Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Study Selection
2.2.1. Inclusion Criteria
2.2.2. Exclusion Criteria
2.3. Data Extraction
2.4. Quality Assessment
3. Undernutrition in Patients with Hip Fracture
3.1. Prevalence of Undernutrition
3.2. Impact of Undernutrition on Clinical Outcomes
3.3. Highlights of Undernutrition in Hip Fracture
4. Sarcopenia in Patients with Hip Fracture
4.1. Definition of Sarcopenia
4.2. Prevalence of Sarcopenia
4.3. Impact of Sarcopenia on Clinical Outcomes
4.4. Highlights of Sarcopenia in Hip Fracture
5. Frailty in Patients with Hip Fracture
5.1. Definition of Frailty
5.2. Prevalence of Frailty
5.3. Impact of Frailty on Clinical Outcomes
6. Nutritional Intervention for Patients with Hip Fracture
7. Combined Nutritional Intervention with Rehabilitation Exercise
8. Advanced Strategies for Improvement of Clinical Outcomes
9. Comprehensive Intervention Based on Combined Nutritional Intervention with Rehabilitation Exercise for Patients with Hip Fractures
10. Strengths and Limitations
11. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Author, Year, Country | Design, Setting | Age (Years) Male/Female, n (%) | Sample Size | Evaluation Tool (Timing of Assessment) | Prevalence of Undernutrition | Outcome | Main Results |
---|---|---|---|---|---|---|---|
Miyanishi et al., 2010 [26] Japan | Observational study, acute hospital | Mean 79 24 (18.9)/103 (81.1) | 129 | Serum albumin BMI | Not stated | Four-year mortality | In, multiple logistic regression analysis, serum albumin level (OR 5.854, p < 0.001) and BMI (OR 1.169, p = 0.02) significantly influenced mortality. |
Koren-Hakim et al., 2012 [13] Israel | Observational study, acute hospital | Mean 83.5 (SD 6.0) 61 (28.4)/154 (71.6) | 215 | MNA-SF (at admission and up to 48 h after admission) | Well-nourished: 44.2% At risk: 44.2% Malnourished: 11.6% | In-hospital complications Mortality (up to 36 months) | Only comorbidity and low functioning can predict long-term mortality (a minimum of 12 up to 36 months). Nutritional status had no effect on outcomes. |
Gumieiro et al., 2012 [28] Brazil | Prospective observational study, general hospital | Mean 80.2 (SD 7.3) 20 (23.3)/66 (76.7) | 86 | MNA-FF NRS-2002 (within the first 72 h of the patient’s admission) | Not stated | Gait status (patients who could walk or could not walk) and mortality at 6 months after hip fracture | In a multivariate analysis, only the MNA-FF was associated with gait status (OR 0.773, 95% CI 0.663−0.901) and mortality 6 months after hip fracture (HR 0.869, 95% CI 0.757−0.998). |
Drevet et al., 2014 [29] France | Prospective observational study, university hospital | Mean 86.1 (SD 4.4) 15 (30)/35 (70) | 50 | MNA-FF (no details provided) | At risk for PEM: 58% PEM: 28% | Activities of daily living Hospital stay | PEM was associated with functional dependence (p = 0.002) and 8 days longer mean hospital stay (p = 0.012). |
Goisser et al., 2015 [17] Germany | Prospective observational study, urban maximum care hospital | Mean 84 (SD 5) (21)/(79) | 97 | MNA-FF (preoperative nutritional status was evaluated retrospectively) | At risk: 38% Malnourished: 17% | Barthel Index after 6 months | Malnourished patients suffered more from remaining losses in ADL ≥25% of initial Barthel Index points (p = 0.033), and regained their prefracture mobility level to a lesser extent (p = 0.020) than well-nourished patients. |
Bajada et al., 2015 [16] UK | Retrospective observational study, general hospital | Mean 79 years (range: 60–96 years) 19 (18)/89 (82) | 108 | Serum albumin (normal level > 35 g/L) Lymphocyte count (normal 1−4.5 × 109 L) (on admission) | No details provided | Failure of internal fixation | In binary logistic regression analysis, lymphocyte count, and albumin levels were independent predictors of failure of internal fixation. |
