Increased association with malnutrition and malnourishment in older adults admitted with hip fractures with cognitive impairment and delirium, as assessed by 4AT

Chris H Fry*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: The Royal College of Physicians recently introduced the 4AT (Alertness, Abbreviated Mental Test-4, Attention and Acute change or fluctuating course) for screening patient cognitive impairment and delirium. The 4AT and nutritional status are both indicators of health status, but their relationship has not been studied. Here, we examined the association of the 4AT with nutritional status in patients admitted to a single hospital with hip fractures between January 1, 2016 and June 6, 2019.

Methods: Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST) protocol and the 4AT was assessed within 1-day after hip surgery. Differences between categorical outcome variables were tested with chi-squared tests, and logistic regression was conducted to assess the association of nutritional status (dependent variable) with 4AT scores (independent variable).

Results: From 1082 patients (298 men, 784 women: mean age 83.8 ±8.7 (SD) years, range=60-103) categorized into 4AT scores of 0, 1-3 or ≥4, the prevalence of malnutrition risk was 15.5, 27.3 and 39.6% and for malnourishment were 4.1, 13.2 and 11.3%, respectively. After age and sex adjustment, compared with the 4AT=0 cohort, a 4AT score of 1-3 was associated with an increased malnutrition risk: (odds ratio (OR)=2.3, 95% confidence interval (CI)=1.6-3.1), or malnutrition itself (OR =3.6, 95%CI=2.1-6.3). For a 4AT score ≥4 corresponding ORs were 4.0 (95%CI=2.8-5.9) and 3.6 (95%CI=1.9-6.8) . These associations persisted with additional adjustments for polypharmacy, anticholinergic burden and co-morbidities including dementia, stroke and Parkinson’s disease. Overall, there was a significant positive association, whereby as 4AT scores increased, so also did malnutrition risk.

Conclusions: Among older adults admitted with hip fractures, high 4AT scores, suggestive of cognitive impairment and delirium, identified patients at increased malnutrition risk. These findings lend further support for the use of 4AT as a screening tool to identify patients, who are in an acute setting, at increased health risk.
Original languageEnglish
JournalNutrition in Clinical Practice
Publication statusAccepted/In press - 16 Nov 2020

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