Nutrition screening and assessment of patients attending a multidisciplinary falls clinic. (Original Research).Abstract
Objective: To describe the nutritional health and current nutritional management of a representative sample of patients attending an Australian falls clinic.
Design: Descriptive study.
Subjects: Ninety adults (65 years old and over) attending the Falls Clinic.
Setting: Fall and Injury Risk Assessment Clinic, Repatriation Repatriation
The process of converting a foreign currency into the currency of one's own country.
If you are American, converting British Pounds back to U.S. dollars is an example of repatriation. General Hospital, Daw Park, South Australia Daw Park (Postcode 5042) is a suburb of Adelaide, Australia, in the Local Government Area of the City of Mitcham. Daw Park is part of the South Australian House of Assembly electoral district of Elder and the House of Representatives Division of Boothby. .
Main outcome measures: The Australian Nutrition Screening Initiative (ANSI (American National Standards Institute, New York, www.ansi.org) A membership organization founded in 1918 that coordinates the development of U.S. voluntary national standards in both the private and public sectors. It is the U.S. member body to ISO and IEC. ) tool was administered. Measurements of height, weight, mid-upper arm circumference (MAC) and triceps triceps, any muscle having three heads, or points of attachment, but especially the triceps brachii at the back of the upper arm. One head originates on the shoulder blade and two on the upper-arm bone, or humerus. skinfold skinfold /skin·fold/ (skin´fold) the layer of skin and subcutaneous fat raised by pinching the skin and letting the underlying muscle fall back to the bone; used to estimate the percentage of body fat. thickness (TSF TSF Text Services Framework
TSF TOE Security Functions
TSF Télégraphie Sans Fil (French: former term for radio)
TSF Twelve Step Facilitation (counseling intervention) ) were taken by a trained investigator on one occasion. Body mass index (BMI BMI body mass index.
body mass index
Body mass index (BMI)
A measurement that has replaced weight as the preferred determinant of obesity. ) was calculated for each participant. A BMI of less than 22 kg per [m.sup.2] and greater than 30 kg per [m.sup.2] were classified as underweight Underweight
An situation where a portfolio does not hold a sufficient amount of securities to satisfy the accepted benchmark of the portfolio's asset allocation strategy.
Notes: and overweight respectively. A BMI of less than 22 kg per [m.sup.2] and MAC or TSF less than the fifteenth percentile percentile,
n the number in a frequency distribution below which a certain percentage of fees will fall. E.g., the ninetieth percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level were considered undernourished. Case notes were audited to determine the number of referrals to the dietetics dietetics /di·e·tet·ics/ (-iks) the science of diet and nutrition.
The branch of therapeutics concerned with the practical application of diet in relation to health and disease. department.
Statistical analysis: Descriptive statistics descriptive statistics
see statistics. were used to summarise the data. To identify significant differences between variables and genders, independent sample t-tests were used for continuous data and chi-square tests chi-square test: see statistics. of significance for categorical data categorical data
data relating to category such as qualitative data, e.g. dog, cat, female. It may be nominal when a name is used, e.g. location, breed, or ordinal when a range of categories is used, e.g. calf, yearling, cow. . A significance level of P < 0.05 was applied to all statistical tests.
Results: According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the ANSI checklist 41 of 90 participants were assessed as high nutritional risk'. The most common ANSI risk factors were 'taking three or more different medications daily' (n = 65), 'eating alone most of the time' (n = 41), having a 'history of unintentional weight change' (n = 28), and having an 'illness or condition that affects dietary intake' (n = 26). Seventeen participants were considered overweight with a BMI > 30 kg/[m.sup.2] and 11 were classified as undernourished with a BMI < 22 kg/[m.sup.2] and a MAC or TSF less than the fifteenth percentile. One referral was made to the dietetics department at the Repatriation General Hospital.