van Wissen et al., 2016 [18] Netherlands | Retrospective cohort study, acute hospital | Mean Malnourished: 85 (SD 5) At risk: 84 (SD 5) Well-nourished: 83 (SD 5) 61 (27.0)/165(73.0) | 226 | MNA-FF (before surgery) | Well-nourished: 4.9% At risk: 26.5% Malnourished: 68.6% | Hospital stay Postoperative complications, Mortality (in-hospital and 1-year) | Preoperative malnutrition is associated with in-hospital (OR 4.4; 95% CI 1.0, 20.4) and 1-year mortality (OR 2.7; 95% CI 1.1, 7.0). Malnutrition was not associated with any other outcome. |
Miu et al., 2017 [30] China | Observational study, rehabilitation unit | Mean 83.5 (SD 7.5) 74 (33.9)/44 (66.1) | 218 | MNA-SF (within 72 h of admission) | Well-nourished: 21.1% At risk: 52.6% Malnourished: 26.1% | Functional status and place of residence at 6 months Hospital stay Mortality (in-hospital, 6 months) | Functional recovery was slower in the malnourished group. In-patient mortality was higher in malnourished patients than in those at risk of malnourishment and well-nourished individuals. |
Helminen et al., 2017 [12] Finland | Prospective observational study, acute hospital | No details provided 169 (28.5)/425 (71.5) | 594 | MNA-SF MNA-FF Serum albumin (preoperative period) | MNA-SF Well-nourished: 53% At risk: 40% Malnourished: 7% MNA-FF Well-nourished: 35% At risk: 58% Malnourished: 7% Serum albumin <34 g/L: 46% | Poorer mobility (transfer to more assisted living accommodation) Mortality (1 month, 4 months, and 1 year after fracture) | Risk of malnutrition and malnutrition measured by MNA-FF predicted mobility and living arrangements within 4 months of hip fracture. At 1 year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements when measured by the MNA-FF. Malnutrition, but not risk measured by the MNA-SF, predicted living arrangements at all time points. Neither measure predicted 1-month mobility. |
Vosoughi et al., 2017 [25] Iran | Cross-sectional study, university hospital | Mean 75.7 (SD 10.6) 318 (43.9)/406 (56.1) | 724 | BMI (at admission) | No details provided | Mortality at 3 months and 1 year | Multivariate logistic regression analysis recognized age (OR 1.08; 95% CI 1.05, 1.11), BMI (OR 0.88; 95% CI 0.82−0.96), and smoking (OR 1.76; 95% CI 1.05−2.96) as major independent risk factors for 1- and 3-year mortality. |
Mazzola et al., 2017 [14] Italy | Prospective observational study, university hospital | Mean 84.0 (SD 6.6) 106 (25.5)/309 (74.5) | 415 | MNA-SF (within 24 h of admission) | Well-nourished: 36.6% At risk: 44.6% Malnourished: 18.8% | Postoperative delirium | Multivariate regression analysis showed that those at risk of malnutrition (OR 2.42; 95% CI = 1.29–4.53) and those overtly malnourished (OR 2.98; 95% CI = 1.43–6.19) were more likely to develop postoperative delirium. |
Inoue et al., 2017 [15] Japan | Prospective observational study, three acute hospitals | Mean 82.7 (SD 9.2) 69 (10.1)/165 (80.9) | 204 | MNA-SF (first few days after admission before surgery) | Well-nourished: 27.0% At risk: 48.0% Malnourished: 25.0% | FIM at discharge | In multiple regression analyses, MNA-SF was a significant independent predictor for FIM at discharge (well-nourished vs. malnourished, β = 0.86, p < 0.01). |
Nishioka et al., 2018 [11] Japan | Retrospective observational cohort study, convalescent rehabilitation units | Mean 85 years (21.8)/(78.2) | 110 | MNA-SF (on admission and at discharge) | Only malnourished patients at admission were included | FIM at discharge Discharged to home | Multivariable analysis revealed a significant association between improvement in nutritional status and higher FIM score at discharge (β = 7.377, p = 0.036). No association with discharge to home. |
