Wang Zitong, Dong Ying-Qiu, Kumari Shikha, Murphy Diarmuid, Merchant Reshma Aziz
Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
The Value Driven Outcome Office, National University Health System, Singapore 119228, Singapore.
Nutrients. 2025 Aug 12;17(16):2612. doi: 10.3390/nu17162612.
Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk.
We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment.
We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan-Meier analysis and multivariate logistic regression models.
A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349-1.664, < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001-1.040, = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753-0.890, < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922-3.443, < 0.001; CFS: aOR = 2.348, 95% CI: 1.738-3.156, < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210-3.922, < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082-1.902, = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005-1.588, = 0.045).
Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age.
营养不良会导致衰弱性痴呆，加剧包括死亡风险在内的不良健康后果。
我们旨在调查衰弱和功能下降者的营养不良风险对患有痴呆和/或认知障碍的老年人短期死亡率的影响。
我们进行了一项回顾性队列研究，纳入了2677名年龄≥65岁、于2022年3月至2023年12月期间出院且诊断为痴呆或认知障碍的住院患者。信息来自电子病历。使用临床衰弱量表（CFS）和医院衰弱风险评分（HFRS）评估衰弱情况，使用病前日常生活活动（ADL）评分评估功能状态，使用3分钟营养筛查（3-Min NS）工具评估营养不良风险。使用Kaplan-Meier分析和多变量逻辑回归模型检验与30天和90天死亡率的关联。
共有29.2%的人存在营养不良风险，在高龄老人中最高（37.1%）。30天死亡率与CFS（调整后比值比[aOR]=1.498，95%置信区间[CI]：1.349-1.664，P<0.001）、HFRS（aOR=1.020，95%CI：1.001-1.040，P=0.038）和ADL（aOR=0.819，95%CI：0.753-0.890，P<0.001）显著相关。在所有模型中，营养不良风险显示出最强的关联（ADL：aOR=2.573，95%CI：1.922-3.443，P<0.001；CFS：aOR=2.348，95%CI：1.738-3.156，P<0.001；HFRS：aOR=2.944，95%CI：2.210-3.922，P<0.001）。90天死亡率与营养不良风险之间的关联在所有模型中均保持显著，包括调整了CFS和ADL的模型。值得注意的是，营养不良与CFS之间的相互作用进一步放大了高龄老人的死亡风险（30天：aOR=1.435，95%CI：1.082-1.902，P=0.012；90天：aOR=1.263，95%CI：1.005-1.588，P=0.045）。
营养不良风险独立预测了患有痴呆或认知障碍的老年人的短期死亡率，特别是在那些有衰弱、功能下降和高龄的人群中。
