Nutritional status and delirium in long-term care elderly individuals

Culp, Kennith; Cacchione, Pamela Z.

doi:10.1016/j.apnr.2006.09.002

Cited by 24 publications

(20 citation statements)

References 71 publications

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“…8 We selected intervention components that had evidence to support their use in ameliorating delirium risk factors that were highly prevalent in nursing home residents, including cognitive impairment, 3 immobility, 7,9 dehydration, 7,9,10 malnutrition, 11 and sleep problems. 7 We chose to employ a CNA to deliver HELP-LTC because CNAs have the skills and knowledge to deliver HELP components and they can be drawn from a large available nursing home workforce pool.…”

Section: Methodsmentioning

confidence: 99%

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Boockvar

Teresi

Inouye

2016

J American Geriatrics Society

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Nursing home (NH) patients have a high prevalence of delirium risk factors, experience 2-4 acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions that is similar to that of hospitalized older adults. Many NH patients with delirium do not return to their prior level of cognitive function. As compared to those without delirium, they are more likely to die, be hospitalized, and less likely to be discharged home. Research on the prevention or treatment of delirium in the NH remains limited. This article describes the development and pilot-testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (“HELP-LTC”). We developed delirium-risk reducing activities appropriate for functionally-impaired NH patients that were delivered during treatment for and recovery from acute illness, a novel patient targeting approach. Activities were provided by an expertly trained certified nursing assistant (CNA) who visited patients throughout the facility. We report on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. We also report on the integration and acceptance of the CNAs’ activities by patients and staff. Hospitalization and death were ascertained in a non-intervention comparison group. Findings support a test of the intervention in a controlled trial. The potential impact is great: there are approximately 1.4 million NH patients in the U.S. and an estimated 1 million with dementia or cognitive impairment, a key delirium risk factor. An intervention would be broadly adoptable if the cost of the program’s CNAs were offset by a reduction in health care costs through prevention of hospitalization.

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Section: Methodsmentioning

confidence: 99%

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Boockvar

Teresi

Inouye

2016

J American Geriatrics Society

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“…delirium, falls, malnutrition, and functional disability, with muscle measures were previously studied in specific populations. Low muscle mass was associated with increased prevalence of delirium in older participants living in nursing homes [12] . Low muscle mass and muscle strength were associated with increased prevalence of falls in the past year in community-dwelling older adults [13] and in older outpatients [23] , and with dependence in ADL and malnourishment in older hospitalized patients [14] .…”

Section: Discussionmentioning

confidence: 99%

“…However, the included studies were small and did not identify individual risk factors for a decrease in muscle strength and muscle mass. Due to an impaired physiological reserve, patients at risk of geriatric conditions like delirium, falls, malnutrition, and functional disability might have an even greater risk of physical deterioration compared to patients not at risk [12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Muscle Strength and Muscle Mass in Older Patients during Hospitalization: The EMPOWER Study

et al. 2017

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Background: Low muscle strength and muscle mass are associated with an increased length of hospital stay and higher mortality rate in inpatients. To what extent hospitalization affects muscle strength and muscle mass is unclear. Objective: We aimed to assess muscle strength and muscle mass at admission and during hospitalization in older patients and its relation with being at risk of geriatric conditions. Methods: The EMPOWER study included patients aged 70 years and older, admitted to 4 wards of the VU University Medical Center in the Netherlands between April and December 2015. At admission, patients were screened for being at risk of 4 geriatric conditions: delirium, falls, malnutrition, and functional disability. At admission and at discharge, muscle strength and muscle mass were assessed. Results: A total of373 patients (mean age, standard deviation [SD]: 79.6, 6.38 years) were included at admission, and 224 patients (mean age, SD: 80.1, 6.32 years) at discharge. At admission, lower muscle strength in both female and male patients and low muscle mass in male patients were associated with being at risk of a higher cumulative number of geriatric conditions. Muscle strength increased during hospitalization, but no change in muscle mass was observed. Changes in muscle measures were not associated with being at risk of geriatric conditions. Discussion: Older patients with lower muscle strength and muscle mass at admission were at risk of a higher cumulative number of geriatric conditions. However, being at risk of geriatric conditions did not forecast further decrease in muscle strength and muscle mass during hospitalization

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“…Nutritional requirements in individuals with delirium in intensive care are routinely addressed using tube or parenteral feeding regimes, although these regimens often fail to meet the person's caloric needs. Delirious individuals outside of the intensive care unit are particularly vulnerable to underfeeding and weight loss, none more so than in the nursing home . Loss of independence with self‐feeding, poor‐quality food, and polypharmacy are documented risk factors for undernutrition in institutionalized older adults, so it behooves geriatricians to comprehensively screen for and treat malnutrition across care settings to prevent delirium, new‐onset or worsening frailty, and functional decline.…”

Section: Research Directionsmentioning

confidence: 99%

Vulnerability: The Crossroads of Frailty and Delirium

Quinlan

Marcantonio

Inouye

et al. 2011

J American Geriatrics Society

122

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Frailty and delirium, though seemingly distinct syndromes, both result in significant negative health outcomes in older patients. Frailty and delirium may be different clinical expressions of a shared vulnerability to stress in older patients and future research will determine whether this vulnerability is age-related, pathological, genetic, or environmental or, most likely, a combination of all of these factors. This paper explores the clinical overlap of frailty and delirium, describes possible pathophysiological mechanisms linking the two, and proposes research opportunities to further our knowledge of the interrelationships between these important geriatric syndromes. Frailty, a diminished ability to compensate to stressors, is generally viewed as a chronic condition, while delirium is an acute change in attention and cognition. However, there is a developing literature on transitions in frailty status around acute events, as well as on delirium as a chronic, persistent condition. If frailty predisposes a patient to delirium and delirium delays recovery from a stressor, then both syndromes may contribute to a downward spiral of declining function, increasing risk, and negative outcomes. Additionally, frailty and delirium may have shared pathophysiology, such as inflammation, atherosclerosis, and chronic nutritional deficiencies, which will require further investigation. The fields of frailty and delirium are rapidly evolving and future research may help to better define the interrelationship of these common and morbid geriatric syndromes. Because of the heterogeneous pathophysiology and presentation associated with frailty and delirium, typical of all geriatric syndromes, multicomponent prevention and treatment strategies are most likely to be effective, and should be developed and tested.

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Nutritional status and delirium in long-term care elderly individuals

Cited by 24 publications

References 71 publications

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Muscle Strength and Muscle Mass in Older Patients during Hospitalization: The EMPOWER Study

Vulnerability: The Crossroads of Frailty and Delirium

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