Nutritional status and frailty have 'multiplicative effect' on adverse outcomes for elderly: Korea study
The elderly population worldwide is growing, from 461 million people aged 65 and older in 2004 to an estimated 2 billion by 2050. In South Korea, the percentage of elderly in the country's population rose from 7.2% in 2000 to 11% in 2010, and is predicted to increase to 20.8% by 2026.
Along with this comes a higher prevalence of frailty and malnutrition, the former having been found to raise the risk of adverse outcomes like impaired functional and cognitive status, falls, long-term hospital assistance, and mortality.
However, while nutritional deficiency affects frailty and both are closely related to mortality and morbidity in seniors, there have been no studies on the subject.
Researchers at Chonnam National University and Korea Institute of Health and Social Affairs therefore conducted a study to determine whether the interaction of frailty and nutritional deficiency is additive and / or multiplicative.
Taking data from the 2008 Survey on Health and Welfare Status of the Elderly in Korea, they assessed 8,907 respondents aged 65 and above.
They then reported that when it came to mortality, the hazard ratios of frailty and high nutritional risk were 2.63 and 1.04, respectively. In terms of mortality and long-term hospitalisation, the respective values were 2.56 and 1.18.
They added: "In the interaction effect model, multiplicative interaction existed between frailty and nutritional status. Participants with frail x high nutritional risk had much higher hazard ratios for mortality and mortality and long-term hospitalisation risk."
They further stated that malnutrition and frailty are 'two distinct conditions' despite being closely linked, and for this reason, should be separately evaluated using 'specific instruments' as part of a geriatric assessment.
They were referring to a previous study that had found almost 90% of its particpants well-nourished and only 1.8% malnourished. However, among frail individuals, only 63.9% were malnourished and 36.1% were well nourished.
In conclusion, they wrote: "We found that frailty and nutritional status have a multiplicative effect on adverse outcomes in community-dwelling older adults.
"Frail, malnourished individuals have a higher risk of adverse outcomes than frail, well-nourished individuals. Nutritional status assessment in older adults is important because improving nutritional status through supplementation may also improve frailty."
Source: Archives of Gerontology and Geriatrics
"Interaction between frailty and nutritional status on mortality and long-term hospitalization in older Koreans: A retrospective analysis of data from the 2008 Survey on Health and Welfare Status of the Elderly in Korea"
Authors: Yu-Ri Choe, et al.
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