Conclusion or application: The results of this study have shown that a substantial number of older adults susceptible to falling are at risk of poor nutritional health and that there is limited nutritional management of this population. While weight and height are routinely collected in this falls clinic and the possibility to monitor weight is available, there is an opportunity to raise awareness of the nutritional health of these patients. (Nutr Diet 2002;569:234-9)
Key words: elderly, nutrition assessment, falls, nutrition screening, body mass index
The number of persons aged 65 years and over currently comprises 12% of the total Australian population and this is projected to increase to 24 to 27% in 2051 (1). Age-related changes including increased body sway, altered gait pattern, impaired balance and visual impairment Visual Impairment Definition
Total blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and make older adults vulnerable to falls (2). It has been estimated that of people aged 65 years and over who live in the community, approximately 30% fall each year (3,4) and for those aged over 80 years, the Years, The
the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109]
See : Time rate is as high as 50% (5). Total health costs for accidental falls for those aged over 65 years were $406 million, in 1993-94 (6) and are projected to increase exponentially with the ageing of the population. Fractures, loss of confidence and independence, fear, institutionalisation This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. and death contribute to health care costs and are themselves important consequences of falling (7).
Poor nutritional health is a risk factor for accidental falls. Age-associated loss of muscle mass is exacerbated by undernutrition Undernutrition
A type of malnutrition caused by inadequate food intake or the body's inability to make use of needed nutrients.
Mentioned in: Appetite-Enhancing Drugs
see malnutrition, starvation. (8) and it has been suggested weakness and gait abnormalities are also related to undernutrition (9). In addition, a tendency to fall is compounded by being undernourished (10). The prevalence of undernutrition among frail older adults is estimated at between 20 and 60% depending on which criteria and cutoff points Cutoff point
The lowest rate of return acceptable on investments. are adopted (11). Low body weight is a known risk factor for osteoporosis (12) and there is data to suggest that the prevalence of undernutrition in patients admitted to hospital with a fall-related fracture is high (13-15). Aside from increased risk of falls and fall-related fracture, the consequences of undernutrition include longer length of hospital stay, impaired immune response immune response
An integrated bodily response to an antigen, especially one mediated by lymphocytes and involving recognition of antigens by specific antibodies or previously sensitized lymphocytes. , increased risk of complications, and higher rates of morbidity and mortality Morbidity and Mortality can refer to:
There is some evidence that an elevated body mass index (BMI > 26 to 28 kg/[m.sup.2]) provides some protection against fall-related fractures as body fat is thought to act as a cushion for bone on impact of a fall, especially in the hip region for women (17). Increased weight is also known to enhance bone mineral maintenance (18). In contrast to this, increased body weight has been shown to increase falls risk. In women, a BMI greater than 30 kg/in2 has been associated with immobility immobility
standing still and disinclined to move, as in an animal suddenly blinded; responds to other stimuli unless immobility is part of a dummy syndrome when all stimuli are ignored. (18-20), osteoarthritis osteoarthritis
or osteoarthrosis or degenerative joint disease
Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. (21) and an increased tendency to fall (22).
There are currently no recommended guidelines for falls clinics but generally these clinics involve a multidisciplinary team and provide individual assessment and management of falls risk factors with the overall aim of reducing an individual's falls, related injuries and associated problems (23). In the Fall and Injury Risk Assessment Clinic patients are assessed at an initial two-hour visit by a rehabilitation medicine rehabilitation medicine Physiatry, physiotherapy A field of therapeutics that bridges the gap between conventional and nonconventional medicine; rehabilitation physicians may adminsiter or prescribe mechanical–eg, massage, manipulation, exercise, movement, or geriatrics geriatrics (jĕrēă`trĭks), the branch of medicine concerned with conditions and diseases of the aged. Many disabilities in old age are caused by or related to the deterioration of the circulatory system (see arteriosclerosis), e.g. registrar, a physiotherapist and a nurse, in order to obtain a history and identify risk factors. This falls clinic uses treatment protocols based on evidence and interventions generally focus on medication advice, exercise programs, footwear advice, home modification Home Modification
Alterations made to a home to meet the needs of people with physical limitations so they can live independently (to some degree) and safely. Examples of home modifications include removing throw rugs to prevent slips and falls, installing grab bars in the bathroom and equipment, and gait and balance re-education (24). Currently in Australia, few multidisciplinary falls clinics assess nutritional health and even fewer have dietitians as part of the clinic team (23). At our falls clinic, height and weight are routinely measured at the patient's initial visit. However, there is no standard procedure for interpreting height and weight and referral for nutritional care. The aim of this study was to describe the nutritional health and current nutritional management of patients attending our falls clinic in Adelaide.
