Dolores Sanchez-Rodriguez1, Cédric Annweiler2, Ester Marco3, Suzy Hope4, Karolina Piotrowicz5, Murielle Surquin6, Annette Ranhoff7, Nele Van Den Noortgate8. 1. Geriatrics Department. Parc de Salut Mar, Spain; Rehabilitation Research Group. Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU - Sart Tilman. Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium. Electronic address: dolores.sanchez@uliege.be. 2. Department of Neurosciences and Aging, Division of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, University of Angers, UNAM, Angers, France; Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. Electronic address: CeAnnweiler@chu-angers.fr. 3. Rehabilitation Research Group. Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain; Physical Medicine and Rehabilitation Department. Parc de Salut Mar, Barcelona, Spain; Universidad Autònoma de Barcelona, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: emarco@parcdesalutmar.cat. 4. University of Exeter Medical School, Exeter, UK; Healthcare for Older People Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom. Electronic address: S.V.Hope@exeter.ac.uk. 5. Faculty of Medicine. Department of Internal Medicine and Gerontology. Jagiellonian University. Krakow, Poland; University Hospital, Krakow, Poland. Electronic address: zona3@interia.pl. 6. Geriatrics Department. CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: MurielleSURQUIN@chu-brugmann.be. 7. Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway. Electronic address: ahranhoff@yahoo.no. 8. Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: Nele.VanDenNoortgate@uzgent.be.
Abstract
INTRODUCTION: Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. METHODS: A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class). RESULTS: Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n = 36, 100%), body mass index (n = 30, 85.7%), and low energy/food intake (n = 27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM = 0%, ASPEN = 0%; n = 9, ESPEN = 25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. CONCLUSIONS: Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.
INTRODUCTION: Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. METHODS: A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class). RESULTS: Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n = 36, 100%), body mass index (n = 30, 85.7%), and low energy/food intake (n = 27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM = 0%, ASPEN = 0%; n = 9, ESPEN = 25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. CONCLUSIONS: Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.