Nutritional state predicts all-cause death independent of comorbidities in geriatric patients with coronary artery disease

Objective

To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD).

Design

Cohort study.

Setting

Patients referred for coronary angiography in West China Hospital, Sichuan University, China.

Participants

1772 patients with angiographic documented CAD whose age was above 65 years.

Measurements

Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without.

Results

During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35–2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death.

Conclusion

Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation.

     

Dizziness as a geriatric condition among rural community-dwelling older adults

Background

Dizziness is a common symptom in older adults. The majority of those with dizziness tend to have more than one risk factor, suggesting that dizziness is a multifactorial geriatric condition. Therefore, associated factors must be determined to permit risk-reduction approaches.

Objective

To examine the associations between dizziness and socio-demographic, physical, functional and psychological health factors among older persons living in the Andes Mountains.

Design

Population-based cross-sectional study.

Settings/Participants

One thousand six hundred ninety-two community-living people aged 60 years and over living in four rural and suburban areas of villages in coffee-grower zones in the Colombian Andes Mountains.

Measurements

Outcome measures included self-reporting of dizziness as a symptom experienced either very frequently or continuously during the last month. Independent variables were demographic, socioeconomic and social factors; disease and biomedical factors; functional status and performance-based measures; and psychological factors such as depressive symptoms and self-rated health.

Results

Dizziness was reported by 15.2% of participants in the study. Variables independently associated with dizziness were: number of chronic conditions, visual impairment, and use of more than four medications. Independently associated psychological variables were: poor self-perceived health, cognitive impairment and depression. Health and psychological factors accounted for 85% of dizziness.

Conclusion

Older persons who reported dizziness were more physically frail, with more instances of chronic conditions and sensory impairments, and had poor self-perceptions of their health. Biomedical and psychological factors showed a strong independent association with dizziness. A multifactorial intervention targeting the identified factors would reduce dizziness in older people. However, this approach may need to address different sets of specific factors related to the dizziness categories.

     

A comparison of three sets of criteria for determining the presence of differential item functioning using ordinal logistic regression

Background

Several techniques have been developed to detect differential item functioning (DIF), including ordinal logistic regression (OLR). This study compared different criteria for determining whether items have DIF using OLR.

Objectives

To compare and contrast findings from three different sets of criteria for detecting DIF using OLR. General distress and physical functioning items were evaluated for DIF related to five covariates: age, marital status, gender, race, and Hispanic origin.

Research design

Cross-sectional study.

Subjects

1,714 patients with cancer or HIV/AIDS.

Measures

A total of 23 items addressing physical functioning and 15 items addressing general distress were selected from a pool of 154 items from four different health-related quality of life questionnaires.

Results

The three sets of criteria produced qualitatively and quantitatively different results. Criteria based on statistical significance alone detected DIF in almost all the items, while alternative criteria based on magnitude detected DIF in far fewer items. Accounting for DIF by using demographic-group specific item parameters had negligible effects on individual scores, except for race.

Conclusions

Specific criteria chosen to determine whether items have DIF have an impact on the findings. Criteria based entirely on statistical significance may detect small differences that are clinically negligible.

     

Evaluation of a continuing educational intervention for primary health care professionals about nutritional care of patients at home

Objective

Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.

Design

Observational cohort study.

Setting

10 primary health care centers in Stockholm County, Sweden.

Participants

140 district nurses/registered nurses and general practitioners/physicians working with home care.

Intervention

87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.

Measurements

The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.

Results

In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.

Conclusion

The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.

     

Individually tailored dietary counseling among old home care clients - Effects on nutritional status

Objective

To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older.

Design

Non-randomised controlled study.

Setting and participants

The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L).

Intervention

Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months.

Measurements

The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention.

Results

The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group.

Conclusions

Individually tailored dietary counseling may improve nutritional status among older home care clients.

     

The contribution of comprehensive geriatric assessment to primary care physicians

Background

To provide quality care to the growing number of older patients, primary care physicians (PCPs) will require support from geriatric specialists. Multidisciplinary comprehensive geriatric assessment (CGA) has been found to improve outcomes in older people. This study explored the contribution of CGA to the management of older patients by their PCPs; PCP attitudes to CGA; and PCP satisfaction with CGA.

Methods

Two hundred PCPs in an Israeli Preferred Provider Organization were interviewed as part of an evaluative study of the contribution of a national outpatient CGA program to older patients, their families and physicians.

