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Nutritional status and functional capacity in elderly people with hip fracture
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to study nutritional status and functional capacity in elderly men and women admitted to hospital with a hip fractnre, and to evaluate the effect of nutritional intervention and surgical method. A total of 176 patients participated in the study. Of them 84 received protein- and energy-enriched meals at hospital and nutritional advice on discharge and at home. A total of 100 patients with displaced femoral neck fracture were randomised to treatment with either total hip arthroplasty or osteosynthesis with Olmed® screws.

The patients were examined and interviewed the first time within 4-6 days after surgery, as well as one and three months aud one year after surgery. The nutritional status was assessed with body mass index, measures of triceps skinfold thickness, estimation of muscle mass and body composition. Serum albumin, insulin-like growth factor-I and hormones were measured. Functional capacity was assessed with the Modified Norton scale, Katz index of ADL and a questionnaire measuring instrumental activities of daily living.

Mentally impaired patients had worse nutritional status aud functional condition compared with the lucid group at inclusion, deteriorated more in activity and mobility fimctions and had a higher one-year mortality rate. The nutritional intervention was not powerful enough to have effect on anthropometric or biochemical measurements. The patients treated with total hip arthroplasty had reduced pain, better locomotion ability and a slight weight gain compared with the osteosynthesis group.

In conclusion, a marked deterioration of nutritional and functional status was found after a hip fracture. Studies of the effect of a more powerful nutritional intervention on nutritional status and functional capacity in this group are warranted. Patients treated with total hip arthroplasty had a more favourable rehabilitation period with regard to nutritional status and locomotion ability.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 649
Keyword [en]
elderly people, functional capacity, hip fractnre, mental impairment, nutritional status
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27458Local ID: 12111ISBN: 91-7219-750-1 (print)OAI: oai:DiVA.org:liu-27458DiVA: diva2:248010
Public defence
2000-11-18, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-15Bibliographically approved
List of papers
1. Nutritional state and functional capacity among elderly Swedish people with acute hip fracture
Open this publication in new window or tab >>Nutritional state and functional capacity among elderly Swedish people with acute hip fracture
2000 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 14, no 4, 268-274 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to describe characteristics in a group of elderly men and women with hip fracture, regarding presumed risk factors, such as nutritional state and functional capacity. A total of 142 men and women aged 75 years or more were consecutively included on admittance to the hospital. Anthropometry and body composition were measured 4-6 days after the fracture. Data on functional status, activities of daily living and living arrangements at the time of the fracture were collected. The women and men had a body mass index (BMI) of 22.3 ▒ 3.7 kg/m2 and 21.7 ▒ 2.1 kg/m2, respectively. Of the whole group, 71% had a BMI < 24 kg/m2 and 25% a BMI < 20.0 kg/m2. Forty-five percent of the patients needed daily home help, and a majority of them were mentally impaired (p < 0.0001). Women with a trochanteric hip fracture were shorter, had lower body weight, lower lean body mass and lower arm muscle circumference (AMC) than the cervical fracture group (p < 0.05). Fewer women with a trochanteric fracture and fewer women with mental impairment took walks outside before the fracture, (p = 0.023 and p = 0.002, respectively). Characteristics found in the group were low BMI, low muscle mass as indicated by low lean body mass and mental impairment. It seems important to evaluate such factors when developing post-operative care plans aimed at avoiding further deterioration. Extra frail sub-groups of patients, such as people who are mentally impaired, women with trochanteric fracture and women with high dependency concerning ADL functions were identified.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26796 (URN)12035218 (PubMedID)11402 (Local ID)11402 (Archive number)11402 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Mental Impairment as a Risk Indicator for Underweight and Aggravated Rehabilitation After Hip Fracture in Elderly Women
Open this publication in new window or tab >>Mental Impairment as a Risk Indicator for Underweight and Aggravated Rehabilitation After Hip Fracture in Elderly Women
1999 (English)In: Journal of Nutritional & Environmental Medicine, ISSN 1359-0847, E-ISSN 1364-6907, Vol. 9, no 1, 55-61 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this prospective study was to analyze the role of mental impairment on nutritional status and functional capacity after hip fracture. Fifty-seven women aged 75 years or older, acutely admitted to a university hospital with a hip fracture, were consecutively included. Nutritional status with anthropometry and body composition, functional condition and activities of daily living (ADL) were collected 4-6 days and 3 months after surgery. Both lucid and mentally impaired women deteriorated in nutritional status in the postoperative period owing to loss of fat and muscle mass. In the mentally impaired group there was a 50% greater loss of body weight (not significant), causing underweight, mean body mass index 19.5 +/- 3.0 kg m-2, whereas body mass index remained normal in the lucid group, 21.3 +/- 3.0 kg m-2. Ability for activity, mobility and continence deteriorated significantly, whereas food and fluid intake remained unchanged in the mentally impaired group. Mental impairment is a major risk indicator for loss of functional capacities after an acute hip fracture. The development of malnutrition and underweight is explained by the lower pre-fracture body weight, giving little margin for the further post-fracture weight loss in this group. Actions to preserve preoperative ability regarding activity, mobility and continence among mentally impaired women seem warranted. A special caring programme directed towards the special needs of this high-risk group might increase their well-being and ability to continue living in their own homes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26795 (URN)10.1080/13590849961843 (DOI)11400 (Local ID)11400 (Archive number)11400 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture
Open this publication in new window or tab >>Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture
2001 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 20, no 3, 217-223 p.Article in journal (Refereed) Published
Abstract [en]

