Skip to main content
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1989 Dec;42(12):1241–1245. doi: 10.1136/jcp.42.12.1241

Biochemical predictors of short term mortality in elderly residents of chronic care institutions.

J Woo 1, S M Chan 1, Y T Mak 1, R Swaminathan 1
PMCID: PMC502046  PMID: 2515213

Abstract

A survey of 208 elderly subjects living in four long term care institutions was undertaken over three months to identify nutritional and other variables that could be used to predict mortality during the subsequent three months. There were 58 men (mean age (SD) 75.6 (9.6) years) and 150 women (79.5 (8.4) years). Twenty nine subjects died (12 men and 17 women) within three months of completing the study. Twenty eight out of 57 variables differed significantly between those who died and those who survived. Subjects who died had lower systolic blood pressure, poorer intake of protein calories, lower concentrations of haemoglobin, plasma retinol, zinc, total cholesterol, and higher albumin adjusted plasma calcium concentrations. Stepwise regression analysis identified five variables that predicted mortality: plasma fructosamine; transferrin; glycosylated haemoglobin; prealbumin; and haemoglobin. The sensitivity, specificity, and predictive values of the discriminant function score using 0 as the demarcation between survivors and non-survivors were 75%, 97%, and 95%, respectively. This score could therefore be used to identify those most in need of nutritional support.