Results

The main reasons for referral to CGA were cognitive impairment and rapid functional decline. Three domains described the contribution of CGA to PCPs: medical treatment, support in counseling patients, and treatment of cognitive impairment. About 69% of PCPs definitely agreed that CGA more fully addressed the physical, mental and social needs of patients than other consultative clinics. About half were very satisfied with the CGA staff’s attitudes to patients, their families and to the PCP.

Conclusions

CGA contributed significantly to the care provided to older patients by PCPs. The expansion of CGA services deserves consideration.

     

A comparison of frailty indexes based on a comprehensive geriatric assessment for the prediction of adverse outcomes

Objective

To compare the ability of different frailty indexes based on a standardized comprehensive geriatric assessment (FI-CGAs) for predicting adverse outcomes.

Design and Setting

Prospective cohort study. Geriatric wards of a general hospital.

Participants

307 hospitalized patients ≥ 65 years.

Measurements

The FI-CGA-10D (potential health deficits in ten functional domains), the FI-CGA-10D+CM (aforementioned potential health deficits and co-morbidity burden) and the FI-CGA-MIHD (multiple, individual potential health deficits, including functional deficits, co-morbid diseases, amongst others) were assessed at baseline during the patients` hospital stay. The FI-CGAs were analyzed as categorical (according to a FI-CGA score < and ≥ 0.25) and continuous variables. Patients were followed up over 6 months.

Results

The FI-CGA-10D, FI-CGA-10+CM and the FI-CGA-MIHD predicted 6-month mortality when expressed as categorical (area under the receiver operating characteristic curve (AUC): AUC = 0.611, AUC = 0.637, AUC = 0.616, all p < 0.050, respectively) or continuous variables (AUC = 0.769, AUC = 0.837, AUC = 0.834, all p < 0.001, respectively). AUC comparisons showed that all three FI-CGAs exhibited a comparable ability to predict 6-month mortality when the FI-CGAs were expressed as categorical variables (all p > 0.200) and the FI-CGA-10D+CM and the FI-CGA-MIHD showed a better ability to predict 6-month mortality than the FI-CGA-10D, when the FI-CGAs were expressed as continuous variables (p < 0.001 and p = 0.007, respectively). None of the FI-CGAs predicted any of the other outcomes, i.e., unplanned re-admission to hospital and a fall during follow-up, irrespective of whether the FI-CGAs were expressed as categorical or continuous variables (all p ≥ 0.050).

Conclusions

The more complex FI-CGAs, i.e., the FI-CGA-10D+CM and the FI-CGA-MIHD, revealed better ability to predict 6 month mortality than the more simple FI-CGA, i.e., the FI-CGA-10D.

     

Malnutrition and laboratory markers in geriatric patients. A comparison of neurologic-psychiatric,internal and trauma surgical diseases

Objectives

There is minimal information on malnutrition in neurologic-psychiatric patients compared to internal and trauma-surgical patients. The aim of the present study was to explore if there is a correlation of these different disease groups with the nutritional assessment and biochemical markers.

Design

Cross - sectional study.

Setting and Participants

The study was done in a department of geriatric medicine with subspecialisation in neurologic diseases and stroke unit. 338 patients (m / f = 136 / 202, mean age 81.4 ± 7.3 years) were evaluated.

Measurements

The nutritional status was evaluated by using the short form of the Mini Nutritional Assessment (MNA-SF) and seven biochemical markers (hemoglobin, iron, ferritin, vitamin B 12, folic acid, albumin and cholinesterase) were measured.

Results

There were 74 (22%) patients with MNA ≤ 7 points (malnutrition), 148 (44%) patients with an MNA 8 - 11 points (risk of malnutrition) and 116 (34%) patients with an MNA ≥ 12 points (good nutritional status). The mean MNA score of the three major disease groups trauma-surgery, internal medicine and neurology-psychiatry was 9.1 ± 3.2 vs. 9.9 ± 3.1 vs. 10.0 ± 2.8 (p=0.236). There were significant differences of laboratory markers between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in trauma-surgical and internal patients than in neurological-psychiatric patients (albumin: 21.4%, 15.7%, 5.3%; p=0.001; cholinesterase 16.7%, 16.9%, 6.3%; p=0.007; hemoglobin 78.6%, 61.4%, 50.0%; p=0.002).

Conclusions

Following Mini Nutritional Assessment, the additional measurement of albumin, cholinesterase and hemoglobin allowed a more precise grading of malnutrition. There were significant differences between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in multimorbid trauma-surgical and internal patients than in neurologic-psychiatric patients.

