Abstract
Background
Malnutrition has been suggested to increase the risk of falls in frail elderly. It has been hypothesised that elderly, orthopaedic trauma patients may be malnourished. We conducted an observational study to identify if this was the case.
Methods
30 trauma patients (? 65 years) admitted for surgical intervention for a fracture were recruited. Consent/ethical approval was obtained. Serum markers (LFTs, CRP, U&Es, FBC, magnesium), anthropometric measurements (triceps skin-fold thickness [TSF], mid-arm circumference [MAC], body mass index [BMI]) and short form mini-nutritional assessment (MNA-SF®) were carried out at presentation and at 3 months post-operation. Serum markers were also repeated at day 1 and day 3 post-operation.
Results
60% had an initial MNA-SF® score of ?11 points indicating that they were at risk from possible malnutrition. However, median BMI at presentation was normal at 22.79 kg/m2 (WHO) (Interquartile range 19.8–28). Interestingly, a higher proportion of the group (67%) were below the 50th centile for age related BMI centiles. At follow-up (15 patients), there was no significant difference in anthropometric measures (BMI p=0.884; BMI Centile p=0.687; MAC p=0.095; TSF p=0.260) or with the MNA-SF® (p=0.121). The mean MNA-SF® had increased, but not significantly.
Conclusions
This study indicates that elderly trauma patients may be at risk of malnutrition regardless of their BMI at presentation and should be screened and monitored. The MNA-SF® has been shown to be 100% specific and 98% sensitive in predicting malnutrition. Our study correlates with others illustrating that patients may have normal BMI and albumin levels, but have poor nutritional intake, highlighting the need to identify patients at risk of malnutrition prior to detectable changes in BMI. Screening should be given to all elderly trauma patients being admitted to a trauma unit. We would suggest that it become the standard. Further research is needed using larger sample sizes.