Full text

PDF
1241

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker H., Frank O., Thind I. S., Jaslow S. P., Louria D. B. Vitamin profiles in elderly persons living at home or in nursing homes, versus profile in healthy young subjects. J Am Geriatr Soc. 1979 Oct;27(10):444–450. doi: 10.1111/j.1532-5415.1979.tb01724.x. [DOI] [PubMed] [Google Scholar]
  2. Bienia R., Ratcliff S., Barbour G. L., Kummer M. Malnutrition in the hospitalized geriatric patient. J Am Geriatr Soc. 1982 Jul;30(7):433–436. doi: 10.1111/j.1532-5415.1982.tb03378.x. [DOI] [PubMed] [Google Scholar]
  3. Cashman M. D. Geriatric malnutrition: recognition and correction. Postgrad Med. 1982 Mar;71(3):185-8, 190-4. doi: 10.1080/00325481.1982.11716022. [DOI] [PubMed] [Google Scholar]
  4. Dempsey D. T., Buzby G. P., Mullen J. L. Nutritional assessment in the seriously ill patient. J Am Coll Nutr. 1983;2(1):15–22. doi: 10.1080/07315724.1983.10719905. [DOI] [PubMed] [Google Scholar]
  5. Graf R. J., Halter J. B., Porte D., Jr Glycosylated hemoglobin in normal subjects and subjects with maturity-onset diabetes. Evidence for a saturable system in man. Diabetes. 1978 Aug;27(8):834–839. doi: 10.2337/diab.27.8.834. [DOI] [PubMed] [Google Scholar]
  6. Haider M., Haider S. Q. Assessment of protein-calorie malnutrition. Clin Chem. 1984 Aug;30(8):1286–1299. [PubMed] [Google Scholar]
  7. Harvey K. B., Moldawer L. L., Bistrian B. R., Blackburn G. L. Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr. 1981 Oct;34(10):2013–2022. doi: 10.1093/ajcn/34.10.2013. [DOI] [PubMed] [Google Scholar]
  8. Ingenbleek Y., Van Den Schrieck H. G., De Nayer P., De Visscher M. Albumin, transferrin and the thyroxine-binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition. Clin Chim Acta. 1975 Aug 18;63(1):61–67. doi: 10.1016/0009-8981(75)90379-4. [DOI] [PubMed] [Google Scholar]
  9. Johnson R. N., Metcalf P. A., Baker J. R. Fructosamine: a new approach to the estimation of serum glycosylprotein. An index of diabetic control. Clin Chim Acta. 1983 Jan 7;127(1):87–95. doi: 10.1016/0009-8981(83)90078-5. [DOI] [PubMed] [Google Scholar]
  10. Kergoat M. J., Leclerc B. S., PetitClerc C., Imbach A. Discriminant biochemical markers for evaluating the nutritional status of elderly patients in long-term care. Am J Clin Nutr. 1987 Nov;46(5):849–861. doi: 10.1093/ajcn/46.5.849. [DOI] [PubMed] [Google Scholar]
  11. MacDonald D., Swaminathan R. Seasonal variation in 25-OH vitamin D in plasma of Hong Kong Chinese. Clin Chem. 1988 Nov;34(11):2375–2375. [PubMed] [Google Scholar]
  12. Mattila K., Haavisto M., Rajala S., Heikinheimo R. Blood pressure and five year survival in the very old. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):887–889. doi: 10.1136/bmj.296.6626.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mullen J. L., Buzby G. P., Waldman M. T., Gertner M. H., Hobbs C. L., Rosato E. F. Prediction of operative morbidity and mortality by preoperative nutritional assessment. Surg Forum. 1979;30:80–82. [PubMed] [Google Scholar]
  14. Payne R. B., Little A. J., Williams R. B., Milner J. R. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973 Dec 15;4(5893):643–646. doi: 10.1136/bmj.4.5893.643. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Rainey-Macdonald C. G., Holliday R. L., Wells G. A., Donner A. P. Validity of a two-variable nutritional index for use in selecting candidates for nutritional support. JPEN J Parenter Enteral Nutr. 1983 Jan-Feb;7(1):15–20. doi: 10.1177/014860718300700115. [DOI] [PubMed] [Google Scholar]
  16. Rudman D., Feller A. G., Nagraj H. S., Jackson D. L., Rudman I. W., Mattson D. E. Relation of serum albumin concentration to death rate in nursing home men. JPEN J Parenter Enteral Nutr. 1987 Jul-Aug;11(4):360–363. doi: 10.1177/0148607187011004360. [DOI] [PubMed] [Google Scholar]
  17. Rudman D., Mattson D. E., Nagraj H. S., Caindec N., Rudman I. W., Jackson D. L. Antecedents of death in the men of a Veterans Administration nursing home. J Am Geriatr Soc. 1987 Jun;35(6):496–502. doi: 10.1111/j.1532-5415.1987.tb01394.x. [DOI] [PubMed] [Google Scholar]
  18. Rudman D., Mattson D. E., Nagraj H. S., Feller A. G., Jackson D. L., Caindec N., Rudman I. W. Prognostic significance of serum cholesterol in nursing home men. JPEN J Parenter Enteral Nutr. 1988 Mar-Apr;12(2):155–158. doi: 10.1177/0148607188012002155. [DOI] [PubMed] [Google Scholar]
  19. Sachs E., Bernstein L. H. Protein markers of nutrition status as related to sex and age. Clin Chem. 1986 Feb;32(2):339–341. [PubMed] [Google Scholar]
  20. Woo J., Cheung C. K., Ho S. C., Mak Y. T., Swaminathan R. Protein nutritional status in elderly Chinese in Hong Kong. Eur J Clin Nutr. 1988 Nov;42(11):903–909. [PubMed] [Google Scholar]
  21. Woo J., Ho S. C., Mak Y. T., Tsao N., Lam L. M., Donnan S., Swaminathan R. Nutritional status of the water-soluble vitamins in an active Chinese elderly population in Hong Kong. Eur J Clin Nutr. 1988 May;42(5):415–424. [PubMed] [Google Scholar]
  22. Woo J., Ho S., Mak Y. T., Shek C. C., Swaminathan R. Vitamin A and E status in healthy elderly Chinese in Hong Kong. Eur J Clin Nutr. 1988 Aug;42(8):689–695. [PubMed] [Google Scholar]
  23. Woo J., Swaminathan R., Cockram C., Pang C. P., Mak Y. T., Au S. Y., Vallance-Owen J. The prevalence of diabetes mellitus and an assessment of methods of detection among a community of elderly Chinese in Hong Kong. Diabetologia. 1987 Nov;30(11):863–868. doi: 10.1007/BF00274795. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES