Suleyman Emre KOCYIGIT, Ali Ekrem AYDIN, Ahmet Turan IŞIK

Yaşlı Bireylerde Nütrisyonel Durum Fiziksel Performans ve Fonksiyonellikle İlişkili Olabilmektedir

Yaşlı bireylerde malnütrisyon ve malnütrisyon riskinin etkisinin, diğer geriatrik sendrom ve ayrıntılı geriatrik değerlendirme (AGD) parametreleri açısından araştırılması amaçlandı. Ocak 2019-Haziran 2020 tarihleri arasında geriatri polikliniğine başvuran hastalar çalışmaya dahil edildi. 460 hasta değerlendirildi. Hastalar malnütrisyon, malnütrisyon-riski ve normal beslenme açısından üç gruba ayrıldı. Bu üç grup geriatrik sendromlar ve AGD parametreleri açısından karşılaştırıldı. Normal beslenen grup ile malnütrisyon riski ve malnütrisyon grubu, yaş ve cinsiyete göre düzeltme yapılarak, geriatrik sendromlar ve AGD parametreleri açısından değerlendirildi. 460 hastanın% 64,5'i kadın olup, ortalama yaş 77,75 ± 8,12 olarak izlendi ve bu hastaların 65'inde malnütrisyon ve 141'inin malnütrisyon riski mevcuttu. Normal beslenme durumuna sahip grup, malnütrisyon ve malnütrisyon risk grubu ile karşılaştırıldığında yaş, eğitim yılı, serebrovasküler hastalık sıklığı istatistiksel olarak farklıydı. Düşme, demans, uyku bozukluğu, üriner inkontinans, ortostatik hipotansiyon, polifarmasi, sarkopeni ve kırılganlık sıklığı malnütrisyon ve malnütrisyon riski olan gruplarda normal gruba göre daha yüksekti (p<0.05). Ayrıca, günlük yaşam aktiviteleri (GYA) ile yürüme ve denge skorları malnütrisyon ve malnütrisyon riski olan grupta daha düşüktü (p <0.05). Yaş ve cinsiyete göre düzeltilmiş regresyon analizinde, geriatrik depresyon, üriner inkontinans, demans, ortostatik hipotansiyon, sarkopeni ve kırılganlık normal gruba göre, malnütrisyon ve malnütrisyon riski olan grupta daha yüksek gözlendi (p <0.05). Malnütrisyon ve malnütrisyon riski, diğer geriatrik sendromlar ve GYA'larda bozulma ile ilişkilidir. Bu nedenle, nütrisyonel değerlendirme yaşlı erişkinlerin değerlendirmesinde yer almalı ve beslenme durumunu optimize etmek için gerekli müdahaleler yapılmalıdır.

Anahtar Kelimeler:

malnütrisyon, geriatrik sendrom, ayrıntılı geriatrik değerlendirme

Nutritional Status Might Be Related to Physical Performance and Functionality in Older Adults

It was aimed to investigate the effect of malnutrition with and the risk of malnutrition in elderly individuals with regards to other geriatric syndromes and comprehensive geriatric assessment (CGA) parameters. Patients who applied to the geriatric outpatient clinic between January 2019 and June 2020 were included in the study. 460 patients were examined. The patients were divided into three groups according to malnutrition, malnutrition-risk, and normal nutritional status. These three groups were compared in terms of geriatric syndromes and CGA parameters. The well-nourished group and the risk of malnutrition and malnutrition group were compared in terms of geriatric syndromes and CGA parameters adjusted for age and gender. Of 460 patients, 64.5% of these patients were female, and the mean age was 77.75±8.12, 65 had malnutrition, and 141 had malnutrition-risk. When the well-nourished group was compared with the malnutrition and malnutrition-risk group, age, education year, frequency of cerebrovascular disease were statistically different. The frequency of falls, dementia, sleep disturbance, urinary incontinence, orthostatic hypotension, polypharmacy, sarcopenia, and frailty was higher in groups with malnutrition and malnutrition-risk than in the normal group (p<0.05). Also, activities of daily living (ADLs) and gait and balance scores were lower in the group with malnutrition and malnutrition risk (p<0.05). In the regression analysis adjusted for age and gender, geriatric depression, urinary incontinence, dementia, orthostatic hypotension, sarcopenia, and frailty were increased in the group with malnutrition and malnutrition risk compared to the normal group (p<0.05). Malnutrition and risk of malnutrition is associated with other geriatric syndromes and deterioration in ADLs. Therefore, nutritional evaluation must be included in the assessment of older adults, and necessary interventions should be made to optimize the nutritional status.