     

Lifestyle factors in somatic patients with and without potential alcohol problems

Background

In the present study, we investigated the overall lifestyles of patients with hazardous alcohol use and alcohol dependence who were admitted to the hospital and investigated unhealthy lifestyle factors and their clustering in inpatients.

Methods

Patients admitted to the gastrointestinal, neurologic or orthopedic departments at Odense University Hospital or to the emergency department at Aabenraa Hospital in the inclusion period, October 2013 to June 2016, completed a lifestyle questionnaire asking questions about their diet, alcohol consumption, exercise and smoking habits. Patients were divided into three groups depending on their score from the alcohol use disorder identification test, which was embedded in the lifestyle questionnaire, and odds ratios were calculated using logistic regression.

Results

Patients with alcohol dependence had statistically significantly higher odds of being smokers, having unhealthy diets and being physically inactive compared with patients without alcohol problems. Among patients with hazardous alcohol drinking, we found an increased occurrence of smokers and an inverse association between hazardous alcohol drinking and being physically inactive. Many of the patients had attempted to change their unhealthy lifestyles.

Conclusion

We found that alcohol problems are related to a clustering of other lifestyle factors and that many of the patients admitted to certain departments showed signs of various kinds of alcohol problems. Therefore, specific hospital departments could be opportune settings for preventive alcohol interventions.

     

Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care

Objectives

To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved.

Design

Observational prospective cohort study.

Setting

Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital.

Participants

206 subjects with a mean age of 85 years.

Measurements

Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists’ and GPs’ opinions about quality of communication and information transfer at hospital-general practice interface were investigated.

Results

5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients’ discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients’ hospitalization.

Conclusion

Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.

     

The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

Purpose

The physical demands and hazards associated with emergency service work place particular stress on responders’ cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.

Methods

A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.

Results

Fifteen studies were rated ‘Weak’ and one study was rated ‘Strong’. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.

Conclusion

Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

     

Association between body mass index and all-cause mortality among oldest old Chinese

Objectives

To examine the association between BMI and all-cause mortality in the oldest old (≥80 years).

Design

The study used a prospective cohort study design.

Setting

Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998/99 and 2011.

Population

8026 participants aged 80 years and older were followed every two to three years.

Measurements

Body weight and knee height were measured. Height was calculated based on knee height using a validated equation. Deaths were ascertained from family members during follow-up.

Results

The mean BMI was 19.8 (SD 4.5) kg/m². The prevalence of underweight, overweight and obese was 37.5%, 10.2% and 4.4%, respectively. There were 5962 deaths during 29503 person-years of follow-up. Compared with normal weight, underweight was associated with a higher mortality risk (HRs: 1.20 (95%CI 1.13-1.27) but overweight (HR 0.89 (95%CI 0.81-0.99)) were associated with a lower risk. Obesity had a HR 0.91 (95%CI 0.78-1.05) for mortality.

Conclusion

Among oldest old Chinese, underweight is associated with an increased risk of all-cause mortality but overweight is associated with a reduced risk. Interventions to reduce undernutrition should be given priority among the oldest old Chinese.

     

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur,Malaysia

Background

This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia.

Methods

A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases.

Results

A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), p<0.05. Likewise, male participants who had experienced impregnating their partners had a significantly lower contraceptive knowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), p<0.05.

Conclusion

The results showed evidence of premarital unplanned pregnancy among this suburban community. The low level of contraceptive knowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge.

     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

     

Knowledge of parents from public and private school students on emergency management of avulsed permanent teeth

Aim

To evaluate the level of general knowledge of parents with regards to first-aid measures for permanent tooth avulsion and to correlate such knowledge with their children’s school setting (public or private).

Subjects and methods

A total of 179 parents answered a questionnaire containing 6 objective questions regarding the management of dental avulsion and emergency procedures. Data concerning the age and schooling of the respondents were also obtained.

Results

Parents from the private school group had higher levels of education and were more likely to have a correct attitude regarding the immediate replantation of the avulsed tooth as compared to parents of children studying in public schools (p?<?0.05). However, the pattern of answers given for the questions concerning the cleaning of the avulsed tooth and the appropriate storage medium was very similar between both groups of parents, suggesting a lack of technical information among the participants.

Conclusion

Parents were found to have low levels of knowledge regarding first-aid measures in an emergency related to permanent tooth avulsion and replantation, irrespective of their children’s school setting.

