Saudi Cultural Missions Theses & Dissertations
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Item Restricted Investigation of Malnutrition, Sarcopenia and Frailty in Middle-Aged and Older People aged 50 years and above using UK Biobank(University of Manchester, 2024-04-18) Almohaisen, Nada; Burden, Sorrel; Gittins, Matt; Todd, ChrisBackground Malnutrition, frailty, and sarcopenia are widespread health conditions in older adults across different settings. These conditions are associated with negative impacts on physical and cognitive function, falls, disability, hospitalisation, increased risk of infections, and fractures. Despite similarities in diagnostic criteria and health outcomes, the relationship between these conditions is still poorly understood. Furthermore, these conditions are frequently underdiagnosis, leading to delayed treatment and management, resulting in deteriorating health status and increased healthcare costs. Thus, it is crucial to understand the relationship between these conditions for early detection and intervention to improve the overall well-being of adults who are ageing. Aims This project aimed to investigate the relationship between malnutrition, frailty, and sarcopenia in the middle-aged and older populations in the UK, using the UK Biobank database. It comprises of three quantitative studies. The first study evaluated the feasibility of mapping the three conditions in the database, determining their prevalence and overlap. The second study estimated their incidence and examined the relationship between them. Lastly, the third study explored the dietary habits of participants with these conditions. The project is important for improving the understanding of the overlap between the three conditions and the dietary habits of people who are malnourished, frail or sarcopenic. Methods This quantitative project analysed secondary data from the UK Biobank. Study 1 was a cross-sectional study of participants aged 50 and over at the baseline assessment visit to estimate the prevalence and overlap of malnutrition, frailty and sarcopenia. Study 2, a prospective cohort design, used data from Study 1 and the reassessment phase to estimate the incidence and overlap of new cases of these conditions. Lastly, Study 3 used a cross-sectional design to explore the dietary habits of participants with these three conditions using the results of Study 1 and data from the baseline assessment. Results Study 1 included 384,609 participants, the number of participants and estimated prevalence of those at risk of malnutrition was 63,489(16.5%), for frailty 17,589 (4.6%) and for sarcopenia 13,833 (3.6%), in participants aged 50 years and over. The overlap between these conditions showed that 51,156 (13.3%) were at risk of malnutrition and prefrailty, and all participants with sarcopenia had a minimum of two of the conditions. The presence of all three conditions was observed in only 2,325 individuals (0.6%). The cohort study included 18,545 participants, aged 50 and above who were condition free at baseline. The incidence of those “at risk of malnutrition” was 44.4 per 1,000 person-years among 13,863 participants. For “frailty”, the incidence was 3 per 1,000 person-years among 10,461 participants, while for “sarcopenia” it was 11 per 1,000 person-years among 16,293 participants. The overlap between these conditions was observed in 44 (0.4%) participants, with most participants “at risk of malnutrition” (n 1,629) also having prefrailty 1,502 (4.3%) among 10,479 participants. Study 3 found that participants with all three conditions had a higher intake of meat and vegetables than the control group, with odds ratios (OR) of 1.13 (95% CI 1.04 to 1.23) and 1.4 (95% CI 1.07 to 1.89), respectively. However, they had a lower intake of cheese, fibre, and fish, with OR 0.49 (95% CI 0.45 to 0.53), 0.44 (95% CI 0.39 to 0.49), and 0.87 (95% CI 0.79 to 0.96), respectively. In addition, individuals with all three conditions consumed less drinking milk infrequently compared to the control group (OR 0.59, 95% CI 0.52 to 0.66). Conclusion The study found a considerable prevalence and incidence of malnutrition risk, frailty, and sarcopenia in middle-aged and older adults. Notably, malnutrition risk decreases with ageing at a population level, whereas frailty increases as did sarcopenia. There was a strong coexistence between malnutrition risk and prefrailty, as well as between sarcopenia, prefrailty, and frailty. Moreover, participants with these three conditions were found to be following standard dietary guidelines aimed at the general population instead of consuming high-energy foods, underscoring the need for tailored dietary advice for some middle-aged and older. Future research should explore multimodal interventions to prevent and manage the coexistence of these conditions, focusing on their interrelating nature and potential synergistic effects.22 0Item Restricted An Exploration of the Association Between Polypharmacy and Frailty Among Hospitalized Older Adult Patients(The University of North Carolina at Greensboro, 2024) Yasin, Reham; Kennedy-Malone, LauriePurpose/Objective The study's main purpose is to explore the association between polypharmacy and frailty among hospitalized older adults. Significance Polypharmacy is considered a matter of concern in many U.S. geriatric healthcare settings. Frail older adults are at special risk of experiencing higher rates of medication-related complications, such as drug–drug interactions, worsening morbidity, falls, delirium, and rehospitalization due to physiological changes. Most studies investigated the relationship among community-dwelling older adults. However, the relationship between polypharmacy and frailty among hospitalized older adults has not yet been well described. Design/Methods This retrospective cross-sectional study offers a secondary data analysis of the EHR in adults aged 50 years or older (N=46,645) hospitalized in medical-surgical units in a healthcare system between 2013 and 2017. Polypharmacy was defined as the concurrent use of seven or more prescribed medications. Potential Inappropriate Medications/High-Risk Medications (PIMs/HRMs) were classified using AGS Beers criteria® 2023 and HIDES, and then grouped into 10 classes (Lekan et al., 2022). A Frailty Index (FI) was created based on the accumulation of a deficit theoretical framework (Mitnitski et al., 2001). After a detailed review of components contributing to frailty, the FI was constructed following the guidance provided by Searle et al. (2008) and Theou et al. (2023). This study’s FI was unique because it included indicators from nursing flowsheets, ICD-10 codes, laboratory blood biomarkers, as well as indicators more customarily used, including comorbidities, and functional status, activities of daily living, and psychosocial indicators. The indicators were coded as “1” for present and “0” for absent. FI-35 was calculated by dividing the number of indices in an individual by the total number of indices measured, with frailty defined by a cut-off point of ≥ 0.25. Findings/Outcomes The average age of patients upon admission was 70.0 years (SD=11.4). The prevalence of polypharmacy was 49.6% (n=19,072). Out of the total number of patients included in the study (25,961), 42.0% were identified as frail. The study showed a significant association between polypharmacy and frailty with 54.5% of individuals with polypharmacy classified as frail. The multivariable logistic regression yielded a significant association between polypharmacy and frailty. The odds of frailty were 53.1 % higher for those in the polypharmacy groups relative to non-polypharmacy groups, adjusting for age and ECI score (AOR = 1.531, 95% CI = [1.437, 1.631], p < 0.001). The study found a significant association between 8 PIMs/HRMs classes and frailty (P<0.001) and with using one or more PIMs/HRMs. However, no significant association was found between genitourinary or anti-infective PIMs/HRMs class and frailty (P > 0.05). Conclusion/Implications for Practice By using EHR data, nurses can identify patients at high risk of adverse outcomes. Including measures of frailty and polypharmacy in assessments can aid in reducing these risks and guide interventions by nurses to prevent negative health outcomes. Identifying frail older adults with Frailty, polypharmacy and exposure to PIMs/HRMs is important, emphasizing the need for specialized care, medication review, de-prescribing, and frailty screening. Post-discharge care plans for frail patients with complex medication regimes help ensure recovery and prevent hospital readmission.21 0