To deliver quality management of a frail individual, a clinician should understand the concept of frailty, be aware of its epidemiology and be able to screen for frailty and assess it when it is ...present, and, finally, to recommend successful interventions.
A systematic literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published in the period from 2002 to 2017. From 67432 initial hits, 27 publications were selected.
Useful interventions to address frailty are supplementation of vitamin D, proper nutrition, multicomponent training, home-based physiotherapy and comprehensive geriatric assessment, particularly when performed in geriatric wards.
Comprehensive geriatric assessment is an effective way to decrease frailty status especially when performed in geriatric wards. Multicomponent physical training and multidimensional interventions (physical training, nutrition, vitamin D supplementation and cognitive training) are effective measures to reduce frailty.
Malnutrition has become a prevalent condition, with European and international studies reporting rates of approximately 25-40% in hospitals. We set out to perform a multi-center cross-sectional study ...to assess malnutrition rates in Slovenian hospitals and to convert the findings into a mobile application suitable for use by nurses and staff at the bedside. In addition, we examined the association of the results of this mobile application with parameters for body composition measured by bioimpedance method, muscle strength, anthropometrics, and specific blood markers.
We selected the Nutritional Risk Screening 2002 (NRS-2002) method, the second version of the modified short-form of Mini-Nutritional Assessment (MNA-SF), and the diagnostic criteria for cachexia proposed by Evans (CDE) as evidence-based methods for estimating the risk of and prevalence of malnutrition or/and cachexia. The methods were converted into the Android mobile application named MalNut that was used in three Slovenian hospitals by nurses and dietitians.
We applied NRS-2002 and MNA-SF to screen for malnutrition risk and to assess malnutrition in 207 individuals aged 18 years and older, regardless of gender or reason for hospitalization during 1-week periods. Totally, 98% of these patients consider nutrition an important part of medical treatment care. NRS-2002 estimated the malnutrition risk to be 66.3%, which includes both patients to be at risk for malnutrition and patients that are truly malnourished. The malnutrition risk in the elderly (65+) estimated by MNA-SF was 39.6% and malnutrition 42.5%. When applying the CDE score in these two categories, 66.7% were identified as cachectic and 21.4% as pre-cachectic. In the patients assessed with the CDE score, malnutrition risk increased with higher extracellular water and decreased body mass index, hemoglobin, phase angle, and muscle strength. In all, 75% of patients assessed as high risk for malnutrition by NRS-2002, were identified as cachectic and 15.7% as pre-cachectic. In NRS-2002 assessed patients, this risk increased with higher C-reactive protein and lower phase angle.
The study showed that both malnutrition and cachexia are largely overlapping notions and are common in hospitalized adults in Slovenia. The MNA-SF and NRS-2002 tools showed that malnutrition risk was not significantly correlated with age, gender, serum albumin, but was correlated with lower phase angle, CRP, and muscle strength in elderly patients. The results have been used to develop further nutritional interventions in Slovenia.
Abstract
Purpose
The need for geriatric treatment is increasing with the aging of the population. Multimorbid patients with social care problems and increased need for rehabilitation and paliative ...care are more common. Mortality of the elderly, due to falls is 2.5 times higher in Slovenia than in the other EU countries. Until the national regulation of integrated geriatric care in Slovenian health system and in other relevant environments (community, long-term care, social care) and the establishment of appropriate, licensed postgraduate training for health professionals, it is necessary to start educating wider range of health and social care personnel, for most common geriatric syndromes such as frailty, falls and NCDs. Establishing a community approach to health is one effective way to address vulnerability of elderly population.
Project description
Project Integration of geriatric care for the elderly is implementing the existing commitment from WHO Decade of healthy ageing and the Slovenian Health Care Plan until 2025. With planned activities, it will ensure equal access to quality and safe health services, integrated and comprehensive treatment and will contribute to the deinstitutionalization of the Slovenian eldest population. It will develop a unified set of tools, for the systematic identification of elderly needs, new digital tools for optimization and better communication between different levels of providers and training a wider range of new and already employed health and social care personnel, for optimal health care. Evaluation of new competency models for health care personnel, training methods and proposed clinical pathways will be carried out at the end of the project. Based on final proposals, we will establish a new approach to the system level of integrated geriatric care and bring the treatment closer to the patient's home.
Conclusions
Project will also contribute to upgrading competences of physiotherapists, kinesiologists, standard health teams in Health Promotion Centers, community nurses, family medicine and internal medicine doctors and social care workers for the integrated geriatric care for the elderly. It will address especially treatment of the physical component in geriatric syndrome, such as decreased muscle strength, balance, impaired walking and frailty, at different levels of health care and communities.
There is sufficient evidence that nutrition and frailty status are related. In order to deliver quality management of frail and pre-frail patients, clinicians and dieticians should understand the ...role of nutrition in the concept of frailty. This study examines the role of nutrition in ageing in general, malnutrition and the risk of frailty, individual nutritional factors as the risk factors of frailty and lastly nutritional interventions that have a significant role in frailty.
A literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published between 2002 and 2017. From 39,885 initial hits, 28 publications were selected.
Malnutrition or being at risk of malnutrition increases the risk of frailty and its consequences. With regard to the importance of recognizing malnutrition and the risk of malnutrition, the Mini Nutritional Assessment is a validated tool with acceptable sensitivity/specificity to be used for screening and assessment. Frail patients who are at an elevated risk of falls and fractures need Vitamin D supplementation. The promotion of a Mediterranean diet and a protein intake of at least 1–1.2 g per kilogram of body weight per day is beneficial.
One of the main variable risk factors for the development of frailty can be unsuitable nourishment and there is evidence that nutrition and frailty status are related. Successful comprehensive management of frailty requires a balanced healthy nutrition at all ages, preferably in combination with physical activity.
•Healthy older people should consume in average 1.0–1.2 g/kg of body weight of protein per day.•Nutritional interventions are effective when combined with physical exercise.•Vitamin D supplementation is important in people with 25-OH vitamin D level < 30 nmol/l.
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