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Author(s): M Díaz de Bustamante [1]; T Alarcón [1, 2, 3]; R Menéndez-Colino [1, 2]; R Ramírez-Martín [1]; Á Otero [2, 3, 4]; J I González-Montalvo [1, 2, 3] Introduction [...], Backgrounds/objectives: Malnutrition is very common in acute hip fracture (HF) patients. Studies differ widely in their findings, with reported prevalences between 31 and 88% mainly because of small sample sizes and the use of different criteria. The aim of this study was to learn the prevalence of malnutrition in a large cohort of HF patients in an comprehensive way that includes the frequency of protein-energy malnutrition, vitamin D deficiency and sarcopenia. Subjects/methods: A 1-year consecutive sample of patients admitted with fragility HF in a 1300-bed public University Hospital, who were assessed within the first 72 h of admission. Clinical, functional, cognitive and laboratory variables were included. Energy malnutrition (body mass index (BMI) [less than] 22 kg/m[sup.2]), protein malnutrition (serum total protein [less than] 6.5 g/dl or albumin [less than] 3.5 g/dl), vitamin D deficiency (serum 25-OH-vitamin D [less than] 30 ng/dl) and sarcopenia (low muscle mass plus low grip strength) were considered. Results: Five hundred nine HF patients were included. The mean age was 85.6[+ or -]6.9 years and 79.2% were women. Ninety-nine (20.1%) patients had a BMI [less than] 22 kg/m[sup.2]. Four hundred nine patients (81.2%) had protein malnutrition. Eighty-seven (17.1%) patients had both energy and protein malnutrition. Serum vitamin D was [less than] 30 ng/ml in 466 (93%) patients. The prevalence of sarcopenia was 17.1%. Conclusions: Protein malnutrition and vitamin D deficiency are the rule in acute HF patients. Energy malnutrition and sarcopenia are also common. A nutritional assessment in these patients should include these aspects together. European Journal of Clinical Nutrition (2018) 72, 77-81; doi: 10.1038/ejcn.2017.72; published online 17 May 2017

Purpose: Many institutionalized older people have died during the first wave of COVID-19. Other related consequences have not yet been described objectively. The aim of this study was to compare functional, cognitive, and nutritional status before and after the first wave among nursing home residents, in both COVID-19 and non-COVID-19 patients., Methods: Older adults institutionalized in four nursing homes were assessed from May to June 2020, by a geriatric multidisciplinary team in collaboration with the nursing homes staff. Comprehensive geriatric assessment was performed including functional, cognitive, and nutritional variables before and after the first wave of the pandemic. Data from residents with positive results for microbiological testing for SARS-CoV-2 were compared with those who did not., Results: 435 nursing home residents were included. The median age was 86.77 ± 8.5 years, 78.4% were women. 190 (43.9%) tested positive for coronavirus. Functional decline after the first wave was detected in 20.2% according to the Barthel Index and in 18.5% according to functional ambulation categories, p < 0.001. Cognitive status worsened by 22 and 25.9% according to the global deterioration scale (p < 0.001) and Lobo's Mini-Examen Cognoscitivo (p 0.01), respectively. Onset of depressive symptoms was found in 48% (p < 0.001). The prevalence of malnutrition increased by 36.8 and 38.4% lost weight. When comparing the functional, cognitive, and nutritional decline between COVID-19 and non-COVID-19 patients no clinical or statistically significant differences were found except for the presence of prior malnutrition, higher in the COVID-19 group., Conclusion: We observed a significative functional, cognitive, and nutritional decline in institutionalized elderly after the first wave of COVID-19. These results may be caused by the lockdown itself, since no differences have been found between COVID-19 and non-COVID-19 patients. According to these results, interventions are necessary during social isolation or confinement to prevent systemic decline in the elderly., (© 2021. European Geriatric Medicine Society.)

Purpose: The aim of this study was to develop a new comprehensive preoperative risk score for predicting mortality during the first year after hip fracture (HF) and its comparison with 3 other risk prediction models., Methods: All patients admitted consecutively with a fragility HF during 1 year in a co-managed orthogeriatric unit at a university hospital were assessed and followed for 1 year. Factors independently associated with 1-year mortality were used to create the HULP-HF (Hospital Universitario La Paz - Hip Fracture) score. The predictive validity, discrimination and calibration of the HULP-HF score, the American Society of Anesthesiologists (ASA) scale, the abbreviated Charlson comorbidity index (a-CCI) and the Nottingham Hip Fracture score (NHFS) were compared. Discriminative performance was assessed using the area under the curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit-test., Results: 509 patients were included. 1-year mortality was 23.2%. The 8 independent mortality risk factors included in the HULP-HF score were age >85 years, baseline functional and cognitive impairment, low body mass index, heart disease, low hand-grip strength, anaemia on admission, and secondary hyperparathyroidism associated with vitamin D deficiency. The AUC was 0.79 in the HULP-HF score, 0.66 in the NHFS, 0.61 in the abbreviated CCI and 0.59 in the ASA scale. The HULP-HF score, the NHFS and the abbreviated CCI all presented good levels of calibration ( p  > 0.05)., Conclusions: The HULP-HF score has a predictive capacity for 1-year mortality in HF patients slightly superior to that of other previously existing scores.

Introduction: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible., Method: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments., Results: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05., Conclusions: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years., (Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)