ObjectiveThe aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.ResultsPatients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).ConclusionsContrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.Trial registration numberClinicalTrials.gov: NCT02297581.

T he prevalence of malnutrition in one study in a United Kingdom hospital is about 11-44% and it is increasing to 29-61% in the elderly. 1 The risk of undernutrition and malnutrition range from loss of appetite, decreased taste buds, abnormality in digestion and malabsorption, oral care and teeth problems. 2 Malnutrition also affects the immune system, the healing of wounds, loss of muscle mass and increased length of stay in hospital. [3][4][5][6] Nutrition screening in the elderly is important and those who are at risk of malnutrition should be detected early in order to provide appropriate nutrition support in time. Adam et al. 4 reported that medical staff, including doctors and nurses, were concerned about malnutrition in only 19 percent of the total at risk patients in the hospital. Usually, the process to screen for risk of malnutrition takes a lot of time and it is difficult to do because there are a lot of factors: history of body weight, weight change in the past 6 months, body mass index, anthropometry, nutrition chemical data and dietary history. A Mini Nutritional Assessment (MNA) is developed to screen malnutrition in the elderly and it is reported that the MNA is related to malnutrition. 5 MNA has been accepted by 71.3% of dietitians, but is only used to screen malnutrition in the elderly in around 20% of cases, 6 as MNA takes a lot of time (average 15 minutes per person) and is not always easy to measure arm and calf circumference. Mostly, the elderly have no data of current body weight (54.1%) nor of height (25.9%) because they cannot be weighed or stand. 7 In Thailand, Elimitus Professor Comindr S. has developed the Nutrition Alert Form (NAF) which is easy to use and can screen nutrition status in people who do not have body weight by total lymphocyte (commonly blood test) or serum albumin. NAF has been accepted by the Asian Pacific Journal of Nutrition. 8 But, there have been no reports of the use of NAF in the elderly. Therefore, the objective of this research is to study the correlation and concordance between NAF and MNA Abstract OBJECTIVES: This research aimed to study the correlation between a Nutrition Alert Form (NAF) and a Mini Nutritional Assessment (MNA) in evaluating the nutritional status of the elderly and evaluated the relation between NAF, MNA and biochemical nutrition data. MATERIALS AND METHODS: A cross sectional study was conducted in 153 outpatient and inpatient elder at Bangkok Hospital from February to September 2015. The nutrition status of participants was screened by a longevity nurse with MNA and NAF and serum pre-albumin was collected. After that, the dietitian evaluated the nutrition assessment and recalled dietary habit, and the reason of weight change. Statistical analysis of this study used SPSS (Statistical Package for Social Science) version 19.0. Kappa index to analyze the agreement between NAF and MNA. The correlation was analyzed by Spearman's correlation coefficient. RESULTS:The kappa index between the NAF and the MNA (standard) which was moderate: K 0.563 w...

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