Stone et al., 2018 [27] USA | Retrospective observational cohort study, acute hospital | Not stated 241(39.7)/366(60.3) | 607 | Albumin Prealbumin Total protein Vitamin D | Not stated | Thirty-day readmission | The model incorporated four nutritional makers (albumin, prealbumin, total protein, and vitamin D) with an internally cross-validated C-statistic of 0.811 (95% CI; 0.754, 0.867). |
Zanetti et al., 2018 [19] Italy | Observational study, acute hospital | Mean 84.7 (SD 7.4) 259 (21.4)/952 (78.6) | 1211 | MNA-FF (within 72 h from admission) | Mean MNA-FF score: 22.3 (SD 5.1) | Three, six and twelve-month mortality | Poor nutritional status was significantly associated with 3, 6, and 12- month mortality after adjustment for potential confounders. |
Kotera et al. 2019 [22] Japan | Retrospective observational cohort study, acute hospitals | Mean 87 (SD 6) Not stated | 607 | GNRI CONUT | GNRI Normal: 0.8% Light: 3.0% Moderate: 5.7% Severe: 14.4% CONUT Normal: 1.6% Light: 2.7% Moderate: 8.1% Severe: 38.9% | Mortality of 180 days | The GNRI value in the nonsurvivors was significantly lower than that in the survivors. The CONUT value in the nonsurvivors was significantly higher than that in the survivors. |
Yagi et al., 2020 [21] Japan | Retrospective observational cohort study, community-based hospital | Median 86 years (interquartile range 80–90) (19.9)/(80.1) | 211 | CONUT (admission day) | Malnourished (CONUT score >1): 78.7% | Postoperative complications | Multivariable analysis found that the CONUT score was an independent risk factor for postoperative complications (OR 1.21; 95% CI = 1.01–1.45). |
Hao et al., 2020 [23] USA | Retrospective observational study (secondary analysis), 47 sites in North America | Mean 82 (SD 7) (27)/(73) | 290 | 25-hydroxyvitamin D GNRI (preoperative) | 25-hydroxyvitamin D (ng/mL) ≥30: 17% 20 to <30: 37% 12 to <20: 34% <12: 12% GNRI No risk: 33 Some risk: 33 Major/moderate risk: 34 | Mortality and mobility at 30 and 60 days after surgery | Compared with patients with <12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 days (p = 0.031): 12 to <20 ng/mL (adjusted OR 2.61; 95% CI 1.13, 5.99); 20 to <30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). There was also greater mobility at 60 days (p = 0.028) in patients with higher 25(OH)D compared with the reference group (<12 ng/mL). GNRI <92 showed an overall trend to reduce mobility (adjusted p = 0.056) at 30 but not at 60 days. There was no association of vitamin D or GNRI with mortality at either time. |
Han et al., 2020 [24] UK | Retrospective observational study, National Health Service hospital | Mean 83.8 (SD 8.6) 349(28.2)/890(71.8) | 1239 | MUST | Low risk Medium risk High risk | Mobilization (starting rehabilitation within 1 day after surgery) Pressure ulcers In-patient mortality Change in discharge destination | Compared with the well-nourished group, malnourished individuals showed increased risk for failure to mobilize within 1 day of surgery (OR 1.6; 95% CI 1.0–2.7), pressure ulcers (OR 5.5, 95% CI, 1.8–17.1), in-patient mortality (OR 2.3; 95% CI, 1.1–4.8), and discharge to residential/nursing care (OR 2.8; 95% CI, 1.2–6.6). |
Author, Year, Country | Design, Setting | Age Male/Female, n (%) | Sample Size | Diagnosis Criteria Measurement Methods of Muscle Strength, Muscle Mass, Physical Function | Prevalence of Sarcopenia | Outcome | Main Results |
---|---|---|---|---|---|---|---|