Keywords:

Malnutrition, geriatric syndrome, comprehensive geriatric assessment,

PDF

___

1. Ellis G,Whitehead MA, Robinson D, et al. Comprehensive geriatric assessment for older adults admitted to hospital:meta-analysis of randomised controlled trials. BMJ. 2011; 343: d6553.
2. Garrard JW, Cox NJ, Dodds RM, et al. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res. 2020; 32: 197-205.
3. Johnson LE, Sullivan DH. Malnutrition in older adults. 2016, Brocklehurst’s textbook of geriatric medicine and gerontology (Eight Edition) Philadelphia: Elsevier.
4. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010; 5: 207-16.
5. Söderström L, Rosenblad A, Adolfsson ET, et al. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr. 2017; 117: 532–40.
6. Vellas B, Guigoz Y, Garry PJ, et al. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15: 116e22.
7. Saka B, Kaya O, Ozturk GB, et al. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr. 2010; 29: 745-8.
8. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996; 46: 1470.
9. Ates Bulut E, Soysal P, Dokuzlar O, et al. Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults. Aging Clin Exp Res. 2020;32(9):1749-1755.
10. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48: 16–31.
11. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: 146–56.
12. Unutmaz GD, Soysal P, Tuven B, et al. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018; 13: 607-13.
13. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.
14. Kaiser MJ, Bauer JM, Rämsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010; 58: 1734–8.
15. Guyonnet S, Rolland Y. Screening for malnutrition in older people. Clin Geriatr Med. 2015; 31: 429-37.
16. Marcell TJ. Sarcopenia: causes, consequences, and preventions. J Gerontol A Biol Sci Med Sci. 2003; 58: 911-6.
17. Dhillon RJ, Hasni S. Pathogenesis and management of sarcopenia. Clin Geriatr Med. 2017; 33: 17-26.
18. Agarwal E, Miller M, Yaxley A, et al. Malnutrition in the elderly: a narrative review. Maturitas. 2013; 76: 296-302.
19. Cesari M, Calvani R, Marzetti E. Frailty in older persons. Clin Geriatr Med. 2017; 33: 293-303.
20. Boulos C, Salameh P, Barberger-Gateau P. Malnutrition and frailty in community dwelling older adults living in a rural setting. Clin Nutr. 2016; 35: 138-43.
21. Laur CV, McNicholl T, Valaitis R, et al. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab. 2017; 42: 449-58.
22. Gillette Guyonnet S, Abellan Van Kan G, Alix E, et al. International Academy on Nutrition and Aging Expert Group. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease. J Nutr Health Aging. 2007; 11: 38-48.
23. Volkert D, Chourdakis M, Faxen-Irving G, et al. ESPEN guidelines on nutrition in dementia. Clin Nutr. 2015; 34: 1052-73.
24. Smith KL, Greenwood CE. Weight loss and nutritional considerations in Alzheimer disease. J Nutr Elder. 2008; 27: 381-403.
25. Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs. 2008; 17: 2266-74.
26. Smoliner C, Norman K, Wagner KH, et al. Malnutrition and depression in the institutionalised elderly. Br J Nutr. 2009; 102: 1663-7.
27. Thomas P, Hazif-Thomas C, Clement JP. Influence of antidepressant therapies on weight and appetite in the elderly. J Nutr Health Aging. 2003; 7: 166-70.
28. Abrams RC, Teresi JA, Butin DN. Depression in nursing home residents. Clin Geriatr Med. 1992; 8: 309-22.
29. Zhao R, Bu W, Chen X. The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr. 2019; 19: 341.
30. Isenring E, Baker J, Kerr G. Malnutrition and falls risk in community-dwelling older adults. J Nutr Health Aging 2013; 17: 277-9.
31. Geinoz G, Rapin CH, Rizzoli R, et al. Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int. 1993; 3: 242-8.
32. Mol A, Bui Hoang PTS, Sharmin S, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20: 589-97.
33. Kocyigit SE, Soysal P, Ates Bulut E, et al. Malnutrition and malnutrition risk can be associated with systolic orthostatic hypotension in older adults. J Nutr Health Aging. 2018; 22: 928-33.
34. Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006; 50: 1306-14.
35. Miu DK, Lau S, Szeto SS. Etiology and predictors of urinary incontinence and its effect on quality of life. Geriatr Gerontol Int. 2010; 10: 177-82.
36. Parker-Autry C, Houston DK, Rushing J, Richter HE, Subak L, Kanaya AM, Kritchevsky SB. Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence. Obstet Gynecol. 2017;130(5):1025-1032.
37. Soysal P, Smith L, Dokuzlar O, et al. Relationship between nutritional status and insomnia severity in older adults. J Am Med Dir Assoc .2019; 20: 1593-8.
38. Bytzer P. Dyspepsia as an adverse effect of drugs. Best Pract Res Clin Gastroenterol. 2010;24(2):109-20.
39. Zadak Z, Hyspler R, Ticha A, et al. Polypharmacy and malnutrition. Curr Opin Clin Nutr Metab Care. 2013;16(1):50-5.