Poster Presentation ANZTS Trauma 2024 Conference

Associations between malnutrition, frailty, and functional outcomes in older persons admitted to a Major Trauma Centre (21617)

Barbra Charge 1 , Caitlin MacCana 1 , Sarah Phillips 2 , Nicholas Van Veenendaal 1 , Hannah Broadhurst 1 , Kym Wittholz 1 , David Read 3 4 5 , Hilda Griffin 1 , Kate Gregorevic 6 7
  1. Clinical Nutrition , Royal Melbourne Hospital, Parkville, VIC, Australia
  2. Clinical Nutrition , Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
  3. Surgery, University of Melbourne, Melbourne, VIC, Australia
  4. Royal Melbourne Hospital, Parkville, VIC, Australia
  5. Trauma and Colorectal Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
  6. Aged care, Royal Melbourne Hospital, Parkville, VIC, Australia
  7. Medicine, University of Melbourne, Melbourne, VIC, Australia

Background: 

In 2022 the Royal Melbourne Hospital introduced a new Trauma Older Persons Service (TOPS) to provide care for patients ≥65 years admitted after traumatic injuries. This study aimed to describe any associations between malnutrition status, frailty and functional outcomes in TOPS patients.

Methods: 

All patients admitted under TOPS bed card between November 2023 and March 2024 were assessed by a dietitian. Prospective observational data including nutritional status, assessed via Subjective Global Assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) criteria, Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), and Katz Activities of Daily Living scores (KATZ) were collected. Descriptive statistics were generated and relative risks of malnutrition based on diagnosis of frailty as per CFS were calculated using Microsoft Excel.

Results:

Of the 100 patients (55% male, mean (SD) age 80.75 (7.6) years), 25% were malnourished on admission (15% mild, 6% moderate and 4% severe) and 44% were frail (CFS≥5). Mean (SD) CCI for malnourished patients was 1.9 (2.1) compared to 1.2 (1.2) in well-nourished patients. 39% of patients with a CFS ≥5 (i.e. frail) were malnourished compared with 15% of those with a CFS ​​<5 (relative risk 2.5, P=0.014). Median [IQR] KATZ score at baseline was 6.0 [5.0-6.0] for malnourished and well-nourished patients. On discharge KATZ score decreased to 4.0 [2.5=5.0] and 4.0 [2.0-6.0], respectively. 

Conclusion:

Malnutrition and frailty were frequently observed in TOPS patients. Frail patients were 2.5 times more likely to be malnourished. Geriatric trauma services should ensure sufficient dietetic services are available to meet this need.