González-Montalvo et al., 2015 [45] Spain | Prospective observational study, university hospital | Mean 85.3 (SD 6.8) 47 (20.3)/382 (79.7) | 479 | EWGSOP Handgrip strength Bioimpedance analysis | 17.1% | Barthel Index at discharge | In the multivariate analysis, sarcopenia was not associated with functional prognosis at discharge (OR 1.68, 95% CI 0.99–2.84). |
Di Monaco et al., 2015 [46] Italy | Observational study, rehabilitation hospital | Normal: 78.9 (SD 7.7) Presarcopenia: 73.8 (SD 5.5) Sarcopenia: 81.3 (SD 7.5) All female: 138 (100) | 138 | EWGSOP Handgrip strength Dual-energy X-ray absorptiometry | Presarcopenia: 17% Sarcopenia: 58% | Barthel Index (at admission, end of the rehabilitation course) | Sarcopenia was associated with Barthel Index scores at the time of assessment but not at the end of the rehabilitation course after adjusting for multiple adjustments (p < 0.001). |
Landi et al., 2017 [43] Italy | Observational study, Geriatric Rehabilitation Unit of the hospital | Mean age 81.3 (SD 4.8) 45 (36.4)/82 (64.6) | 127 | FNIH Dual-energy X-ray absorptiometry | Sarcopenia: 48% | Barthel Index (at discharge and 3 months after discharge) | After adjustment for potential confounders, participants with sarcopenia had a significantly increased risk of incomplete functional recovery compared with nonsarcopenic patients (OR 3.07, 95% CI 1.07–8.75). |
Di Chang et al., 2018 [47] Taiwan | Retrospective observational study, university hospital | Mean age 81.1 (SD 12.2) 24 (26.4)/67 (73.6) | 91 | Computed tomography (total skeletal muscle area at L4) | No details provided | Hospital stay Perioperative mortality Medical complications In-hospital blood transfusion volume Readmission rate at 90 days | Low skeletal muscle index was independently associated with longer length of hospitalization (p = 0.032) but was not associated with any other outcomes. |
Kim et al., 2018 [48] Korea | Retrospective observational study, National Police Hospital | Mean 78.5 years (range, 65–94 years) 27 (29.7)/64 (70.3) | 91 | Choi et al. reported criteria Computed tomography (L3) | 49.5% | One-year and five-year mortality rates | Kaplan–Meier analysis showed that sarcopenia did not affect the 1-year mortality rate (p = 0.793) but had a significant effect on the 5-year mortality rate (p = 0.028). Both perioperative sarcopenia (p = 0.018) and osteoporosis (p < 0.001) affected the 5-year mortality rate. |
Yoo et al., 2018 [49] Korea | Retrospective observational study, university hospital | Mean 77.8 (SD 9.7) 78 (24.1)/246 (75.9) | 324 | AWGS Handgrip strength Dual-energy X-ray absorptiometry | 37.7% | One-year mortality | Osteosarcopenia (15.1%) was higher for 1-year mortality than other groups (normal: 7.8%, osteoporosis alone: 5.1%, sarcopenia alone: 10.3%). |
Steihaug et al., 2018 [50] Norway | Prospective observational study, acute hospital (three hospitals) | Mean 79.4 (SD 8.2) (24)/(76) | 282 | EWGSOP Handgrip strength The formula reported by Heymsfield et al. (using gender, height, arm circumference, and triceps skinfold) New Mobility Score | 38% | Change in New Mobility Score Resident of a nursing home Death | Sarcopenia did not predict change in mobility (p = 0.6), but it was associated with having lower mobility at 1-year (p = 0.003), becoming a resident of a nursing home (OR 3.2, p = 0.048), and the combined endpoint of becoming a resident of a skilled nursing home or death (OR 3.6, p = 0.02). |
Malafarina et al., 2019 [51] Spain | Prospective observational study, two rehabilitation units | Mean 85.2 (SD 6.3) 49 (26.2)/138 (73.8) | 187 | EWGSOP2 Handgrip strength Bioimpedance analysis 4 meter walking test | Incident sarcopenia during hospitalization: 54 patients Sarcopenia at admission and at discharge (chronic sarcopenia): 41 patients Sarcopenic at admission but reverted sarcopenia during the admission period (reverted sarcopenia): 17 patients | Mortality after 7 years | Cox regression analyses showed that sarcopenia was a risk factor for mortality (HR: 1.67, 95% CI 1.11–2.51) and low handgrip strength (HR: 1.76, 95% CI 1.08–2.88). |
