slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO He PowerPoint Presentation
Download Presentation
The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO He

Loading in 2 Seconds...

play fullscreen
1 / 26

The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO He - PowerPoint PPT Presentation


  • 224 Views
  • Uploaded on

The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO Health Service. Amy Nichols, Dietetic Intern Julie Campagna, RD, Research Advisor SCO Health Service July 17th, 2008. Outline. Introduction Objectives Methodology Results

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO He' - thaddeus


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

The prevalence of protein and protein-energy malnutrition in a population of geriatric rehabilitation patients at SCO Health Service

Amy Nichols, Dietetic Intern

Julie Campagna, RD, Research Advisor

SCO Health Service

July 17th, 2008

outline
Outline
  • Introduction
  • Objectives
  • Methodology
  • Results
  • Discussion
  • Conclusion
introduction
Introduction

SCO Health Service

  • 4 facilities in Ottawa
  • Élisabeth-Bruyère Health Centre
    • Location of Geriatric Rehabilitation Program
    • GRP: 98 beds  largest inpatient rehab site

http://www.scohs.on.ca

introduction4
Introduction

Malnutrition

  • Inadequate nutrition
  • Determinants of malnutrition
    • Body weight, body fat and protein stores, lab values
  • Definitions vary within literature
introduction5
Introduction

Malnutrition

  • Protein malnutrition: Alb <35 g/L ; BMI ≥24.0
  • Protein-energy malnutrition (PEM): Alb <35 g/L ; BMI <24.0

Salva et al (2004), Manual of Clinical Dietetics, Mahan et al (2004)

introduction6
Introduction

Malnutrition

  • Prevalence:
    • 35 – 85% (4)
    • Geriatric unit: 35% – 61% with 93% at risk (5,6)
    • Hospitalized: 23% (7)
    • Rehabilitation: 56.1% (8)
introduction7
Treatment:

Nutritional supplementation

 muscle strength,  bone loss (10)

 LOS (10)

Weight loss prevention (11)

Malnutrition

Complications:

 admission rates (9)

 rates of morbidities (8)

 death rates (5)

Introduction
objectives
Objectives
  • To assess the overall nutritional status of the group of patients admitted to the SCO Health Service GRP during 2006
  • To calculate the prevalence of protein and protein-energy malnutrition within this group
methodology
Methodology

Subjects

  • 357 eligible GRP patients
  • Admitted January 1st – December 31st, 2006
  • Inclusion criteria:
    • >65 years of age
    • Stable medical condition
    • Serum albumin concentration, height and weight recorded within 7 days of admission
methodology10
Methodology

Methods

  • Design: Retrospective chart review
  • Collection of pertinent information from charts:
    • Age
    • Gender
    • Reason for admission to GRP
    • Length of stay (LOS)
    • Relevant current diagnoses
methodology11
Methodology

Methods

  • Kidney, liver, inflammatory disease identified as having negative impact on serum albumin concentration (5,8,12,13)

Total group

“Acutely Ill” subgroupthose who presented with kidney, liver, inflammatory disease

“Non-Acutely Ill” subgroupthose who did not present with these conditions

methodology12
Methodology

Methods

  • Classification of protein or protein-energy malnourished patients using Alb and BMI
  • Calculation of prevalence in total group, “Acutely Ill” and “Non-Acutely Ill” subgroups

Prevalence = # of malnourished patients x 100 total # of patients

methodology13
Methodology

Statistics

  • SPSS version 16.0
  • Frequency: Crosstabulations
  • Effect of illness: Chi Square Test of Independence (X2) (p<0.05)
  • Significance: binomial test (p<0.05)
results
Results

Participant characteristics

  • 306 eligible patients
  • Most common reasons for admission:
    • 50.7% following fracture(s) (n=155)
    • 20.6% following surgery (n=63)
    • 16.7% for deconditionning (n=51)
results15
Results

Participant characteristics

results16
Results

Prevalence

*p=0.755; **p=0.470; ***p=0.372

discussion
Discussion

Results

  • Objectives accomplished
  • Prevalence: 49% vs 56.1% (8)
    • Difference likely due to varying definitions of malnutrition and data used to determine status
  • Effect of Illness: 30.9% vs 21.2%
    • Consistent with expected results, though not significant
discussion18
Discussion

