|Kehayias, J. J.|
|Ribeiro, S.m. L.|
Submitted to: Journal of Nutrition Health and Aging
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/21/2010
Publication Date: 1/11/2012
Citation: Kehayias, J., Ribeiro, S., Skahan, A., Itzkowitz, L., Dallal, G., Rogers, G., Khodeir, M. 2012. Water homeostasis, frailty and congnitive function in the nursing home. Journal of Nutrition Health and Aging. 16(1):35-39. Interpretive Summary: Sarcopenia, the loss of muscle and function with age, occurs in all elderly people. The reduced amount of muscle makes it difficult for the elderly to recover from illness or injury. Most nutritional deficits in the elderly can be identified, monitored and managed using tests that produce numerical values. These can then be compared against a normal range and the patient’s own medical history. Frailty, although obvious in many cases, cannot be measured easily. The Body Composition Laboratory of the JM HNRCA at Tufts University proposed a method for measuring and monitoring frailty that may improve significantly the quality of care provided to the elderly by promoting prevention. To be practical for field use, researchers took into consideration that the method should provide numerical data with little or no action from the patient. It also must give information to the clinician quickly, and be sensitive enough so that follow-up measurements can be used to track progress, decline or response to treatment. Two methods were proposed and tested based on the measurement of water compartments in the body. One measures water balance by providing a non-radioactive drink and collecting a small amount of urine or blood a few hours later and the other by simple electrical measurements of the body. The validity and possible clinical value of a frailty factor, or "FF," was tested by comparing data obtained with nursing home residents with healthy free-living elderly, as well as elderly from a national U.S. database. The investigators proposed a successful method that measures and monitors frailty. The creation of new, portable instruments using these methods holds promise, if field tests in nursing homes further validate their proposed “Frailty Factor” in future studies.
Technical Abstract: The goal of this study is to develop and test a practical clinical method to assess frailty in nursing homes and to investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. This is a cross-sectional study, conducted at two nursing homes in Boston, MA. Body mass and height were evaluated to calculate BMI (body mass index, in Kg/m2). The cognitive decline was evaluated based on the scores obtained from the Mini Mental-Status Exam (MMSE); the extracellular to total body water ratio (ECW/TBW) was calculated after the analysis of TBW from deuterium and tritium dilution and ECW from bromide dilution. Single-frequency BIA analysis data were investigated for resistance (R) and reactance (Xc), plotted in an R/H Xc/H graph (vectorial analysis-BIVA). The BIVA results of nursing home residents were compared against the data obtained from the NHANES III study. TBW and ECW values were compared with a group of free-living elderly volunteers. The ECW/TBW was significantly higher in nursing home residents than in the free-living individuals. BIVA analysis showed significantly higher Xc/H values in the reference subjects. The MMSE did not present a significant correlation with ECW/TBW for either gender. We proposed the ECW/TBW ratio and BIVA as surrogate methods for the clinical assessment of frailty. We tested successfully both approaches with nursing home patients and free-living volunteers and compared them to a national data base. The advent of new, portable instruments will enable field tests to further validate our proposed “Frailty Factor” in future studies. We found no correlation between frailty and cognitive decline in the nursing home.