Byun et al., 2019 [52] Korea | Retrospective study, university hospital | Mean 78.4 (SD 9.7) 121 (24.5)/373 (75.5) | 494 | AWGS Handgrip strength Computed tomography (psoas cross-sectional area at L4–L5 level) | No details provided | One-year mortality | After adjusting for potential confounders, the lowest quintile of psoas cross-sectional area was significantly associated with mortality only in females (HR 1.76, 95% CI 1.05–2.70). |
Chen et al., 2020 [53] Hong Kong | Prospective observational study, acute hospital | Mean 80.72 (SD 9.66) 36 (25.9)/103 (74.1) | 139 | AWGS Handgrip strength Dual-energy X-ray absorptiometry | 50.36% | EQ5D and Barthel Index at 6 months after the operation | After 6 months, patients with sarcopenia had a poor Barthel Index and a lower EQ5D than patients without sarcopenia before injury. |
Chiles Shaffer et al., 2020 [54] USA | Prospective observational study, the seventh cohort of the Baltimore Hip Studies | Male: 81.0 (SD 7.5) Female: 80.2 (SD 7.6) 82 (51.3)/78 (48.7) | 160 | EWGSOP IWGS FNIH Handgrip strength Dual-energy X-ray absorptiometry Gait speed | No details provided | Sarcopenia prevalence over 12 months after hip fracture | Sarcopenia prevalence was stable over time in men by all definitions, whereas the prevalence in women by FNIH was lowest at 2 months, significantly increased at 6 months (p = 0.03) and remained higher at 12 months. Sarcopenia prevalence differed significantly by sex and varied by time point and definition; however, when different, men had a higher prevalence than women did (p < 0.05). |
Shin et al., 2020 [55] Korea | Retrospective cohort study, university Hospital | Mean age 74.1 (range, 25–96) 35 (25.9)/100 (74.1) | 135 | AWGS Dual-energy X-ray absorptiometry | 45.9% | Harris Hip Score Parker’s mobility score at the last follow-up Discharge disposition | In multiple regression analysis, no significant association was found between sarcopenia and the Harris Hip Score of mobility at the last follow-up, nonunion, or time to union. |
Nagano et al., 2020 [56] Japan | Retrospective observational study, acute hospital | Mean 85.9 (SD 6.5) All female patients, 89 (100) | 89 | AWGS 2019 Handgrip strength Bioimpedance analysis | 76.4% | Incidence of dysphagia on day 7 and discharge | All patients who developed dysphagia had underlying sarcopenia. |
Ha et al., 2020 [57] Korea | Cross-sectional study, acute hospital | Not sarcopenia: 76.02 (SD 6.87) Sarcopenia: 82.62 (SD 7.72) 22 (19.1)/93 (80.9) | 115 | SARC-F, EWGSSOP2, AWGS, IWGS Handgrip strength Dual-energy X-ray absorptiometry | SARC-F: 63.5% EWGS2: 43 (37.4%) AWGS: 35 (30.4%) IWGS: 60 (52.2%) | Comparison of the results with criteria | Accuracy of SARC-F was that the sensitivity, specificity, positive predictive value, negative predictive value, and positive predictive value with the EWGSOP2 criteria as the reference standard were 95.35%, 56.94%, 56.94%, 95.35%, and 71.3%, respectively. |
Author, Year, Country | Design, Setting | Age Male/Female, n (%) | Sample Size | Diagnosis Criteria Details of Criteria | Prevalence of Frailty | Outcome | Main Results |
---|---|---|---|---|---|---|---|
Patel et al., 2014 [70] USA | Retrospective observational study, acute hospital | Mean 81.05 (SD 8.45) No gender details provided | 697 | Modified frailty index 19 items Comorbidities, cognitive function, and walking ability | No details provided | One-year and two-year mortality rates after femoral neck fracture | Patients with a modified frailty index had an OR of 4.97 for 1-year mortality and an OR of 4.01 for 2-year mortality as compared with patients with an index less than 4. |