In this descriptive study, 90 adults aged 65 years and over were recruited from the Falls Clinic of the Repatriation General Hospital.
All patients scheduled with an appointment to attend the falls clinic over a five-month period (23 April to 27 September 2001) were contacted regarding participation in the study. Each was sent a letter of invitation to participate and patient information sheet explaining what participation in the study would entail. A follow-up telephone call was made to each individual to provide further details of the study and to identify those individuals willing to participate. Written informed consent was obtained at the falls clinic appointment. The Repatriation General Hospital Research and Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. approved the study protocol.
Demographic data and medical history
Demographic data (age, gender, living situation) and medical history (falls history, dietetic dietetic /di·e·tet·ic/ (di?ah-tet´ik) pertaining to diet or proper food.
1. Of or relating to diet.
2. referral and intervention) were collected from medical notes and confirmed by the participant and carers where required.
Nutrition tools and measurements
The Australian Nutrition Screening Initiative (ANSI) was administered to all participants. Responses were self-reported. The screening tool consists of a 12-question checklist developed to assist in the identification of older adults living in the community, at risk of poor nutritional health (25). It is based on a screening tool developed in the US (26) and has been modified for use in Australia (27). Risk factors are shown in Figure 1. The tool has been evaluated among independently-living older Australians and shown to be a significant predictor of the adequacy of food intake (28). Each checklist question incurs a score according to the presence or absence of each risk factor. A total ANSI score is derived by summation summation n. the final argument of an attorney at the close of a trial in which he/she attempts to convince the judge and/or jury of the virtues of the client's case. (See: closing argument) of the question scores. This 'total' is used to classify nutritional risk as high ( 6), moderate (4 to 5) or low (0 to 3).
Mid-upper arm circumference (MAC) and triceps skinfold thickness (TSF) were measured for each participant by the same trained investigator (DS). These measurements were performed on the right side of the body, unless affected by disease or disability, using standard techniques (29). A flexible steel tape measure was used to measure MAC to the nearest 0.1 cm. Harpenden skinfold calipers (British Indicators, West Sussex West Sussex, nonmetropolitan county (1991 pop. 692,800), 768 sq mi (1,990 sq km), S England. A chalk ridge runs from the county's east to west edge. In the south the land flattens into a gentle plain. After early Roman invasions, the Saxons moved across Sussex. , UK) measured TSF to the nearest 0.2 mm. Measurements were made in triplicate and mean values calculated. As standard Falls Clinic procedure, body weight and height were measured at each patient's initial visit. Weight and height were requested by the investigator if a patient was attending a follow-up appointment. Body weight was measured (to the nearest 0.5 kg) using portable platform medical scales (Propert Australia Pty Ltd PTY LTD Propriety Limited (company structure in Australia) , Sydney). Height was measured (to the nearest 0.5 cm) using a wall-mounted measuring tape. All individuals were able to stand in the correct position for the measurement to be made (29).
Body mass index was calculated for each participant. A BMI of less than 22 kg/[m.sup.2] and greater than 30 kg/[m.sup.2] was classified as underweight and overweight respectively. The BMI cut-off cut-off Anesthesiology The point at which elongation of the carbon chain of the 1-alkanol family of anesthetics results in a precipitous drop in the anesthetic potential of these agents–eg, at > 12 carbons in length, there is little anesthetic activity, points of 22 and 30 kg/[m.sup.2] equate to the 15th and 85th percentiles respectively, of the Australian Longitudinal Study longitudinal study
a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. of Ageing data (20). The latter study is a large Adelaide-based longitudinal study of community-dwelling adults aged 65 years and over that aims to identify the factors that influence health and wellbeing in old age (30). Definitions of undernutrition vary between studies. We defined undernourished as a BMI of less than 22 kg/[m.sup.2] and a MAC (males 26.2 cm, females 25.2 cm) or a TSF (males 7.9 mm, females 13.5 mm) less than the 15th percentile (31) of a representative sample of older adults participating in the Australian Longitudinal Study of Ageing (32).
