Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

Geriatric patients with hip fractures often experience overlap in problems related to nutrition, including undernutrition, sarcopenia, and frailty. Such problems are powerful predictors of adverse responses, although few healthcare professionals are aware of them and therefore do not implement effective interventions. This review aimed to summarize the impact of undernutrition, sarcopenia, and frailty on clinical outcomes in elderly individuals with hip fractures and identify successful strategies that integrate nutrition and rehabilitation. We searched PubMed (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant literature published over the last 10 years and found that advanced interventions targeting the aforementioned conditions helped to significantly improve postoperative outcomes among these patients. Going forward, protocols from advanced interventions for detecting, diagnosing, and treating nutrition problems in geriatric patients with hip fractures should become standard practice in healthcare settings.

Han TS et al.
Quality of the selected observational study was assessed using the National Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Criteria1. Was the research question or objective in this paper clearly stated? Criteria 2. Was the study population clearly specified and defined? Criteria 3. Was the participation rate of eligible persons at least 50%? Criteria 4. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants? Criteria 5. Was a sample size justification, power description, or variance and effect estimates provided? Criteria 6. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured? Criteria 7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed? Criteria 8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)? Criteria 9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 10. Was the exposure(s) assessed more than once over time? Criteria 11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 12. Were the outcome assessors blinded to the exposure status of participants? Criteria 13. Was loss to follow-up after baseline 20% or less? Criteria 14.
Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)? The overall judgment is determined by Good, Fair, Poor. CD, cannot determine; NA, not applicable; NR, not reported.
Quality of the selected observational study was assessed using the National Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Criteria1. Was the research question or objective in this paper clearly stated? Criteria 2. Was the study population clearly specified and defined? Criteria 3. Was the participation rate of eligible persons at least 50%? Criteria 4. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants? Criteria 5. Was a sample size justification, power description, or variance and effect estimates provided? Criteria 6. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured? Criteria 7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed? Criteria 8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)? Criteria 9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 10. Was the exposure(s) assessed more than once over time? Criteria 11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 12. Were the outcome assessors blinded to the exposure status of participants? Criteria 13. Was loss to follow-up after baseline 20% or less? Criteria 14.
Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)? The overall judgment is determined by Good, Fair, Poor. CD, cannot determine; NA, not applicable; NR, not reported.
Quality of the selected observational study was assessed using the National Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Criteria1. Was the research question or objective in this paper clearly stated? Criteria 2. Was the study population clearly specified and defined? Criteria 3. Was the participation rate of eligible persons at least 50%? Criteria 4. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants? Criteria 5. Was a sample size justification, power description, or variance and effect estimates provided? Criteria 6. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured? Criteria 7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed? Criteria 8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)? Criteria 9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 10. Was the exposure(s) assessed more than once over time? Criteria 11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants? Criteria 12. Were the outcome assessors blinded to the exposure status of participants? Criteria 13. Was loss to follow-up after baseline 20% or less? Criteria 14. Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)? The overall judgment is determined by Good, Fair, Poor. CD, cannot determine; NA, not applicable; NR, not reported.