Krishnan et al., 2014 [71] UK | Prospective study, university-affiliated community hospital | Mean 81 (range, 47–101) 47 (26.5)/131 (735) | 178 | Frailty index Fifty-one deficits Motivation, self-rated health, cognitive assessments, clock face drawing, comorbidities, continence, mobility, and functional independence Low-frailty group (FI ≤ 0.25), intermediate (FI > 0.25–0.4), high-FI group (FI > 0.4) | Low-frailty group (FI ≤ 0.25): 56 (31.5%) Intermediate (FI >0.25–0.4): 58 (32.5%) High (FI >0.4): 64 (36%) | Hospital stay Discharge disposition | The mean length of hospital stay for the intermediate group was 36.3 days in the high-FI group compared with 67.8 days in the high-FI group (p < 0.01). 30-day mortality was 3.4% for the intermediate group compared with 17.2% for the high-FI group (p < 0.001). |
Kistler et al., 2015 [72] USA | Prospective observational study, university-affiliated community hospital | Mean 86 (SD 4) 6 (17)/29 (83) | 35 | Fried frailty index (modified for a post fracture population) Shrinking, exhaustion, slowness, weakness, and physical activity Participants with a total score of 3 or higher were considered frail | 51% | Overall hospital complication rate Hospital stay Complications | Frail patients (67%) versus nonfrail patients (29%) had a complication (p = 0.028). Mean length of stay was longer in patients with frailty (7.3 (SD) 5.9 vs. 4.1 (SD) 1.2 days, p = 0.038). |
Gleason et al., 2017 [73] USA | Retrospective observational study, acute hospital | Mean 82.3 (SD 7.4) 44 (25.1)/131 (74.9) | 175 | The FRAIL scale Five-question assessment Fatigue, resistance, aerobic capacity, illnesses, and loss of weight Classified the patients into three categories: robust (score = 0), prefrail (score = 1–2), and frail (score = 3–5) | Robust (n = 29): 16.6% Prefrail (n = 73): 41.7% Frail (n = 73): 41.7% | Postoperative complications Unplanned intensive care unit admission Hospital stay Discharge disposition 30-day readmission and mortality | There was a statistically significant association between frailty and both length of stay (4.2, 5.0, and 7.1 days, p = 002, in robust, prefrail, and frail groups) and the development of any complication (3.4%, 26%, and 39.7%, p = 0.03) after surgery. There were also significant differences in discharge disposition (31% of robust vs. 4.1% frailty, p = 0.008) and follow-up completion (97% of robust vs. 69% of frail). |
Choi et al., 2017 [74] Korea | Retrospective study, university hospital | Mean 80.4 (IQR 75.3–85.3) 139 (28.8)/343 (71.3) | 481 | Hip-Multidimensional Frailty Score Sex, Charlson Comorbidity Index, Albumin, Koval grade, risk of falling, MNA, and mid-arm circumference High risk: >8 and low risk: ≤8 | High risk: 24.3% | One-year all-cause mortality Postoperative complication Hospital stay Institutionalization | High-risk patients showed a higher risk of six-month mortality (HR: 3.545, 95% CI: 1.466–8.572) than low-risk patients after adjustment. Hip-Multidimensional Frailty Score could predict six-month mortality, postoperative complications, and prolonged hospital stay after surgery. Hip-Multidimensional Frailty Score more precisely predicted six-month mortality than age or existing tools (p values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age, and NHFS, respectively). |
