutr Health Aging. 2021;25:77-83.
• 9. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj. 2005;173:489-495.
• 10. Sarikaya D, Halil M, Kuyumcu ME, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr. 2015;61:56-60.
• 11. Meza-Valderrama D, Marco E, Dávalos-Yerovi V, et al. Sarcopenia, malnutrition, and cachexia: adapting definitions and terminology of nutritional disorders in older people with cancer. Nutrients. 2021;13:761.
• 12. Ye XJ, Ji YB, Ma BW, et al. Comparison of three common nutritional screening tools with the new European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition among patients with geriatric gastrointestinal cancer: a prospective study in China. BMJ Open. 2018;8:e019750.
• 13. Planas M, Álvarez-Hernández J, León-Sanz M, et al. Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer. 2016;24:429-435.
• 14. Özsürekci C, Balcı C, Kızılarslanoğlu MC, et al. An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale. Acta Clin Belg. 2020;75:200-204.
• 15. Kane RL, Talley KM, Shamliyan T, et al. Common syndromes in older adults related to primary and secondary prevention. AHRQ. 2011.
• 16. Hong X, Yan J, Xu L, et al. Relationship between nutritional status and frailty in hospitalized older patients. Clin Interv Aging. 2019:105-111.
• 17. Ensrud KE, Ewing SK, Cawthon PM, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc. 2009;57:492-498.
• 18. Cunha AIL, Veronese N, de Melo Borges S, et al. Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing Res Rev. 2019;56:100960.
• 19. Kaeppeli T, Rueegg M, Dreher-Hummel T, et al. Validation of the clinical frailty scale for prediction of thirty-day mortality in the emergency department. Ann Emerg Med. 2020;76:291-300.
• 20. Collard RM, Boter H, Schoevers RA, et al. Prevalence of frailty in community‐dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487-1492.
• 21. Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci. 2006;61:589-593.
• 22. Çevik A, Basat O, Sema U. Evde sağlık hizmeti alan yaşlı hastalarda beslenme durumunun değerlendirilmesi ve beslenme durumunun laboratuar parametreleri üzerine olan etkisinin irdelenmesi. Konuralp Tıp Derg. 2014;6:31-37.
• 23. Listì F, Candore G, Modica MA, et al. A study of serum immunoglobulin levels in elderly persons that provides new insights into B cell immunosenescence. Ann N Y Acad Sci. 2006;1089:487-495.
• 24. Khan SR, Van der Burgh AC, Peeters RP, et al. Determinants of serum immunoglobulin levels: a systematic review and meta-analysis. Front Immunol. 2021;12:664526.
• 25. Wu IC, Shiesh SC, Kuo PH, et al. High oxidative stress is correlated with frailty in elderly chinese. J Am Geriatr Soc. 2009;57:1666-1671.
• 26. Mailliez A, Guilbaud A, Puisieux F, et al. Circulating biomarkers characterizing physical frailty: CRP, hemoglobin, albumin, 25OHD and free testosterone as best biomarkers. Results of a meta-analysis. Exp Gerontol. 2020;139:111014.
• 27. Valentini A, Federici M, Cianfarani MA, et al. Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects. Clin Interv Aging. 2018:1237-1244.
• 28. Li C, Chen XM, Li Y, et al. Factors and outcome of renal osteodystrophyassociated initial fragility fracture in end-stage renal disease patients. Kidney Dis. 2019;5:118-125.
• 29. Palmer K, Vetrano DL, Marengoni A, et al. The relationship between anaemia and frailty: a systematic review and meta-analysis of observational studies. J Nutr Health Aging. 2018;22:965-974.
• 30. Sahin S, Tasar PT, Simsek H, et al. Prevalence of anemia and malnutrition and their association in elderly nursing home residents. Aging Clin Exp Res. 2016;28:857-862.
• 31. Pillatt AP, Da Silva B, Franz LBB, et al. Muscle, endocrine, and immunological markers of frailty in older people. Exp Gerontol. 2021;151:111405.
• 32. Beck LH. Changes in renal function with aging. Clin Geriatr Med. 1998;14:199-210.
• 33. Yanagita I, Fujihara Y, Eda T, et al. Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients. J Diabetes Investig. 2018;9:419-425.