Mortality Risks of Body Mass Index and Energy Intake Trajectories in Institutionalized Elderly People: a Retrospective Cohort Study

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2022 Feb 1

PMID 35100993

Authors

Yoshiaki Kawakami

Jun Hamano

Affiliations

Soon will be listed here.

Abstract

Background: Many factors can identify the mortality risks of institutionalized elderly people; among all such factors, body mass index (BMI) and energy intake (EI) can be employed as independent predictors. The objective of this study was to elucidate about the mortality risks and the trajectory of two parameters obtained from continuously monitored data.

Methods: This retrospective cohort study targeted 218 elderly people who were admitted to a nursing home for at least 6 months between 2007 and 2020 and passed away at the nursing home. BMI and EI (kcal) per body weight (BW) were continuously measured until death.

Results: BMI continued to decrease for 5 years until death. The rate of change of BMI significantly increased for 3 years before death (P = 0.004). In contrast, the rate of change of EI per BW significantly increased after 1 year before death (P < 0.001); in addition, 2 months before death, this rate of change significantly exceeded that of BMI (P = 0.007). In the four risk groups that were examined, a BMI of <18.0 + EI per BW of <29.2 and a BMI of <17.3 + EI per BW of <28.3 were significantly correlated with a high risk of death (log-rank test: P < 0.001, P = 0.002, respectively). There was no significant difference in the hazard ratio based on the age at the time of admission; however, when EI per BW was <23.8, the risk of death was significantly higher [hazard ratio = 4.36; 95% confidence interval: 2.31-8.24].

Conclusions: Elderly people in the current study presented a tendency toward decreasing BMI starting 60 months prior to death even if EI per BW remained constant. In the 1 year before death, EI per BW rapidly decreased. When the rate of change of EI per BW exceeded the rate of decrease of BMI, it was considered to be the point of no return when death was imminent. Our study showed that identifying mortality risks from the relationship between the trajectories of the two parameters that were continuously measured for several months to years is possible.

References

Mitchell S, Kiely D, Hamel M . Dying with advanced dementia in the nursing home. Arch Intern Med. 2004; 164(3):321-6. DOI: 10.1001/archinte.164.3.321. View

Lukaszyk E, Bien-Barkowska K, Bien B . Identification of Mortality Risks in the Advancement of Old Age: Application of Proportional Hazard Models Based on the Stepwise Variable Selection and the Bayesian Model Averaging Approach. Nutrients. 2021; 13(4). PMC: 8066062. DOI: 10.3390/nu13041098. View

Mazza A, Zamboni S, Tikhonoff V, Schiavon L, Pessina A, Casiglia E . Body mass index and mortality in elderly men and women from general population. The experience of Cardiovascular Study in the Elderly (CASTEL). Gerontology. 2006; 53(1):36-45. DOI: 10.1159/000095783. View

Pasman H, Onwuteaka-Philipsen B, Kriegsman D, Ooms M, Ribbe M, van der Wal G . [Degree of discomfort following the decision to discontinue artificial nutrition and hydration in institutionalised psychogeriatric patients with severe dementia who no longer or scarcely eat or drink]. Ned Tijdschr Geneeskd. 2006; 150(5):243-8. View

Bamia C, Halkjaer J, Lagiou P, Trichopoulos D, Tjonneland A, Berentzen T . Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study. J Intern Med. 2010; 268(2):133-44. DOI: 10.1111/j.1365-2796.2010.02219.x. View

Hebert R, Dang Q, Schulz R . Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: findings from the REACH study. J Palliat Med. 2006; 9(3):683-93. DOI: 10.1089/jpm.2006.9.683. View

Goldberg T, Botero A . Causes of death in elderly nursing home residents. J Am Med Dir Assoc. 2008; 9(8):565-7. DOI: 10.1016/j.jamda.2008.04.011. View

Sharifi F, Ghaderpanahi M, Fakhrzadeh H, Mirarefin M, Badamchizadeh Z, Tajalizadekhoob Y . Older people's mortality index: development of a practical model for prediction of mortality in nursing homes (Kahrizak Elderly Study). Geriatr Gerontol Int. 2011; 12(1):36-45. DOI: 10.1111/j.1447-0594.2011.00724.x. View

Yokobayashi K, Matsushima M, Fujinuma Y, Tazuma S . Retrospective cohort study of the incidence and risk of fever in elderly people living at home: a pragmatic aspect of home medical management in Japan. Geriatr Gerontol Int. 2013; 13(4):887-93. DOI: 10.1111/ggi.12024. View

10.

Wirth R, Streicher M, Smoliner C, Kolb C, Hiesmayr M, Thiem U . The impact of weight loss and low BMI on mortality of nursing home residents - Results from the nutritionDay in nursing homes. Clin Nutr. 2015; 35(4):900-6. DOI: 10.1016/j.clnu.2015.06.003. View

11.

do Carmo De Stefani F, Pietraroia P, Fernandes-Silva M, Faria-Neto J, Baena C . Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep. 2018; 8(1):15447. PMC: 6194006. DOI: 10.1038/s41598-018-33563-z. View

12.

Bhaskaran K, Dos-Santos-Silva I, Leon D, Douglas I, Smeeth L . Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3·6 million adults in the UK. Lancet Diabetes Endocrinol. 2018; 6(12):944-953. PMC: 6249991. DOI: 10.1016/S2213-8587(18)30288-2. View

13.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

14.

Toscani F, Finetti S, Giunco F, Basso I, Rosa D, Pettenati F . The last week of life of nursing home residents with advanced dementia: a retrospective study. BMC Palliat Care. 2019; 18(1):117. PMC: 6935223. DOI: 10.1186/s12904-019-0510-x. View

15.

Porock D, Parker Oliver D, Zweig S, Rantz M, Mehr D, Madsen R . Predicting death in the nursing home: development and validation of the 6-month Minimum Data Set mortality risk index. J Gerontol A Biol Sci Med Sci. 2005; 60(4):491-8. DOI: 10.1093/gerona/60.4.491. View

16.

Iyen B, Weng S, Vinogradova Y, Akyea R, Qureshi N, Kai J . Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health. 2021; 21(1):576. PMC: 8048253. DOI: 10.1186/s12889-021-10606-1. View

17.

Lee I, Paffenbarger Jr R . Change in body weight and longevity. JAMA. 1992; 268(15):2045-9. View

18.

Pasman H, Onwuteaka-Philipsen B, Kriegsman D, Ooms M, Ribbe M, van der Wal G . Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med. 2005; 165(15):1729-35. DOI: 10.1001/archinte.165.15.1729. View

19.

Gentile S, Lacroix O, Durand A, Cretel E, Alazia M, Sambuc R . Malnutrition: a highly predictive risk factor of short-term mortality in elderly presenting to the emergency department. J Nutr Health Aging. 2013; 17(4):290-4. DOI: 10.1007/s12603-012-0398-0. View

20.

Imahashi K, Kawagoe M, Eto F, Haga N . Clinical status and dependency of the elderly requiring long-term care in Japan. Tohoku J Exp Med. 2007; 212(3):229-38. DOI: 10.1620/tjem.212.229. View