Slee, Adrian; Vignau, Manuela Sumar; Bassett, Paul; Jin, Xinrui; Guo, Junyi; Smithard, David; (2025) Investigation into the Prevalence of Malnutrition, Sarcopenia and Frailty in Very Old Hospitalised Patients and Relationship with Clinical Outcomes. Clinical Nutrition ESPEN , 70 pp. 129-137. 10.1016/j.clnesp.2025.08.036.

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Abstract

BACKGROUND AND AIMS: Malnutrition, sarcopenia and frailty represent common conditions in the geriatric population that have a detrimental impact on quality of life and clinical outcomes. These syndromes also display resembling clinical features and may often co-exist, aggravating adverse health outcomes. This study aimed to investigate the prevalence and co-occurrence of the conditions in a very old aged cohort of hospital patients, and the associations with clinical outcomes. METHODS: A registered clinical audit was performed in a Hospital setting and data collected from older patients aged >85 years of age, between 2019 and 2024. Malnutrition risk was assessed using the nutritional screening tool (NST), geriatric nutritional risk index (GNRI) and global leadership initiative malnutrition (GLIM) criteria. Sarcopenia screening was evaluated with the SARC-F (Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falls) questionnaire and frailty using the clinical frailty scale (CFS). The prevalence and concurrence of the conditions was calculated, alongside the analysis of in-hospital mortality risk and routine blood biomarkers (albumin, C-reactive protein, urea, creatinine and haemaglobin). RESULTS: 768 audits were included for analysis and the median age was 89 years (87–92). Malnutrition was detected in 28.4 %, 32.8 % and 41.2 % of patients by NST, GNRI and GLIM respectively, while the prevalence of sarcopenia was 68.3 % and 73.2 % for frailty. Between 20.8 % and 29.2 % of patients presented all three conditions concomitantly, while 79.2 %–85.1 % had at least one. Cox regression analysis between geriatric syndromes and the risk of in-hospital death showed that high malnutrition risk by NST (adjusted HR = 1.78, p = 0.03), as well as the presence of sarcopenia by SARC-F (adjusted HR = 2.60, p = 0.001) and severe frailty (adjusted HR = 4.89, p < 0.001), were all significantly associated with an increased risk of mortality. Likewise, biomarker levels differed depending on the presence of conditions, with reduced albumin showing most significant associations with heightened risk/presence of malnutrition, sarcopenia and frailty. CONCLUSION: The study showed a high prevalence and overlap between the explored conditions in this large, very old aged cohort, with nearly a third of patients presenting all three simultaneously, which may present significant health burden. Further research is needed to optimise the screening and assessment of conditions and establishing most accurate tools and techniques, to enhance clinical practical and potentially better guide interventions potentially affecting clinical outcomes.

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