Data were entered into a database and analysed using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. (SPSS Inc, Chicago, SPSS for Windows, Advanced Statistics, release 9.0.1 1999). Descriptive statistics were used to summarise the data. Data were expressed as means and standard deviations In statistics, the average amount a number varies from the average number in a series of numbers.
(statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. . To identify significant differences between genders, independent samples t-test was used for continuous data (total ANSI score, BMI, MAC, TSF) and chi-square test of significance for categorical data (age, marital status marital status,
n the legal standing of a person in regard to his or her marriage state. , accommodation, falls history, ANSI category and each ANSI risk factor). For all statistical tests, a significance level of P < 0.05 was used.
Between 23 April and 27 September 2001, 123 patients were offered falls clinic appointments, either for initial or follow-up visits. Two individuals were under 65 years of age and therefore ineligible to participate. Nine individuals declined consent. Reasons given for non-participation were 'feeling too old' (n = 1), 'too confused' (n = 1), 'too busy' (n = 1), 'project is of no benefit' (n = 1) and five participants gave no reason. Seventeen participants did not attend their appointment and five left the Falls Clinic before they were assessed. Written informed consent and complete data was collected from 90 (74%) participants.
Descriptive characteristics are summarised in Table 1. The largest group of participants was the 75- to 84-year- age category (n = 53). The mean age was 80.2 [+ or -] 5.6 years for females and 80.8 [+ or -] 5.8 years for males (P = 0.64). The majority of participants lived in the community (a = 85). Sixty-five participants had two or more falls in the previous 12 months. The median number of falls in the previous 12 months was three (range 0 to 300; interquartile range In descriptive statistics, the interquartile range (IQR), also called the midspread, middle fifty and middle of the #s, is a measure of statistical dispersion, being equal to the difference between the third and first quartiles. 2 to 6), 15 participants had fallen only once.
Current nutritional management
During the study period only one referral was made for a patient to see a dietitian dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease.
di·e·ti·tian or di·e·ti·cian
A person specializing in dietetics. . The dietetic referral was requested by the patient following the research interview due to concern about recent unintentional weight loss and loss of appetite loss of appetite Medtalk Anorexia, see there . The patient was seen by a hospital dietitian for an initial and a review appointment. The patient's current weight, weight history and co-morbidities were addressed in these appointments.
Nutrition tools and measurements
The ANSI checklist was completed by all 90 participants. Using the ANSI checklist 41 of 90 participants were assessed as being at 'high nutritional risk', 27 at 'moderate nutritional risk' and 22 at 'low nutritional risk' (see Table 2). There was no significant difference between genders for total ANSI score (P = 0.13), nor was there any significant difference in the number of males and females in each ANSI category (P = 0.12). Figure 1 shows the prevalence of each nutritional risk factor as measured by ANSI. The most common ANSI risk factors were 'taking three or more different medications daily' (n = 65), 'eating alone most of the time' (n = 41), 'unintentional weight change' (n = 28) and 'having an illness or condition that affects dietary intake' (n = 26). The number of females eating alone was significantly greater compared to males (P < 0.001). More males had the risk factor 'three or more glasses of alcohol most days', than females (P = 0.02). The least common risk factors were 'eating no fruit or vege tables most days' (n = 3), and 'not always having enough money to buy food' (n = 2).
