Prevalência do risco para desnutrição e sarcopenia e valor prognóstico da triagem conjunta no desfecho mortalidade de pessoas idosas hospitalizadas

• Ano de defesa: 2024
• Autor(a) principal: Adriana Keller Coelho
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; EEFFTO - ESCOLA DE EDUCAÇÃO FISICA, FISIOTERAPIA E TERAPIA OCUPACIONAL; Programa de Pós-Graduação em Ciências da Reabilitação; UFMG
• Palavras-chave em Português: Desnutrição; Sarcopenia; Pessoa Idosa; Hospitalização; Mortalidade; Idosos - Saúde e higiene
• Link de acesso: http://hdl.handle.net/1843/75161; https://orcid.org/0000-0001-7559-7903

In hospitalized elderly people, the risk of sarcopenia and malnutrition is high due to acute illness, mobility impairment and anorexia, clinically manifested by a combination of decreased nutrient intake, decreased body weight and decreased muscle mass, strength and function. Previous evidence has shown that the risk of sarcopenia, nutritional risk/malnutrition, and the risk of malnutrition-sarcopenia syndrome (MSS) are associated with negative health consequences such as increased morbidity and mortality, decreased quality of life, decreased functionality, increased re-hospitalisation, length of hospital stay and costs to the health system. In this context, the general aim of this thesis was to assess the prognostic value of joint screening for nutritional risk/malnutrition, the risk of sarcopenia and the risk of malnutrition and sarcopenia syndrome in the clinical outcome of elderly people hospitalized in a public hospital in Belo Horizonte - MG. The thesis consists of two studies. Study 1 aimed to assess the prevalence of nutritional/malnutrition risk, sarcopenia and SDS in hospitalised elderly people, and to verify the factors associated with the occurrence of these problems. The risk of MSS in our study was characterized by the risk of sarcopenia and the risk of malnutrition. This is a crosssectional study based on data obtained from medical records between July 2019 and March 2020. The sample consisted of 2,425 elderly people consecutively admitted to the Governador Israel Pinheiro Hospital in inpatient units, excluding patients in intensive care units or emergency medical services and those who did not undergo both screenings. The study was approved by the institution's CEP, CAAE number 50773521.3.0000.5136. The dependent variables: risk of malnutrition / malnutrition and risk of sarcopenia were assessed using the Mini Nutritional Assessment Shortform - MNA®-SF, and Sluggishness, Assistance in walking, Rise from a chair, Climb stairs, Falls -SARC-F questionnaires, respectively. The presence of risk for SDS was identified when both questionnaires (MNA®-SF and SARC-F) were positive. The sample was characterized using a clinical and demographic questionnaire that included age, gender, length of stay, diseases (International Classification of Diseases - ICD11) and medicines used (National List of Essential Medicines - RENAME). To check the associations between the independent and dependent variables, logistic regression models were constructed and the measures of association adopted were Odds Ratio with a 95% confidence interval. All statistical tests used a significance level of 5% (p ≤0.05). The results of study 1 showed that the majority of participants were female (56.6%), aged between 70 and 79 years (38.2%), had an average of 3.8 (2.45) illnesses and used 9.8 (5.35) medicines. The most frequent diseases were of the circulatory system, followed by endocrine, nutritional and metabolic diseases and diseases of the genitourinary system. The most commonly used drugs were analgesics, antipyretics, anti-inflammatories, drugs that act on the digestive system and the cardiovascular and renal systems. The average length of stay for the participants was 15.3 (21.4) days. The prevalence of nutritional risk/malnutrition, risk of sarcopenia and MSS was 48.2%/33.9%, 40% and 39.1%, respectively. Logistic regression analysis showed that male gender (OR: 1.34, 95%CI: 1.13; 1.58; OR: 1.70, 95%CI: 1.43-2.02) was a predictor of the risk of SDS. The risk of sarcopenia; age greater than or equal to 75 years (OR: 1.05, 95%CI: 1.04-1.06) was a predictor for nutritional risk/ malnutrition (p<0.001). Study 2 was a longitudinal follow-up and aimed to investigate the association of nutritional risk/malnutrition, risk of sarcopenia and SDS with mortality 12 months after the participants' baseline. This retrospective cohort used the Kaplan-Meier curve and the adjusted Cox proportional hazards model. Three independent models were applied for the regression analyses considering sarcopenia risk, nutritional risk/malnutrition and their association (MSS) as independent predictors of the mortality outcome. Malnutrition (HR: 2.17, 95% CI: 1.30, 3.61) and the risk of MSS (HR: 1.20, 95% CI: 1.10, 1.31) increased the participants' risk of death at 12 months. We conclude that the findings of this thesis reinforce the need to implement joint screening for the risk of malnutrition and sarcopenia systematically on admission to hospital for the elderly, through the appropriate application of validated screening instruments, at lower cost, ensuring therapeutic benefits and quality of hospital care and rapid return home.