     

Community-based urgent care in Israel and worldwide

Background

Intermittent treatment of acute lower acuity situations has come to be defined as urgent rather than emergent care. The location of urgent care delivery has been shifting from exclusively hospital or office settings to other community locales.

Aims

To review the concept of urgent care and the new models of health care delivery in the niche between hospitals and primary care. To highlight the roles of urgent care in Israel and compare these roles with those in other countries.

Method

Narrative review of the literature.

Main findings

The new models of community based urgent care include 1) the urgent care center; 2) the retail or convenience clinic, 3) the free standing emergency center, and 4) the walk-in clinic. These models fall on a continuum of comprehensiveness. They offer care at a lower cost than hospital-based emergency departments and greater temporal convenience than primary care physicians. However, their impact on emergency department utilization and overcrowding or primary care physician overload is unclear.Israel has integrated its urgent care centers into its national health system by encouraging the use of urgent care centers and by requiring all health insurance funds to reimburse patients who use these centers. This integration is similar to the approach in England; however, the type of service is different in that the service in England is provided by nurses. It is different from most other countries where urgent care facilities are primarily private ventures.

Conclusions

Community-based acute care facilities are becoming a part of the medical landscape in a number of countries. Still, they remain primarily on the fringe of organized medicine. Despite the important role of community-based acute care facilities in Israel, no nationwide study has been done in two decades. Health policy planning in Israel necessitates further study of urgent care use and its clinical outcomes.

     

Frequency of Hospital Use Before and After Home-Delivery Meal by Meals On Wheels,of Tarrant County,Texas

Background

Patients recently discharged from the hospital are vulnerable and are at high risk for readmission. Home-delivered meals may be beneficial in improving their health and facilitating independent living in the community. The purpose of this study was to identify the association between home-delivered meals and use of hospital services.

Methods

This study includes 120 clients recently discharged from an inpatient hospital stay or from an emergency department (ED) visit who received meal services from Meals On Wheels, Inc., of Tarrant County. Healthcare utilization data was extracted from the Dallas-Fort Worth Hospital Council Foundation, a regional all claims database used by over 90% of hospitals in Dallas-Fort Worth area. Signed tests and generalized linear models (GLM) were performed.

Results

A total of 16,959 meals were delivered from March 2013 through March 2014. Each client received an average of 6.19 meals per week. The average number of ED visits decreased from 5.03 before receipt of meals to 1.45 after receipt of meals, z = -5.23, p <.001. The average number of hospitalizations decreased from 1.33 to.83, z = -7.29, p <.001. The average length of stay per hospitalization decreased from 5.47 days to 2.34 days, z = -5.84, p <.001. Clients who received more meals were less likely to experience ED visits and hospitalizations after controlling for demographic characteristics and levels of physical functioning.

Conclusion

The findings of this study indicate that home-delivered meals services may contribute to a reduction in hospital based care services among frail and vulnerable adults. Additional studies should consider the short and long-term effects of home-delivered meals services on healthcare utilization and the potential to decrease healthcare costs.

     

Trajectories of nutritional risk: The Manitoba follow-up study

Objectives

To identify patterns of nutritional risk among older men over a four-year period and to project their survival rates over the next two and a half years.

Design

A prospective longitudinal study.

Setting

Canada.

Participants

Three hundred and thirty-six male survivors of the Manitoba Follow-up Study (MFUS) cohort with an average age of 90 years in 2011.

Measurements

Four years of nutritional risk SCREEN II scores (five waves) from the male survivors of the MFUS cohort. The semi-parametric group-based trajectory approach and survival analysis were used to investigate the trajectories of nutritional risk.

Results

Of the participants, 30% lived alone. Five distinct developmental trajectory groups for nutritional risk score were identified. Significant statistical differences were found among the five trajectory groups for SF-36 mental health (p=.02), SF-36 physical health (p=<.001), perception of aging successfully (p=.04) and living alone (p=<.001). Among the five groups, the most pairwise differences were found in appetite, intake of meat and alternatives, and vegetables and fruit, weight change, skipping meals and eating with others. Men in the poorest nutritional risk trajectory group were two times more likely to die within a 2 1/2 year period compared to men in the best nutritional risk trajectory group (hazard rate = 2.33, p=.07).

Conclusion

Distinct nutritional risk trajectories were found for older men over a four year period. Poor nutritional risk trajectories are associated with higher risk of mortality for very old men over a short period of time. Timely nutritional assessments by health professionals are needed to identify older men at nutritional risk. Subsequent nutrition education and follow-up may be important in preventing further decline.