Limitations

  • Human error
  • Retrospective design
    • Individual variability; limited to data already in charts
  • Albumin as marker of nutritional status
    • Overlap (12), morbidities (14,15), inflammation (16), negative acute phase reactant (3)
  • BMI as marker of nutritional status
    • Possible to be malnourished and have normal BMI
discussion19
Discussion

Recommendations

  • Prospective study
  • Alternative methods of identifying and confirming malnutrition
    • Ex: Mini-Nutritional Assessment (MNA)
    •  misdiagnosis, better identification of at risk
conclusion
Conclusion
  • Malnutrition   in disease/mortality rates
  • Treatment: dietary therapies specific to individual populations
  • Objective of study to assess nutritional status of patients at Élisabeth-Bruyère Health Centre’s GRP
  • Despite limitations and lack of statistically significant results, substantial portion of patients found to be malnourished
conclusion21
Conclusion

Implications

  • Need for dietary intervention identified
  • Justification for implementation of supplementation or food enrichment trial
  • Benefits able to be quantified and evaluated
  • Improvement of health outcome for future patients
acknowledgements
Acknowledgements
  • Special thanks to the following people for their contribution to the development and evolution of this research project:
    • Julie Campagna – Research Advisor
    • Marisa Leblanc – Research Mentor
    • Carole Ryall and Yvon Rollin – SCO Health Service
    • Louise Gariepy – Statistician
    • Danielle – Peer Reviewer
    • Barbara Khouzam – Research Coordinator
references
References

1. Salva A, Corman B, Andrieu S et al. Minimum data set for nutritional intervention studies in elderly people. J Gerontol 2004:59:724-729.

2. American Dietetic Association and Dietitians of Canada. Manual of clinical dietetics 6th edition. Nutrition assessment of adults. Illinois: Library of Congress, 2000.

3. Mahan LK, Escott-Strump S. Krause’s food, nutrition & diet therapy 11th edition. Philadelphia: Elsevier, 2004:440.

4. Novartis Nutrition Corporation. Resource manual for long term care. Mississauga, 2006.

5. Sullivan DH, Walls RC, Bopp MM. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: a follow-up study. J Am Geriatr Soc 1995:43:507-512.

6. Rypkema G, Adang E, Dicke H et al. Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition. J Nutr Health Aging 2003:8:122-7.

references24
References

7. Guigoz Y. The Mini Nutritional Assessment (MNA®) review of the literature – what does it tell us? J Nutr Health Aging 2006:10:466-487.

8. Donini LM, De Bernardini L, De Felice MR et al. Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients. Aging Clin Exp Res 2004:16:132-138.

9. Sullivan DH. Risk factors for early hospital readmission in a select population of geriatric rehabilitation patients: the significance of nutritional status. J Am Geriatr Soc 1992:40:792-798.

10. Schürch M-A, Rizzoli R, Slosman D et al. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized double-blind, placebo-controlled trial. Ann Intern Med 1998:128:801-809.

11. Gazzotti C, Arnaud-Battandier F, Parello M et al. Prevention of malnutrition in older people during and after hospitalization: results from a randomised controlled clinical trial. Age Aging 2003:32:321-325.

references25
References

12. Covinsky KE, Covinsky MH, Palmer RM et al. Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: different sides of different coins? J Am Geriatr Soc 2002:50:631-637.

13. Sergi G, Coin A, Volpato S et al. Role of visceral proteins in detecting malnutrition in the elderly. Eur J Clin Nutr 2006:60:203-209.

14. Sullivan DH, Patch GA, Walls RC et al. Impact of nutritional status on morbidity and mortality in a select population of geriatric patients. Am J Clin Nutr 1990:51:749-758.

15. Sullivan DH, Walls RC. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients. J Am Geriatr Soc 1994:42:471-477.

16. Sullivan DH, Roberson PK, Johnson LE et al. Association between inflammation-associated cytokines, serum albumins, and mortality in the elderly. J Am Med Dir Assoc 2007:8:458-463.

questions

Questions?

Thank you!