Noelle Probert, MD, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
J Nutr Health Aging. 2020;24(8):870-877. doi: 10.1007/s12603-020-1408-2.
To investigate possible differences in morbidity, malnutrition, sarcopenia and specific drug use in patients with hip fracture, ten years apart. To analyse 1-year mortality and possible associations with variables.
A prospective, observational study.
Örebro University Hospital, Sweden.
Two cohorts of patients with hip fracture, included in 2008 (n=78) and 2018 (n=76).
Presence of comorbidity according to the Elixhauser comorbidity measure, multimorbidity defined as ≥3 comorbidities, preoperative American Society of Anaesthesiologists Classification (ASA-class), malnutrition according to the definition by the Global Leadership Initiative on Malnutrition (GLIM), sarcopenia according to the most recently revised definition by the European Working Group on Sarcopenia in Older People (EWGSOP), polypharmacy defined as ≥5 prescribed medications, use of Potentially Inappropriate Medications (PIM) and Fall-Risk-Increasing-Drugs (FRID) and postoperative 1-year mortality.
When comparing the cohorts, significant increases over time was seen for mean comorbidity-count (Difference -1; p=0.002), multimorbidity (Difference -15%; 95%CI -27;-2), ASA-class 3-4 (Difference -25%; 95%CI -39;-9) and polypharmacy (Difference -17%; 95%CI -32;-2). Prevalence of malnutrition and sarcopenia coherently decreased with 22% (95%CI 5;37) and 14% (95%CI 1;29) respectively. One-year mortality remained unchanged and a significant association was found for a higher ASA-class in 2008 (OR 3.5, 95%CI 1.1;11.6) when adjusted for age. Results on PIM exposure suggest a decrease while exposure to FRID remained high.
Our findings support an increasing morbidity within the population over time. However, also presented is a coherent decrease in malnutrition and sarcopenia, suggesting a decrease in frailty as a possible explanation for the observed unaltered mortality, in turn suggesting advances in treatment of comorbidities.
探究相隔十年的髋部骨折患者在发病率、营养不良、肌肉减少症和特定药物使用方面的差异。分析一年死亡率及可能与变量的关联。
前瞻性、观察性研究。
瑞典厄勒布鲁大学医院。
2008 年（n=78）和 2018 年（n=76）髋部骨折患者的两个队列。
根据 Elixhauser 合并症测量标准评估共病情况，共病≥3 种定义为多种共病；术前美国麻醉医师协会（ASA）分级；根据全球营养不良倡议（GLIM）定义评估营养不良；根据欧洲老年人肌肉减少症工作组（EWGSOP）最近修订的定义评估肌肉减少症；定义为≥5 种处方药的药物滥用；使用潜在不适当药物（PIM）和增加跌倒风险的药物（FRID）；术后 1 年死亡率。
与队列相比，时间上的差异显示平均共病计数显著增加（差值-1；p=0.002），多种共病（差值-15%；95%CI -27；-2），ASA 分级 3-4（差值-25%；95%CI -39；-9）和药物滥用（差值-17%；95%CI -32；-2）。营养不良和肌肉减少症的患病率分别下降 22%（95%CI 5；37）和 14%（95%CI 1；29）。1 年死亡率保持不变，2008 年时，ASA 分级较高（调整年龄后，OR 3.5，95%CI 1.1；11.6）与死亡率显著相关。关于 PIM 暴露的结果表明暴露减少，而 FRID 暴露仍然很高。
我们的研究结果支持随着时间的推移，人群发病率逐渐增加。然而，也呈现出营养不良和肌肉减少症的一致下降，这表明衰弱程度降低，这可能是观察到的死亡率不变的原因，这反过来表明在治疗共病方面取得了进展。