Background & Aims: The aim of this study of women with hip fracture was to describe nutritional status with biochemical markers and anthropometric variables, and to evaluate the effect of nutritional intervention with the intention of increasing protein and energy intake.

Methods: The first consecutive 44 women were included, and used as controls. The next 44 were matched for age, fracture and mental state. Anthropometric variables, IGF-I, hormones and serum albumin were collected 4–6 days (baseline), 1 and 3 months after surgery. Twenty-four women filled out a 7-day food record.

Results: At baseline, one fourth had BMI <20 kg/m2and subnormal triceps skinfold thickness. Baseline serum albumin, IGF-I and growth hormone levels were low, probably as an acute response to trauma. Women with BMI <20 kg/m2had lower IGF-I levels compared to those with higher BMI. At 3 months, one-third of both groups were protein and energy malnourished. The intervention group obtained higher daily energy percentage from fat but none of the groups reached their calculated energy need.

Conclusions: Using biochemical markers in the acute postoperative situation to assess nutritional status is not recommended. The intervention had no impact on anthropometric or biochemical variables.

Keyword
nutritional status, IGF-I, hip fracture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24915 (URN)10.1054/clnu.2000.0383 (DOI)9319 (Local ID)9319 (Archive number)9319 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
4. Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study
Open this publication in new window or tab >>Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study
Show others...
2000 (English)In: Aging, ISSN 1945-4589, E-ISSN 1945-4589, Vol. 12, no 5, 366-374 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim of this study was to evaluate the effect of two different surgical methods on nutritional status and functional capacity during the first postoperative year in patients with displaced femoral neck fractures. A further aim was to evaluate the effect of nutritional support. One hundred patients were randomly assigned to treatment with either primary total hip arthroplasty (THA) or osteosynthesis. Half of the patients in each treatment group received protein- and energy-enriched food in the hospital in addition to individual nutritional advice in order to optimize their intake of protein- and energy-rich food. Nutritional state and functional capacity were examined at baseline, one and three months, and one year after the operation. Pain was examined at three months and one year. The effect of nutritional intervention was equal within both surgical groups. Logistic regression showed that the dependent variable "living at one year" was significantly associated with serum albumin levels at one month. Advanced age, mental impairment and deteriorated nutritional status were predominant in the non-survivors. Overall, the primary THA group performed better compared with the osteosynthesis group concerning weight change over time, locomotion and pain. This study also showed that primary THA could safely be performed in the elderly without an increased postoperative mortality rate.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13730 (URN)11126523 (PubMedID)
Available from: 2002-05-12 Created: 2002-05-12 Last updated: 2017-12-13Bibliographically approved

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