Goisser Sabine, Schrader Eva, Singler Katrin, Bertsch Thomas, Gefeller Olaf, Biber Roland, Bail Hermann Josef, Sieber Cornel C, Volkert Dorothee
Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
J Am Med Dir Assoc. 2015 Aug 1;16(8):661-7. doi: 10.1016/j.jamda.2015.03.002. Epub 2015 Apr 9.
Hip fractures (HFs) in old age frequently cause severe functional impairment and deteriorating autonomy in everyday life. Many older patients with HFs are malnourished or at risk of malnutrition. In this study, we examined the relationship between nutritional status of geriatric patients before HF and their functional and clinical course up to 6 months after hospital discharge.
Observational study with follow-up after 6 months.
Four wards of the department of trauma and orthopedic surgery of a large urban maximum care hospital (Klinikum Nürnberg, Nuremberg, Germany).
Geriatric patients aged ≥75 years with surgically repaired proximal femoral fracture.
Prefracture nutritional status was determined by Mini Nutritional Assessment (MNA). Comorbidities and complications during hospital stay were obtained from medical documentation. Functional status before HF, postoperatively, at hospital discharge, and 6 months later was assessed by Barthel Index for activities of daily living (ADL) and patients' mobility level and related to MNA categories. Associations were evaluated using χ(2), Fisher exact, Kruskal-Wallis, Mann-Whitney-U, Jonckheere-Terpstra, and Cochrane-Armitage tests as appropriate, as well as analysis of covariance with repeated measures.
Of 97 included patients, 17% were malnourished and 38% at risk of malnutrition before HF. Participants with (risk of) malnutrition were equally mobile but more dependent in ADL prior to HF than well-nourished patients (P < .001). Independent of nutritional status, after 6 months 68% of participants had not regained their prefracture level of independence in ADL. According to analysis of covariance, the ADL development over time until follow-up 6 months after hospital discharge did not depend on nutritional status. However, at follow-up malnourished patients more often suffered from remaining losses in ADL ≥25% of initial Barthel Index points (P = .033) and less often had regained their prefracture mobility level (P = .020) than well-nourished patients. Clinical course did not differ significantly between the groups with different nutritional status.
In this study with geriatric HF patients from all functional and cognitive levels, worse prefracture nutritional status was associated with worse functional status and more frequent remaining functional loss, whereas the trajectory of ADL recovery and clinical course did not differ significantly. Further studies with sufficient statistical power are needed to substantiate these inconclusive results. In order to clarify the association of nutritional status with functional and clinical course in geriatric patients after HF, they should preferably focus on the role of nutritional management during the hospital stay.
老年髋部骨折（HF）常导致严重的功能障碍，并使日常生活中的自主能力不断下降。许多老年髋部骨折患者存在营养不良或有营养不良风险。在本研究中，我们调查了老年髋部骨折患者骨折前的营养状况与其出院后6个月内的功能及临床病程之间的关系。
为期6个月的随访观察性研究。
德国纽伦堡一家大型城市特级护理医院（纽伦堡临床医院）创伤与矫形外科的四个病房。
年龄≥75岁、接受过股骨近端骨折手术修复的老年患者。
采用微型营养评定法（MNA）确定骨折前的营养状况。从医疗记录中获取住院期间的合并症和并发症情况。通过日常生活活动能力（ADL）巴氏指数评估骨折前、术后、出院时及6个月后的功能状态，以及患者的活动水平，并与MNA类别进行关联分析。根据情况使用χ²检验、Fisher精确检验、Kruskal-Wallis检验、Mann-Whitney-U检验、Jonckheere-Terpstra检验和Cochrane-Armitage检验评估相关性，以及进行重复测量的协方差分析。
97名纳入研究的患者中，17%在骨折前营养不良，38%有营养不良风险。存在（有风险）营养不良的参与者在骨折前的活动能力相同，但在ADL方面比营养良好的患者更依赖他人（P <.001）。与营养状况无关，6个月后，68%的参与者在ADL方面未恢复到骨折前的独立水平。根据协方差分析，直到出院后6个月随访时ADL随时间的变化并不取决于营养状况。然而，在随访时，营养不良的患者比营养良好的患者更常出现ADL剩余损失≥初始巴氏指数点的25%（P = 0.033），且更少恢复到骨折前的活动水平（P = 0.020）。不同营养状况组之间的临床病程无显著差异。
在这项针对所有功能和认知水平老年髋部骨折患者的研究中，骨折前营养状况较差与功能状态较差及更频繁的功能持续丧失相关，而ADL恢复轨迹和临床病程无显著差异。需要进行具有足够统计学效力的进一步研究来证实这些不确定的结果。为了阐明老年髋部骨折患者营养状况与功能及临床病程之间的关联，研究最好聚焦于住院期间营养管理的作用。
