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Malnutrition as a Fall Risk Factor

Examining various aspects of malnutrition in elderly patients may be helpful in determining the risk of falls.
Federal Practitioner. 2017 February;34(2):27-30
February 17, 2017|Federal Practitioner
Mary Julius, RDN, LD, CDE;Denise Kresevic, RN, PhD, APN-BC;Maria Turcoliveri, MS, LD;Lynn Cialdella-Kam, MBA;Christopher J. Burant
Author and Disclosure Information

Ms. Julius is a research registered dietitian nutritionist and clinical coordinator of diabetes education; Dr. Kresevic is a nurse researcher and advanced practice nurse; Ms. Turcoliveri is an administrative systems dietitian; and Dr. Burant is the director of the statistical resource center for the Geriatric Research Education and Clinical Center, all at the Louis Stokes Cleveland VAMC in Ohio. Dr. Burant is an assistant professor at the Frances Payne Bolton School of Nursing, and Dr. Cialdella-Kam is an assistant professor in the department of nutrition, both at Case Western Reserve University in Cleveland, Ohio.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Discussion

In this study, falls occurred in a variety of patient populations. Both single-event fallers and recurrent fallers had a significant drop in Hgb values at 12, 6, and 3 months before the first fall. There was not a strong difference of the Hgb value between single-event falls and multiple fallers in the total population. Anemia was a significant risk factor for all fallers. The decline in the Hgb level before a fall is highly predictive of fall risk.

In individuals with dementia, those with the diagnosis of malnutrition are frequent fallers. A tool to assist in identification of this patient population along with a focused intervention strategy for this population is an area of needed research.

Further research is under way to determine which components of malnutrition diagnosis contribute to fall risk. If so, development of a fall assessment tool, including various components of malnutrition is warranted. Intervention strategies to reduce fall risk may soon include new nutrition and education techniques based on the faller constellation. Falls instruments that explore nutritional risk factors and falls should be investigated (ie, weight loss, vitamin D status, and anemia).

Falls occur in patients with a variety of risk factors (eg, mobility and cognition). The current screening instruments to assess fall risk factors do not sufficiently account for nutritional risk factors. In the Eat Well, Fall Less Study of hospitalized veterans, nutritional risk factors of anemia and weight loss also were associated with single- and multiple-event fallers. The AUTUMN falls instrument that includes critical elements of malnutrition, such as a decline in Hgb and weight loss, is currently being created and is in the process of being validated at LSCVAMC; this tool will incorporate components of malnutrition.

Acknowledgments
The authors acknowledge Michelle Pearson, Laura Guidotti, Adam Weier, Elizabeth Gable, and Shannon Corlett for their research contributions. In memory of Anne Raguso, RD, PhD, for her lifelong focus on nutrition research.

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