Comparison of malnutrition assessment tools in terms of revealing the relationship between polypharmacy and inappropriate drug use and malnutrition
Main Article Content
Keywords
malnutrition, mini-nutritional assessment, polypharmacy, potentially inappropriate medication
Abstract
Malnutrition is prevalent among older adults and is associated with morbidity and mortality. This study aims to investigate the relationship between malnutrition and polypharmacy in older adults. We also tested which malnutrition test had a stronger relationship with polypharmacy. We conducted a cross-sectional study for four months. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), long-form (MNA-LF), and Global Leadership Initiative on Malnutrition criteria (GLIM). We evaluated potentially inappropriate medication (PIM) use was by TIME criteria (Turkish Inappropriate Medication Use in the Elderly) criteria. Data analysis was done by SPSS version 22. The study population was composed of 93 women and 57 men, of mean age 73 +/- 9 years. Polypharmacy was present in 73% (n=110) of them. MNA-SF, MNA-LF and GLIM scores were correlated with presence of polypharmacy (p=0.036, p=0.002, p=0.045). MNA-LF was associated with polypharmacy in linear regression analysis (r²=0.06, p=0.046). PIM use was also found to be negatively related to MNA-LF scores (p=0.049, r=-0.166). We demonstrated a cut-off value of 6.5 of drug numbers for being malnourished (sensitivity 80%; specificity 88%; CI:95%; AUC:0.844; p<0.01). In this study, we concluded that malnutrition and polypharmacy, two common geriatric syndromes, are associated with each other. According to the results of our study, we can say that MNA-LF is a powerful malnutrition assessment tool to demonstrate the malnutrition polypharmacy relationship. Prospective studies to evaluate effect of correction of malnutrition on polypharmacy could be useful.
References
2. Sobotka L. Basic Concept in Nutrition.; 2011.
3. Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The mini nutritional assessment®-its history, today’s practice, and future perspectives. Nutr. Clin. Pract. 2008;23(4):388–396.
4. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, vd. Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J. Nutr. Heal. Aging 2009;13(9):782–788.
5. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). Journals Gerontol. - Ser. A Biol. Sci. Med. Sci. 2001;56(6):366–372.
6. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, vd. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin. Nutr. 2019;38(1):1–9.
7. Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin. Nutr. 2012;31(3):345–350.
8. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):1–10.
9. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin. Pharmacol. Ther. 2009;85(1):86–88.
10. Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J. Psychiatr. Res. 2009.
11. Shelkey M, Wallace M. Katz Index of Independence in Activities of Daily Living (ADL). Director 2000.
12. Oort Q, Taphoorn MJB, Sikkes SAM, Uitdehaag BMJ, Reijneveld JC, Dirven L. Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors. J. Neurooncol. 2019;143(1):1–13.
13. Parveen H, Noohu MM. Evaluation of psychometric properties of Tinetti performance-oriented mobility assessment scale in subjects with knee osteoarthritis. Hong Kong Physiother. J. 2017;36:25–32.
14. Lin X, Haralambous B, Pachana NA, Bryant C, Logiudice D, Goh A, vd. Screening for depression and anxiety among older Chinese immigrants living in Western countries: The use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI). Asia-Pacific Psychiatry 2016;8(1):32–43.
15. Sirois C, Domingues NS, Laroche M. Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research ,. 2019:1–14.
16. Bahat G, Ilhan B, Erdogan T, Halil M, Savas S, Ulger Z, vd. Turkish inappropriate medication use in the elderly ( TIME ) criteria to improve prescribing in older adults : TIME ‑ to ‑ STOP / TIME ‑ to ‑ START . Eur. Geriatr. Med. 2020;(0123456789).
17. Tamang MK, Yadav UN, Hosseinzadeh H, Kafle B, Paudel G, Khatiwada S, vd. Nutritional assessment and factors associated with malnutrition among the elderly population of Nepal: A cross-sectional study. BMC Res. Notes 2019;12(1):1–5.
18. Kucukdagli P, Bahat G, Bay I, Kilic C, Oren MM, Turkmen BO, vd. The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults. Aging Clin. Exp. Res. 2020;32(4):681–687.
19. Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, Leõn-Ortiz M. 2012 American geriatrics society beers criteria: Enhanced applicability for detecting potentially inappropriate medications in European older adults? a comparison with the screening tool of older person’s potentially inappropriate prescriptions. J. Am. Geriatr. Soc. 2014;62(7):1217–1223.
20. Tripathi C, Jhaveri B, Patel T, Barvaliya M. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India. Perspect. Clin. Res. 2014;5(4):184.
21. Lam MPS, Cheung BMY, Wong ICK. Prevalence of potentially inappropriate prescribing among hong kong older adults: A comparison of the beers 2003, beers 2012, and screening tool of older person’s prescriptions and screening tool to alert doctors to right treatment criteria. J. Am. Geriatr. Soc. 2015;63(7):1471–1472.
22. Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk. Postgrad. Med. 2015;127(3):330–337.
23. Leszek S, Jadwiga JO, Agnieszka BS. Polypharmacy as a risk factor for depressive symptoms in geriatric patients: An observational, cross-sectional study. Ars Pharm. 2016;57(3):127–135.
24. Little MO. Updates in nutrition and polypharmacy. Curr. Opin. Clin. Nutr. Metab. Care 2018;21(1):4–9.
25. Fenton R, Brook-Barclay L, Delaney CL, Spark JI, Miller MD. Do Medications Commonly Prescribed to Patients with Peripheral Arterial Disease Have an Effect on Nutritional Status? A Review of the Literature. Ann. Vasc. Surg. 2016;32:145–175.
26. Soysal P, Isik AT. Effects of acetylcholinesterase inhibitors on nutritional status in elderly patients with dementia: A 6-month follow-up study. J. Nutr. Heal. Aging 2016;20(4):398–403.
27. Varma RN. Risk for drug-induced malnutrition is unchecked in elderly patients in nursing homes. J. Am. Diet. Assoc. 1994;94(2):192–194.
28. Zadak Z, Hyspler R, Ticha A, Vlcek J. Polypharmacy and malnutrition. 2013;16(1):50–55.
29. Conference I, May B, Burgos R, Joaquin C, Blay C, Ledesma A, vd. Strategy to fight against malnutrition in chronic patients with complex health needs. 2016;16(6).
30. Carlson R V., Boyd KM, Webb DJ. The revision of the Declaration of Helsinki: Past, present and future. Br. J. Clin. Pharmacol. 2004;57(6):695–713.