Winters et al., 2108 [75] Netherlands | Retrospective observational cohort study, general hospital | Mean 83.0 (SD 6.6) 71 (25)/215 (75) | 280 | Groningen Frailty Indicator questionnaire Consisted of 15 questions Physical, cognitive, social, and psychological impairments Score on a scale of 0–15 Score of 4 or higher suggests frailty VeiligheidsManagementSysteem Three items (cognitive impairment or confusion during earlier admissions, falls in the last 6 months, and physical impairments) Falling and another question to determine the frailty | Groningen Frailty Indicator questionnaire: 60% VeiligheidsManagementSysteem: 58% | Mortality 3-years and 30 days after surgery | VMS showed a statistically significant difference in overall survival as compared to nonfrail patients (57 vs 80%, respectively, p < 0.001) with an HR of 3.5 (95% CI 2.1–5.7; p < 0.001)). Classification according to GFI yielded a lower but still significant HR 2.3 (95% CI 1.2–4.1; p = 0.008). |
Vasu et al., 2018 [76] India | Retrospective observational study, acute hospital | Not stated 34 (56.7)/26 (43.3) | 60 | Modified frailty index Nineteen items Comorbidities, cognitive function, and walking ability | Mean modified frailty index score: 3 | 90 days mortality | Modified frailty index and 90-day mortality showed a significantly direct correlation, with <0.001. |
Chen et al., 2019 [77] Taiwan | Prospective observational cohort study | ≤75: 34.3% 76–85: 41.2% ≥86: 25.5% 79 (32.2)/166 (67.8) | 245 | Chinese-Canadian Study of Health and Aging Clinical Frailty Scale Ranged from 1 (very fit) to 7 (severely frail). | Robust: 31.4%. Prefrail: 46.1% Frail: 22.4% | 1, 3, and 6-month postoperative emergency department visits Readmissions Mortality | More cumulative events occurred for frail than for robust patients for each adverse outcome. Frailty had a long-term effect on each adverse outcome. |
Inoue et al., 2019 [78] Japan | Retrospective observational study, two acute hospitals | Mean 83.7 (SD 7.4) 52 (19.3)/217 (80.7) | 274 | Modified frailty index Nineteen items Comorbidities, cognitive function, and walking ability | Mean modified frailty score: 3.2 ±1.9 points (minimum to a maximum range of 0 to 9) | Efficiency on the motor-Functional Independence Measure Postoperative complication Discharge disposition | Higher modified frailty index was significantly associated with increased likelihood of lower functional recovery (OR, 1.60; 95% CI, 1.32–1.93), occurrence of postoperative complication (OR, 1.32; 95% CI, 1.13–1.54) and not returning home (OR, 1.77; 95% CI, 1.38–2.26). |
Van De Ree et al., 2019 [79] Netherlands | Prospective observational study, 10 participating Dutch hospitals | Mean 80.27 (SD 8.62) 206 (29.6)/490 (70.4) | 696 | Groningen Frailty Indicator questionnaire Consisted of 15 questions Physical, cognitive, social, and psychological impairments Score on a scale of 0–15 Score of 4 or higher suggests frailty | 53.3% | EuroQol-5 Dimensions ICEpop CAPability measure for Older people | Frailty was negatively associated with EuroQol-5 Dimensions (β −0.333; 95% CI −0.366 to −0.299), self-rated health (β −21.9; 95% CI −24.2 to −19.6), and capability and well-being (β −0.296; 95% CI −0.322 to −0.270) 1 year after hip fracture. |
Jorissen et al., 2020 [80] Australia | Retrospective cohort study, historical national cohort of the Registry of Senior Australians | Mean 85.8 (SD 6.3) 1164 (24.4)/3607 (75.6) | 4771 | Frailty index Forty-four deficits Eight activity limitations, 24 health conditions, and three signs and symptoms 0–0.18 (quartile 1), 0.19–0.23 (quartile 2), 0.24–0.27 (quartile 3), and 0.28–0.41 (quartile 4) | Quartile 1: 1307 (27.4%) Quartile 2: 1158 (24.3%) Quartile 3: 1123 (23.5%) Quartile 4: 1183 (24.8%) | 2 year survival ADL limitations Permanent residential aged care for patients living in the community | The two-year survival of patients following hip fracture was 43.7% (95% CI 40.9–46.7%) in those in the highest quartile of frailty, compared with 54.4% (95% CI 51.8–57.2%) for those in the lowest quartile (HR = 1.25, 95% CI 1.11–1.41). No associations were found between pre-fracture frailty and post fracture ADL limitations. No association of frailty with transition to permanent residential aged care for patients living in the community was observed (HR = 0.98, 95% CI 0.81–1.18). |
