Changes in nutritional status and associated factors in a geriatric post-hip fracture assessment

Aim: To examine changes in nutritional status and to identify factors associated with poor nutritional status in a comprehensive geriatric assessment after hip fracture. Methods: Nutritional status according to the Mini Nutritional Assessment Short Form (MNA-SF) was assessed in 585 hip fracture patients aged 65 years and over at baseline and six months postoperatively at our geriatric outpatient clinic. Poor nutritional status was defined as being malnourished or at risk of malnutrition according to the MNA-SF. Logistic regression analyses were used. Results: At baseline, 39%, and at follow-up, 59% of patients had poor nutritional status. After adjusting for age, higher age, American Society of Anesthesiologists (ASA)-grade 3, taking 4-10 medications, prefracture diagnosis of memory disorder, non-independent mobility, not living in own home and poor nutritional status at baseline were prognostic factors for poor nutritional status. In the geriatric assessment, MMSE < 24, difficulties in basic activities of daily living, depressive mood, longer time on Timed Up and Go (TUG) and weakened grip strength were associated with poor nutritional status. In multivariate analyses, prefracture memory disorder, MNA-SF at baseline and depressive mood, TUG and grip strength in the outpatient assessment continued to be associated with poor nutritional status at follow-up. Conclusions: Cognition and mood require attention in the nutritional care of hip fracture patients. The strong association of poor nutritional status with impaired mobility and grip strength implies an association between protein-energy malnutrition and sarcopenia. Both muscle strength and nutrition need to be addressed in comprehensive hip fracture care and rehabilitation. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.