Anthropometric measurements anthropometric measurements (anˈ·thrō·p are shown in Table 3. The majority of participants had a BMI between 22 to 30 kg/[m.sup.2] (n = 62). There were no significant differences between male (27.0 [+ or -] 2.9 cm) and female (26.7 [+ or -] 3.3 cm) MAC measurements (P = 0.60). Triceps skinfold measurements were significantly lower in males (12.5 [+ or -] 4.1 mm) compared to females (17.1 [+ or -] 4.0 mm) (P <0.001). The total number of participants classified as undernourished (BMI of less than 22 kg/[m.sup.2] and a MAC or a TSF less than the 15th percentile) was 11.
At present there are no Australian data published on the nutritional health of older adults who have been identified as being at high risk of falling and thus referred to a multidisciplinary falls clinic. The results of this study suggest that almost half (n = 41) the older adults attending the Falls Clinic are at 'high nutritional risk' as assessed by ANSI. Using more objective measures to assess nutritional health, one in eight participants had a BMI less than 22 kg/[m.sup.2] (underweight), whereas one in five participants had a BMI of over 30 kg/[m.sup.2] (overweight).
In our study, ANSI implicated im·pli·cate
tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates
1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot.
2. a large number of participants as at 'high risk' of poor nutritional health (n = 41). There are no other Australian data reporting on the nutritional health of those having falls, therefore we have compared our findings with a general elderly population. In a previous study of older Adelaide residents, only 30% were identified as being at 'high nutritional risk' (28). In our study the greater number identified as at risk of poor nutritional health may reflect the poorer overall health of the falls clinic sample. The risk factor of taking 'three or more medications daily', can be considered an indicator of poor health. It was the most common risk factor for both studies, but was far more common in the falls clinic sample (72% compared to 46%) (28). This further supports the contention that as expected, patients referred to the falls clinic have poorer health than a general community dwelling group. Notably, taking four or more medications is also an identified risk factor for fall ing (33).
The Australia Nutrition Screening Initiative is a screening tool and as such assesses nutritional risk. Whereas, anthropometric measurements provide objective data which can be used to determine nutritional health. It is for this reason that ANSI implicated such a large number of participants at high risk (n = 41), compared to the actual number of participants classified as undernourished (n = 11).
Although ANSI does not distinguish between weight gain and loss, a third of participants having weight change of at least five kilograms in the preceding six months is of concern. The prevalence of unintentional weight change in this study (31%) was almost double that of a previous study of older Adelaide residents (28). In the elderly, unintentional weight loss is perhaps the most established indicator of nutritional risk. Evidence has shown that weight loss over time, regardless of baseline BMI, is related to poor physical function and decline in mobility (20), and this in turn is likely to influence falls risk. Consequently, in the Falls Clinic, establishing a patient's weight history is equally important as knowing current weight and height. As this was a small cross-sectional study cross-sectional study
See synchronic study.
n the scientific method for the analysis of data gathered from two or more samples at one point in time. the anthropometric measurements, while a valuable tool, did not provide information on change over time. Caution is required when relying on self-reported weight change, as it can be affected by recall bias. As patients often return to the Falls Clinic for a review appointment, this provides an opportunity to measure weight and to monitor change.
Using BMI in combination with either MAC or TSF we found that the number of study participants classified as undernourished was much less than anticipated. MAC and TSF are indicators of muscle mass and body fat stores respectively and were used with BMI as an indicator of undernutrition, as BMI alone is not considered a sensitive indicator (31). It is well documented that patients at risk of falls are often those who fracture and these in turn are patients often identified as nutritionally depleted de·plete
tr.v. de·plet·ed, de·plet·ing, de·pletes
To decrease the fullness of; use up or empty out.
[Latin d (13-15). One possible explanation for the low number of 'undernourished' patients in our study may be that the very frail or ill patients did not attend their appointment. For this reason the patients attending the Falls Clinic may have been less likely to be undernourished compared to those who did not attend their scheduled appointment. Though the results presented in this paper are a reflection of the older adults attending the Falls Clinic (consecutive sample and 74% consent rate), we are unable to establish wh ether ether, in chemistry
ether, any of a number of organic compounds whose molecules contain two hydrocarbon groups joined by single bonds to an oxygen atom. the results are a true representation of those actually referred to the Falls Clinic.
