357e265f2e49b95b656d4f87ebe169bf  pmc_10780721.pdf
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18e05ee94c2b12fe324eeef7d09f8480dd3d85b7d904ec7049e9b8527fd9e992  pmc_10780721.pdf

Title:           Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia
Subject:         Background and aims: Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. Methods: This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30–60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. Results: In total, 144 patients of 77.15  7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5  1.6, the Pneumonia Severity Index was 98.1  25.9, and the previous Barthel Index (BI) was 93.06  17.13. Hospital stay was9.72  7.88 days. After 44.6  14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09–1.26), previous institutionalization (29.1; 3.7–224.7), BI (1.09; 1.05–1.14), CCI (1.5; 1.1–2.1), and length of stay (1.1, 1.02–1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93–0.99) and length of stay (1.06; 1.00–1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20–51.21), BI (0.95; 0.92–0.98), and length of stay (1.12; 1.04–1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. Conclusions: After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
Keywords:        vitamins; nutrition assessment; micronutrients; malnutrition
Author:          Sandra Clotet-Vidal, M. Encarna Saez Prieto, Pol Duch Llorach, Álvaro Santos Gutiérrez, Jordi Casademont Pou and Olga H. Torres Bonafonte
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 Date: 2024-04-23 02:35:52 CEST
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     Item: 
      Title: Introduction 
      Destination: section.1
     Item: 
      Title: Methods and Patients 
      Destination: section.2
      Children: 
       Item: 
        Title: Study Design 
        Destination: subsection.2.1
       Item: 
        Title: Subjects 
        Destination: subsection.2.2
       Item: 
        Title: Data Collection and Measures 
        Destination: subsection.2.3
       Item: 
        Title: Statistical Analysis 
        Destination: subsection.2.4
     Item: 
      Title: Results 
      Destination: section.3
      Children: 
       Item: 
        Title: Functional Decline and Institutionalization after the CAP Episode 
        Destination: subsection.3.1
       Item: 
        Title: General Nutritional Assessment 
        Destination: subsection.3.2
     Item: 
      Title: Discussion 
      Destination: section.4
     Item: 
      Title: Conclusions 
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     Item: 
      Title: References
      Destination: appendix.A.
   Info: 
    Title: Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia
    Author: Sandra Clotet-Vidal, M. Encarna Saez Prieto, Pol Duch Llorach, Álvaro Santos Gutiérrez, Jordi Casademont Pou and Olga H. Torres Bonafonte
    Subject: Background and aims: Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. Methods: This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30 60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. Results: In total, 144 patients of 77.15  7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5  1.6, the Pneumonia Severity Index was 98.1  25.9, and the previous Barthel Index (BI) was 93.06  17.13. Hospital stay was9.72  7.88 days. After 44.6  14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09 1.26), previous institutionalization (29.1; 3.7 224.7), BI (1.09; 1.05 1.14), CCI (1.5; 1.1 2.1), and length of stay (1.1, 1.02 1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93 0.99) and length of stay (1.06; 1.00 1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20 51.21), BI (0.95; 0.92 0.98), and length of stay (1.12; 1.04 1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. Conclusions: After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
    Keywords: vitamins; nutrition assessment; micronutrients; malnutrition
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