Geriatri Journal Reading Presentation.pptx

Geriatric

1. Journal Reading : Specialized oral nutritional supplement (ONS) improves handgrip strength in hospitalized, malnourished older patients with cardiovascular and pulmonary disease: A randomized clinical trial

2. Introduction Nutrition plays a critical and often overlooked role in the health of older hospitalized patients who are at high risk of malnutrition. Malnutrition is linked to the loss of lean body mass, decreased strength, and higher mortality rates. Leong et al. found in the PURE study that a 5 kg decrease in grip strength increased the risk of all-cause mortality by 16%. the Adult Health Study in Japan found that mortality decreased by 11% for every 5 kg increase in grip strength .

3. Introduction A recent study involving patients with a hospital stay of ≥ 7 days revealed that lower handgrip strength (HGS) at discharge was linked to malnutrition based on subjective global assessment (SGA). Malnutrition and muscle mass loss contributed to the reduced HGS, possibly due to factors such as inadequate nutrition , the body's metabolic response to injury , or prolonged bed rest . The decline in both muscle strength and functional abilities during hospitalization stands out as one of the most difficult aspects of eldercare.

4. Introduction By 2030, the United States will have 72 million people aged 65 and above, constituting about 20% of the population. A significant study involving 1,279 hospitalized individuals aged 70 and older found that 40% had lost the ability to perform at least one ADL within 90 days after discharge In another study with 2,293 patients of the same age group, 35% experienced a loss of ADL capability during their hospital stay.

5. Introduction Administering beta-hydroxy- methylbutyrate (HMB) alone, a leucine metabolite, helped mitigate muscle mass loss in older individuals during bed rest compared to a placebo. Hospitalized older adults with malnutrition who received a specialized oral nutritional supplement (S-ONS) containing high protein and HMB experienced a significant reduction in mortality rates at 30, 60, and 90 days post-hospital discharge. In our latest analysis of the study , we explore the impact of S-ONS supplementation on handgrip strength (HGS) and its correlation with the patient's nutritional status and ability to perform Activities of Daily Living (ADL).

6. Materials and Method Prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter study Design of study Between May 2012 and October 2014 Study period 652 participants Number of participants

7. Materials and Method Standard nutritional care consume 2 servings of their allocated ONS (S-ONS or placebo) daily During the 90-day post discharge period, participants were instructed to continue to take their allocated ONS (2/day) along with their regular dietary intake Both clinical products were packaged in identical individual single-serve Tetra Paks ® (237 mL) The S-ONS oral supplement was a specialized, nutrient-dense ready-to-drink liquid (Abbott Nutrition, Columbus, Ohio, USA) with 350 kcal, 20 g protein, 11 g fat, 44 g carbohydrate, 1.5 g calcium-HMB, and 26 other essential vitamins and minerals. The placebo was also a ready-to-drink liquid (Abbott Nutrition, Columbus, Ohio, USA), that contained 48 kcal, 12 g carbohydrate, and 10 mg vitamin C Inter- vention

8. Materials and Method HGS was assessed using a handheld Jamar® Hydraulic Hand Dynamometer on the dominant arm of the participants. The dynamometer was positioned and calibrated at the second joint of the finger below the handle, with the arm positioned close to the body and the elbow flexed at a 90-degree angle. Participants were instructed to exert maximum force on the dynamometer for a duration of three to 5 seconds. The force exerted was measured in kilograms . Each participant underwent three trials, and the average of these three measurements was used as the final HGS value.

9. Materials and Method Inclusion criteria: Aged > 65 years with a recent (within 72 h) hospital admission and a primary diagnosis of COPD exacerbation, pneumonia, CHF, or acute myocardial infarction. Malnourished and had a Subjective Global Assessment (SGA) class of B (mild or moderate malnutrition) or C (severe malnutrition). Exclusion criteria: Diabetes mellitus (type 1 or 2) due to product composition not intended for patients with diabetes mellitus. Current active or treated cancer. Significantly impaired liver or renal function.

10. Result In the evaluable cohort, higher HGS was observed in the S-ONS group compared with the placebo group (significant main effect of intervention)

11. Result Analysis of changes in HGS from baseline to discharge and from discharge to d30, d60, and d90 post-discharge showed higher changes in the S-ONS group compared with placebo .

12. Result HGS increased in various subgroups ranging from 0.467 (<75 years old) to 0.906 kg (PN diagnosis at entry), consistent with the HGS increase in evaluable patients compliant to 6 weeks (Overall) of 0.62 kg over 90 days post-discharge.

13. Result Consumption of S-ONS, male gender, younger age, and higher study product intake were positively associated with increased HGS.

14. Discussion Supplementation with the S-ONS was significantly associated with improved HGS relative to placebo . In our 3-month study, participants who received S-ONS gained 0.66 kg (male) and 0.58 kg (female) over those who received placebo. In our study, we observed an average increase in HGS of 4 kg over the 90-day period following discharge compared to baseline. Participants who adhered to the recommended intake of ONS experienced the most significant improvements. Impaired HGS in patients is associated with increased postoperative complications, higher rates of rehospitalization, longer hospital stays, and reduced physical function.

15. Discussion Administration of this specialized ONS led to improvements in nutritional status and significantly enhanced the patients' ADL and QoL, regardless of their baseline BMI. While no single approach can fully address this challenge, a combination of enhanced nutrition and physical therapy may represent the most effective intervention given current technological capabilities. exercise provides additional benefits to muscle strength when used alongside nutritional support in nutritionally vulnerable older adults. Further research is necessary to ascertain the optimal exercise intervention and timing of ONS administration in undernourished older adults, particularly those recovering from hospitalization.

16. Conclusion NOURISH trial revealed that compared to a placebo, the high-protein ONS containing HMB reduced mortality and improved measures of nutritional status over the 90-day period following hospital discharge This specific ONS was linked to enhanced handgrip strength (HGS) during and after hospitalization in these participants. Moreover, the improvement in HGS may be associated with better performance in Activities of Daily Living (ADL). While the inclusion of early patient mobilization with tailored physical therapy programs could potentially offer additional benefits to patients, further research is necessary for validation.

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