One in five of our sample had a BMI greater than 30 kg/[m.sup.2]. There is evidence to suggest that a high BMI is associated with relative immobility (18-20), osteoarthritis (21) and an increased tendency to fall (22). Unintentional weight loss in older adults might not be desirable, even for those with a high BMI (20,34). We cannot find any evidence to suggest that intentional weight loss would be either protective or detrimental in relation to subsequent falls risk, despite evidence suggesting weight loss improves physical function in other patient groups (35). Further research to determine the benefits of a planned weight-loss program in these types of patients is warranted.
While height and weight are routinely measured in our clinic on the initial visit, BMI is not routinely reported or weight monitored, suggesting that interpretation may be lacking. Indeed only one study participant was referred for further nutritional assessment nutritional assessment Oncology The profiling of a Pt's current nutritional status and risk of malnutrition and cancer cachexia. See Cachexia, Malnutrition. and this was initiated by the patient. Thus it seems that in our clinic nutritional health is unrecognised or not seen as an important factor in the management of older adults who have had falls. A recent review of Australian falls clinics by Hill et al. (23) has documented very few falls clinics routinely undertake nutritional assessment of their patients. Of those falls clinics that do, one clinic used ANSI to assess nutritional risk, one clinic used BMI and two clinics used 'other' nutritional assessment tools that were not specified (23). Interpretation of these nutritional assessment tools and the management of patients identified as being nutritionally 'at risk' were not considered in the review.
Diagnosis of undernutrition is multifactorial multifactorial /mul·ti·fac·to·ri·al/ (mul?te-fak-tor´e-al)
1. of or pertaining to, or arising through the action of many factors.
2. and should not be based simply on one nutritional parameter. Although in our study we used a definition of undernutrition that included BMI and MAC or TSF, which is consistent with definitions used in other studies (31), all those participants with a BMI less than 22 kg/[m.sup.2] also had a MAC or TSF less than the 15th percentile, suggesting BMI alone may be sufficient. Weight and height measurements are quick, easy and inexpensive and BMI appears to identify patients that are at the lower end of the distribution for other anthropometric an·thro·pom·e·try
The study of human body measurement for use in anthropological classification and comparison.
an indicators. Caution should be taken when using height measurements in older adults due to loss of height with advancing age. However, currently there are no Australian-specific regression equations Regression equation
An equation that describes the average relationship between a dependent variable and a set of explanatory variables. to estimate stature using alternative methodologies (for example, demi-span or knee height).
The results of this study have shown that a substantial number of older adults susceptible to falling are at risk of poor nutritional health. The results also highlight the most common risk factors influencing poor nutritional health and the limited nutritional management of this population. Currently there is inconsistency and lack of nutritional assessment between Australian falls clinics and no available evidence of nutritional interventions improving the risk of falls. Yet while weight and height are routinely collected in our Falls Clinic and the possibility to monitor weight is available, there is also an opportunity to raise awareness of the nutritional health of these patients. Weight loss affects function and in other overweight patient groups weight loss improves function. Therefore, educating practitioners in the importance and interpretation of these measurements can only be of benefit to patients. We plan to continue our work in the area of falls and nutrition by prospectively examining outcomes of participants from this study.