Lu et al., 2020 [81] China | Longitudinal and observational study, university hospital | Mean 77.5 (SD 8.5) 43 (33)/87 (67) | 130 | The modified Krishnan FI Physical health, mental health, cognitive function, self-care ability, life satisfaction, and social function The Canadian study of health and aging frailty index Cognition, existing diseases, self-care deficits, and abnormal physical signs | The modified Krishnan FI Low: 39% Medium: 50% High: 12% The Canadian study of health and aging frailty index Low: 63% Medium: 36% High: 0.8% | Death Rate of readmission to the hospital Fall within 3 months Hip function Daily activities at 3 months after surgery | The modified Krishnan FI correlated with the Japanese Orthopedic Association hip score (pain, activity, walking ability, and ability for daily living; R = 0.249, p = 0.005), whereas the Canadian study of health and aging frailty index was not correlated (R = 0.125, p = 0.170). Both the modified Krishnan FI (R = 0.415, p < 0.001) and the Canadian study of health and aging frailty index (R = 0.332, p < 0.001) were significantly correlated with the functional recovery scale score. |
Pizzonia et al., 2020 [82] Italy | Prospective observational study, acute hospital | Mean 86.5 (SD 5.65) 80 (22)/284 (78) | 364 | Modified frailty index 19 items Comorbidities, cognitive function, and walking ability | Robust: 2.2% Prefrail: 14.9% Frail: 82.9% | Mortality (median follow-up of 2.4 years) | Modified frailty index was predictive of long-term mortality. |
Low et al., 2020 [83] Australia | Prospective cohort study, rehabilitation and two geriatric evaluation and management wards | Median 86 years (interquartile range 81–90) 254 (30.1)/590 (69.9) | 844 | Clinical Frailty Scale 9 points scale | 69.9% | FIM efficiency Mobility Discharge disposition | Clinical Frailty Scale was the strongest independent predictor of poorer FIM efficiency, inability to recover pre-fracture mobility, and return to community dwelling. |
Narula et al., 2020 [84] Australia | Retrospective observational study, acute hospital | Nonfrail: 73.8 (8.8) Vulnerable: 80.3 (9.0) Mildly frail: 84.3 (8.3) Moderately frail: 84.7 (6.9) Severely frail: 86.6 (7.3) 135 (26.5)/374 (73.5) | 509 | Clinical Frailty Scale 9 points scale | Non frail: 15.7% Vulnerable: 17.9% Mildly frail: 23.0% Moderately frail: 13.8% Severely frail: 29.7% | 30 day and 1-year mortality | The Clinical Frailty Scale demonstrated superior discriminative ability in predicting mortality (area under the curve 0.699; 95% CI 0.651 to 0.747) when compared with the ASA and chronological age groups. |
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Inoue, T.; Maeda, K.; Nagano, A.; Shimizu, A.; Ueshima, J.; Murotani, K.; Sato, K.; Tsubaki, A. Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes. Nutrients 2020, 12, 3743. https://doi.org/10.3390/nu12123743
Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, Sato K, Tsubaki A. Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes. Nutrients. 2020; 12(12):3743. https://doi.org/10.3390/nu12123743
Chicago/Turabian StyleInoue, Tatsuro, Keisuke Maeda, Ayano Nagano, Akio Shimizu, Junko Ueshima, Kenta Murotani, Keisuke Sato, and Atsuhiro Tsubaki. 2020. "Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes" Nutrients 12, no. 12: 3743. https://doi.org/10.3390/nu12123743