This is a prospective, descriptive, correlational study to 1) identify and estimate the prevalence and progression of malnurtition, 2) ascertain the association of identified compromised nutritional states with selected hormonal, skeletal, immunological, functional and psychobehavioral indices and clinical outcomes in newly admitted nursing home patients receiving routine care. Nutritional assessments performed on subjects meeting the inclusion criteria after informed consent is obtained include: 1) calorie and protein intake; 2) anthropometrics - triceps skinfold, mid-arm muscle circumference, height, weight, weight history, and percent ideal body weight; 3) biochemistries- SMAC, cholesterol, total protein, CBC with differential, iron, folate, transferrin, ferritin, B12, zinc, ceruloplasm, and vitamin D; and 4) bioelectrical impedance and dual energy absorptiometry (DEXA) determination of body composition. Selected clinical indices (correlates) are comprised of the following markers: 1) hormonal/endocrine - IGF-1 and binding proteins, thyroid hormones, PICP, gonadal steroids, osteocalcins, and 24-hour urine for urea nitrogen, total nitrogen, free corticol, creatinine; 2) skeletal - bone biochemistries, calcium, pyridinoline crosslinks, and procollagen peptides; 3) immunological - admission and 6-week post-dose reactivity to routine pneumococcal and influenza innoculation; admission serum levels of antibody tetanus toxoid and PPD reactivity, and cytokines (TNF, IL-2, IL-6); 4) functional status - muscle strength, flexibility, and ability to perform activities of daily living (ADLs); and 5) psychobehavioral - levels of response scale, and Geriatric Quality of Life. Data analyses involve: 1) characterizations of distributions of : a) distribution of sample individuals on each of the nutritional parameters, b) characterization of distributions according to normality and symmetry, c) calculation of centering and variation indices, d) estimation of prevalence of malnutrition and types thereof; 2) repetition of above analyses for each correlation matrix; 3) product moment correlation ratios for each nutrition-clinical correlate pair and summarization through a correlation matrix; 4) specification of estimates necessary for future proposed trial. Data from this preliminary study (documentation of malnutrition and the presence and degree of association of study correlates) will be used to develop a definitive clinical intervention trial of the magnitude appropriate to address the hypothesis of malnutrition as a determinant of frailty in the institutionalized elderly. Data collection ended on November 30, 1997, and analyses are currently underway. To date, preliminary data have been used to develop a nutrition intervention pilot study entitled """"""""An Innovative Nutrition Intervention for Nursing Home residents"""""""", which was funded by the Fund for Geriatric Medicine and Nursing, and will be conducted with nurse resources of the GCRC.
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