[FIGURE 1 OMITTED]
Table 1 Descriptive characteristics of the 90 study participants attending the Repatriation General Hospital Falls Clinic between 23 April and 27 September 2001 Male Female Total P value (a) (n = 40) (n = 50) (n = 90) Age 0.93 65-74 years 6 8 14 75-84 years 23 30 53 85 years and over 11 12 23 Marital status <0.001 Married 30 13 43 Not married 10 37 47 Accommodation 0.84 Community 38 47 85 Residential care 2 3 5 Number of falls in 0.61 previous 12 months No falls 1 2 3 One fall 8 7 15 Multiple falls 26 39 65 Unknown 5 2 7 (a)Comparison between genders using chi-square test of significance Table 2 Distribution of nutritional health risk as assessed by Australian Nutrition Screening Initiative (ANSI) for 90 participants attending the Repatriation General Hospital Falls Clinic between 23 April and 27 September 2001 Male (b) Female (c) Total (d) ANSI nutritional score (a) (n = 40) (n = 50) (n = 90) (%) Low (0-3) 10 12 22 (25) Moderate (4-5) 16 11 27 (30) High (6 or more) 14 27 41 (45) (a)ANSI nutritional score (36) (b)ANSI nutritional score 5.4 [+ or -] 2.5 (mean [+ or -] SD) (c)ANSI nutritional score 6.3 [+ or -] 3.2 (mean [+ or -] SD) (d)ANSI nutritional score 5.9 [+ or -] 2.9 (mean [+ or -] SD) Table 3 Anthropometric measurements for participants attending the Repatriation General Hospital Falls Clinic between 23 April and 27 September 2001. Values are n unless otherwise stated. Male Female (n = 40) (n = 50) BMI Mean [+ or -] SD kg/[m.sup.2] 25.9 [+ or -] 3.8 26.7 [+ or -] 4.3 < 22 5 6 22-30 28 34 > 30 7 10 Mid-upper arm circumference Mean [+ or -] SD (cm) 27.0 [+ or -] 3.0 26.7 [+ or -] 3.3 < 15th percentile (b) 16 15 Triceps skinfold thickness Mean [+ or -] SD (mm) 12.5 [+ or -] 4.1 17.1 [+ or -] 4.0 < 15th percentile (c) 6 10 Classified as undernourished (d) 5 6 Total P value (a) (n = 90) BMI Mean [+ or -] SD kg/[m.sup.2] 26.3 [+ or -] 4.1 0.64 < 22 11 22-30 62 > 30 17 Mid-upper arm circumference Mean [+ or -] SD (cm) 26.9 [+ or -] 3.2 0.60 < 15th percentile (b) 31 0.36 Triceps skinfold thickness Mean [+ or -] SD (mm) 15.0 [+ or -] 4.6 < 0.001 < 15th percentile (c) 16 0.51 Classified as undernourished (d) 11 0.94 (a)Comparison between genders using chi-square test of signification and independent samples t-test. (b)Australian Longitudinal Study of Agein (32), males 26.2 cm, females 25.2 cm. (c)Australian Longitudinal Study of Ageing (32), males 7.9 mm, females 13.5 mm. (d)BMI<22 kg/[m.sup.2] and mid-upper arm circumference < 15th percentile or triceps skinfold thickness < 15th percentile.
We wish to acknowledge the staff of the Repatriation General Hospital Fall and Injury Risk Assessment Clinic for their time and patience during the data collection period. Our many thanks to the clinic patients for giving up their time and providing data for this project. Thanks also to the reviewers for their time and expertise in reviewing this paper.
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(14.) Koval KJ, Maurer S, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture hip fracture Orthopedic surgery A femoral fracture which affects 1/6 white ♀–US during life Epidemiology 250,000/yr–US Specifics Proximal femur; 90+% femoral neck, intertrochanteric; 5-10% are subtrochanteric Risk factors Tall, thin ♀, . J Orthop Trauma 1999;13:164-9.
(15.) Hanger HC, Smart EJ, Merrilees M, Frampton CM. The prevalence of malnutrition in elderly hip fracture patients. N Z Med J 1999;112:88-90.
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(18.) Kroger H, Honkanen R, Saarikoski S, Alhava E. Decreased axial axial /ax·i·al/ (ak´se-al) of or pertaining to the axis of a structure or part.
1. Relating to or characterized by an axis; axile.
2. bone mineral density bone mineral density
See bone density.
bone mineral density A measurement of bone mass, expressed as the amount of mineral–in grams divided by the area scanned in cm2. See Bone densitometry. in perimenopausal perimenopausal adjective Referring to a period of a ♀'s life–age 45 to 55-ish–in which menstrual periods become irregular; perimenopause is immediately before, during and after menopause. See Menopause. women with rheumatoid arthritis--a population based study. Ann Rheum rheum (rldbomacm) any watery or catarrhal discharge.
