Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Nutrition

Impaired nutritional status in geriatric trauma patients

European Journal of Clinical Nutrition volume 71, pages 602–606 (2017)Cite this article

Subjects

Abstract

Background/Objectives:

Malnutrition is an established risk factor for adverse clinical outcomes. Our aim was to assess nutritional status among geriatric trauma patients.

Subjects/Methods:

We enrolled 169 consecutive patients (⩾70 years) admitted to the Geriatric Traumatology Centre (University Hospital Zurich, Switzerland). On admission to acute care, nutritional status was assessed with the mini nutritional assessment (score<17=malnourished (M), ⩽23.5=at risk of malnutrition (ARM), >23.5=normal). At the same examination, we assessed mental (Geriatric Depression Scale; GDS) and cognitive function (Mini-Mental State Examination; MMSE), frailty status (Fried Scale), and number of comorbidities and medications. Further, discharge destination was documented. All analyses were adjusted for age and gender.

Results:

A total of 7.1% of patients were malnourished and 49.1% were ARM. Patients with reduced mental health (GDS⩾5: 30.5 vs 11.5%; P=0.004), impaired cognitive function (MMSE⩽26: 23.6±0.5 vs 26.0±0.6; P=0.004), prevalent frailty (32.5 vs 8%; P<0.001), more comorbidities (2.3±0.1 vs 1.3±0.2; P<0.0001) and medications (5.6±0.3 vs 3.4±0.4; P<0.0001) were more likely to have an impaired nutritional status (M+ARM). Further, M+ARM patients were twice as likely to be discharged to destinations different to home (odds ratio=2.08; confidence interval 1.07−4.05).

Conclusions:

In this consecutive sample of geriatric trauma patients, 56.2% had an M+ARM upon admission to acute care, which was associated with indicators of worse physical, mental and cognitive health and predicted a more than twofold greater odds of being discharged to a destination other than home.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

Article 13 February 2020

Marc G. Jeschke, Margriet E. van Baar, … Sarvesh Logsetty

References

  1. Bischoff HA, Staehelin HB, Willett WC . The effect of undernutrition in the development of frailty in older persons. J Gerontol A Biol Sci Med Sci 2006; 61: 585–589.

    Article  Google Scholar 

  2. Hickson M . Malnutrition and ageing. Postgrad Med J 2006; 82: 2–8.

    Article  CAS  Google Scholar 

  3. Drevet S, Bioteau C, Maziere S, Couturier P, Merloz P, Tonetti J 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: 669–674.

    Article  CAS  Google Scholar 

  4. Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R 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: 661–667.

    Article  Google Scholar 

  5. Felder S, Lechtenboehmer C, Bally M, Fehr R, Deiss M, Faessler L et al. Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition 2015; 31: 1385–1393.

    Article  Google Scholar 

  6. Nuotio M, Tuominen P, Luukkaala T . Association of nutritional status as measured by the mini-nutritional assessment short form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr 2016; 70: 393–398.

    Article  CAS  Google Scholar 

  7. Avelino-Silva TJ, Farfel JM, Curiati JA, Amaral JR, Campora F, Jacob-Filho W . Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults. BMC Geriatr 2014; 14: 129.

    Article  Google Scholar 

  8. Khalatbari-Soltani S, Marques-Vidal P . Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: a retrospective study. Clin Nutr 2016; 35: 1340–1346.

    Article  Google Scholar 

  9. Vischer UM, Frangos E, Graf C, Gold G, Weiss L, Herrmann FR et al. The prognostic significance of malnutrition as assessed by the mini nutritional assessment (MNA) in older hospitalized patients with a heavy disease burden. Clin Nutr 2012; 31: 113–117.

    Article  Google Scholar 

  10. Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL . Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 2016; 86: 157–161.

    Article  Google Scholar 

  11. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr 2013; 32: 737–745.

    Article  Google Scholar 

  12. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr 2012; 31: 917–921.

    Article  Google Scholar 

  13. van Wissen J, van Stijn MFM, Doodeman HJ, Houdijk APJ . Mini nutritional assessment and mortality after hip fracture surgery in the elderly. J Nutr Health Aging 2016; 20: 964–968.

    Article  CAS  Google Scholar 

  14. Timmons S, Manning E, Barrett A, Brady NM, Browne V, O'Shea E et al. Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition. Age Ageing 2015; 44: 993–999.

    Article  Google Scholar 

  15. Peng LN, Cheng Y, Chen LK, Tung HH, Chu KH, Liang SY . Cognition and social-physiological factors associated with malnutrition in hospitalized older adults in Taiwan. J Nurs Res 2015; 23: 1–5.

    Article  Google Scholar 

  16. Saka B, Kaya O, Ozturk GB, Erten N, Karan MA . Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr 2010; 29: 745–748.

    Article  Google Scholar 

  17. Felder S, Braun N, Stanga Z, Kulkarni P, Faessler L, Kutz A et al. Unraveling the link between malnutrition and adverse clinical outcomes: association of acute and chronic malnutrition measures with blood biomarkers from different pathophysiological states. Ann Nutr Metab 2016; 68: 164–172.

    Article  CAS  Google Scholar 

  18. Starke J, Schneider H, Alteheld B, Stehle P, Meier R . Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients. Clin Nutr 2011; 30: 194–201.

