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Background. It is unclear whether serial measures of body weight are valid indicators of nutritional status in older patients recovering from illness. Objectives. Investigate the relative influence of nutrient intake and changes in peripheral edema on weight change. Methods. A prospective cohort study of 404 older men (mean age = 78.7±7.5 years) admitted to a transitional care unit of a Department of Veterans Affairs nursing home. Body weight and several indicators of lower extremity edema were measured at both unit admission and discharge. Complete nutrient intake assessments were performed daily. Results. Over a median length of stay of 23 days (interquartile range: 15–41 days), 216 (53%) participants gained or lost more than or equal to 2.5% of their body weight. Two hundred eighty-two (70%) participants had recognizable lower extremity pitting edema at admission and/or discharge. The amount of weight change was strongly and positively correlated with multiple indicators of both nutrient intake and the change in the amount of peripheral edema. By multivariable analysis, the strongest predictor of weight change was maximal calf circumference change (partial R2 = .35, p < .0001), followed by average daily energy intake (partial R2 = .14, p < .0001), and the interaction of energy intake by time (partial R2 = .02, p < .0001). Conclusions. Many older patients either gain or lose a significant amount of weight after admission to a transitional care unit. Because of the apparent high prevalence of co-occurring changes in total body water, the weight changes do not necessarily represent changes in nutritional status. Although repeat calf circumference measurements may provide some indication as to how much of the weight change is due to changes in body water, there is currently no viable alternative to monitoring the nutrient intake of older recuperative care patients in order to ensure that their nutrient needs are being met. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To determine the relationship between prealbumin, nutrient intake, and indicators of inflammation for recuperative and rehabilitative care patients. DESIGN: Prospective cohort. SETTING: Recuperative Care Unit within a Veterans Administration Nursing Home Care Unit. PARTICIPANTS: One hundred eleven men (100 white; mean age 80, range 64–93). MEASUREMENTS: Prealbumin and seven markers of inflammation (C-reactive protein (CRP), tumor necrosis factor, and interleukin-6 (IL-6) and their soluble receptors) were measured at admission and discharge (median length of stay 23 days, interquartile range 15–40 days). Detailed calorie counts were performed daily, and intake was expressed as a percentage of estimated requirements for protein (1.5 g/kg body weight per day) and energy (Harris-Benedict equation). The study objective was examined using least-squares regression analysis. RESULTS: Discharge prealbumin and the change in prealbumin were positively correlated with protein and energy intake and inversely correlated with markers of inflammation, particularly CRP and IL-6. When all covariates were included in a multivariable regression analysis, the markers of inflammation predominantly accounted for the variance in prealbumin change (56%), whereas discharge protein intake accounted for 6%. CONCLUSION: For older recuperative care patients, prealbumin and its change during hospitalization are positively associated with protein intake, but inflammation or changes in inflammation appear to exert a much more-powerful influence on prealbumin concentration. Given the potential confounding effects of inflammation, monitoring the change in prealbumin is not an adequate substitute for a more-detailed nutritional assessment in this population. [ABSTRACT FROM AUTHOR]

The article presents a study on the hospital rehabilitation of older adults with primary or comorbid debility. The study aims to determine the functional outcomes and discharge setting of older patients, who are 65 years old and above, receiving inpatient rehability. Results showed that patients with primary diagnosis of debility (PDD) were unlikely to be discharged home and more likely to be discharged to a hospital. It is suggested that the functional recovery of older patients with primary or comorbid debility is significantly the same.

Objective: To investigate the association between serum albumin, prealbumin, various serum inflammation associated-cytokines, and mortality in older geriatric recuperative care patients. Design: A prospective cohort study. Setting: A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital. Participants: Participants were 53 geriatric patients (mean age 78 ± 7.3, 96% male) admitted to a Geriatric Evaluation and Management (GEM) unit. Patients with documented near-terminal medical disorder, overt infections, and any systemic or localized inflammatory disorders were excluded. Measurements: Inflammation-associated cytokines (IL-8, IL-1β, IL-6, IL-10, TNF-α), albumin, prealbumin, and C-reactive protein were measured at hospital discharge and each subject was then tracked for 1 year. Main results: By Cox Proportional-Hazards Regression analysis, the strongest predictor of mortality within 6 months of study entry was the serum IL-6. For each log increase in IL-6, there was nearly a 9-fold greater 6-month mortality risk (RR 8.99, 95% CI 1.65 to 49.03). The association between albumin and mortality was no longer significant after controlling for IL-6. There was a strong inverse correlation between IL-6 and both albumin (R 2 0.39, P < .001) and prealbumin (R 2 0.41, P < .001). Conclusion: Subclinical inflammation appears to be an important factor contributing to low serum albumins in older recuperative care patients and may confound the association between albumin and mortality in this population. More in-depth studies of these associations are warranted. [Copyright &y& Elsevier]