A watery or thin mucous discharge from the eyes or nose.
any watery or catarrhal discharge. Dis 1994;53:18-23.
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(24.) Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews. Issue 2, 2002.
(25.) Lipski PS. Australian Nutrition Screening Initiative. Aust Ageing 1996;15:14-5.
(26.) Posner BM, Jette AM, Smith KW, Miller DR. Nutrition and health risks in the elderly: The nutrition screening initiative. Am J Public Health 1993;53:972-8.
(27.) Truswell AS. Nutrition screening for older Australians. Aust J Nutr Diet 2000;57:163-5, 174.
(28.) Cobiac L, Syrette JA. What is the nutritional status of older Australians? Proc Nutr Soc Aust 1995;19:139-45.
(29.) World Health Organization. Use and interpretation of anthropometric indicators of nutritional status: Report of a WHO working group. Bull World Health Organ 1986a;929-41.
(30.) Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Aging. Aust Ageing 1989;8:31-5.
(31.) McWhiter J, Pennington C. Incidence and recognition of malnutrition in hospital. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 1994;308:5-8.
(32.) The Australian Longitudinal Study of Ageing Database. Centre for Ageing Studies. Adelaide: Flinders University The university has established a reputation as a leading research institution with a devotion to innovation. It is a member of Innovative Research Universities Australia and ranks among the leading universities in Australia. of South Australia South Australia, state (1991 pop. 1,236,623), 380,070 sq mi (984,381 sq km), S central Australia. It is bounded on the S by the Indian Ocean. Kangaroo Island and many smaller islands off the south coast are included in the state. ; 1992.
(33.) Campbell AJ, Borne MJ, Spears GF. Risk factors for falls in a community based prospective study of people 70 years and older. J Gerontol 1989;44:M112-M7.
(34.) Fischer J, Johnson M. Low body weight and weight loss in the aged. J Am Diet Assoc 1990;90:1697-1706.
(35.) Messier SP, Loeser RF, Mitchell MN, Valle G, Morgan TP, Rejeski WJ, et al. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. J Am Geriatr Soc 2000;48:1062-72.
(36.) National Health and Medical Research Council The National Health and Medical Research Council (NHMRC) is Australia's peak funding body for medical research, with a budget of nearly A$500M a year . The Council was established to develop and maintain health standards and is responsible for implementing the . Dietary Guidelines dietary guidelines Cardiology A series of dietary recommendations from the Nutrition Committee of the Am Heart Assn, that promote cardiovascular health. See Caloric restriction, food pyramid, French paradox. for Older Australians. Canberra: Commonwealth of Australia; 1999.
Flinders University Department of Rehabilitation rehabilitation: see physical therapy. and Aged Care, Repatriation General Hospital, Adelaide, South Australia
D. Stolz, BA/BSc, MNutDiet, Dietitian
M. Miller, BSc, MNutDiet, PhD candidate
C. Whitehead, BMBS BMBS Bachelor of Medicine, Bachelor of Surgery (Hons) FRACP FRACP Fellow of the Royal Australasian College of Physicians , Consultant Geriatrician geriatrician
a specialist in geriatrics.
M. Crotty, BMed, MPH, PhD, FAFRM(RACP RACP Royal Australasian College of Physicians
RACP Regional Airspace Control Plan ), Head Department of Rehabilitation and Aged Care
Nutrition Unit, Flinders University of South Australia, Adelaide
E. Bannerman, BSc(Hons), PhD, SRD SRD Suriname Dollar (ISO currency code)
SRD Sustainable Resource Development (Alberta, Canada)
SRD Short Range Devices (wireless networking)
SRD System Reference Document , Lecturer
L. Daniels, BSc, GradDipNutDiet, MSc, PhD, GradCertTertEduc, Associate Professor
Correspondence: M. Crotty, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park SA 5041. Email: email@example.com