    Article  Google Scholar 

  19. Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, Staubli M et al. Prevalence of undernutrition on admission to Swiss hospitals. Clin Nutr 2010; 29: 38–41.

    Article  Google Scholar 

  20. Venzin RM, Kamber N, Keller WC, Suter PM, Reinhart WH . How important is malnutrition? A prospective study in internal medicine. Eur J Clin Nutr 2009; 63: 430–436.

    Article  CAS  Google Scholar 

  21. Cereda E, Pedrolli C, Klersy C, Bonardi C, Quarleri L, Cappello S et al. Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA. Clin Nutr 2016; 35: 1282–1290.

    Article  Google Scholar 

  22. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr 2015; 34: 745–751.

    Article  Google Scholar 

  23. Coin A, Sergi G, Beninca P, Lupoli L, Cinti G, Ferrara L et al. Bone mineral density and body composition in underweight and normal elderly subjects. Osteoporos Int 2000; 11: 1043–1050.

    Article  CAS  Google Scholar 

  24. Hoekstra JC, Goosen JH, de Wolf GS, Verheyen CC . Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr 2011; 30: 455–461.

    Article  Google Scholar 

  25. Perez Durillo FT, Ruiz Lopez MD, Bouzas PR, Martin-Lagos A . Nutritional status in elderly patients with a hip fracture. Nutr Hosp 2010; 25: 676–681.

    CAS  PubMed  Google Scholar 

  26. Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y . Malnutrition in hip fracture patients: an intervention study. J Clin Nurs 2007; 16: 2027–2038.

    Article  Google Scholar 

  27. 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: 555–562.

    Article  CAS  Google Scholar 

  28. Anbar R, Beloosesky Y, Cohen J, Madar Z, Weiss A, Theilla M et al. Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr 2014; 33: 23–28.

    Article  CAS  Google Scholar 

  29. Formiga F, Chivite D, Mascaro J, Ramon JM, Pujol R . No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture. Aging Clin Exp Res 2005; 17: 343–346.

    Article  Google Scholar 

  30. Myint MW, Wu J, Wong E, Chan SP, To TS, Chau MW et al. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing 2013; 42: 39–45.

    Article  Google Scholar 

  31. Inoue T, Misu S, Tanaka T, Sakamoto H, Iwata K, Chuman Y 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 2016; e-pub ahead of print 31 August 2016; doi:10.1016/j.clnu.2016.08.021.

  32. Zapatero A, Barba R, Canora J, Losa JE, Plaza S, San Roman J et al. Hip fracture in hospitalized medical patients. BMC Musculoskelet Disord 2013; 14: 15.

    Article  Google Scholar 

  33. Guigoz Y . The Mini Nutritional Assessment (MNA) review of the literature—What does it tell us? J Nutr Health Aging 2006; 10: 466–485 (discussion 85-7).

    CAS  PubMed  Google Scholar 

  34. Folstein MF, Folstein SE, McHugh PR . 'Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

    Article  CAS  Google Scholar 

  35. Sheikh J, Yesavage J . Geriatric depression scale (GDS) recent evidence and development of a shorter version. Clin Gerontol 1986; 5: 165–173.

    Article  Google Scholar 

  36. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.

    Article  CAS  Google Scholar 

  37. Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE . Validation of the charlson comorbidity index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc 2014; 62: 342–346.

    Article  Google Scholar 

  38. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN . The self-administered comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 2003; 49: 156–163.

    Article  Google Scholar 

  39. Van Zyl M . The effects of drugs on nutrition. South Afr J Clin Nutr 2011; 24: 38–41.

    Article  Google Scholar 

  40. Bischoff-Ferrari HA . The role of falls in fracture prediction. Curr Osteoporos Rep 2011; 9: 116–121.

    Article  Google Scholar 

  41. Boulos C, Salameh P, Barberger-Gateau P . Malnutrition and frailty in community dwelling older adults living in a rural setting. Clin Nutr 2016; 35: 138–143.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland,

    F S Müller, O W Meyer, P Chocano-Bedoya, S Schietzel, M Gagesch, G Freystaetter & H A Bischoff-Ferrari

  2. Centre on Aging and Mobility, University Hospital Zurich, Zurich, Switzerland,

    F S Müller, O W Meyer, P Chocano-Bedoya, S Schietzel, M Gagesch, G Freystaetter & H A Bischoff-Ferrari

  3. Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,

    F S Müller & W Langhans

  4. Centre for Geriatric Traumatology, University Hospital Zurich, Zurich, Switzerland,

    O W Meyer, S Schietzel, M Gagesch, G Freystaetter, V Neuhaus, H-P Simmen & H A Bischoff-Ferrari

  5. Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland,

    V Neuhaus & H-P Simmen

Authors
  1. F S Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O W Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Chocano-Bedoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Schietzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Gagesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G Freystaetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H-P Simmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. W Langhans
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H A Bischoff-Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H A Bischoff-Ferrari.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Müller, F., Meyer, O., Chocano-Bedoya, P. et al. Impaired nutritional status in geriatric trauma patients. Eur J Clin Nutr 71, 602–606 (2017). https://doi.org/10.1038/ejcn.2017.25

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2017.25

This article is cited by

Search

Advanced search

Quick links