NUTRITION AND FRAILTY: HOW TO CAPTURE THE COMPLEXITY OF OLDER PEOPLE

The older population is characterized by a high clinical complexity. Poor nutritional status is highly prevalent in older people and has been repeatedly evoked as a major contributor to several health-related negative outcomes. The aim of this thesis was to evaluate the contribution of nutrition in some age-related conditions, taking into account the older people’s complexity. Study I. We explored the association between lack of energy and malnutrition in nursing home residents. Lack of energy was highly prevalent in our sample (i.e., 43.2%). We found a significant association between malnutrition and lack of energy, independent of potential confounders. Decrease in food intake, reduced mobility, and psychological stress or acute disease in the past 3 months were identified as the items of the Mini Nutritional Assessment contributing the most to the association between malnutrition and lack of energy. Study II. We investigated the association between unintentional weight loss and mortality in a population of older patients undergoing hemodialysis. Older patients experiencing unintentional weight loss during the follow-up period had a 3.4-fold risk of death independently of comorbidities and other risk factors. Study III. We explored the prevalence of frailty and its association with hospitalization and mortality in a population of older patients undergoing haemodialysis. Study III outlined a high prevalence of frailty (i.e., 55.2%) among older patients undergoing haemodialysis. Frailty was significantly associated with a higher risk of hospitalization and all-cause mortality in our sample. Conclusions. Nutritional status is an aspect frequently overlooked, despite it has been repeatedly evoked as a major determinant of health status in all stages of life. Our findings clearly show the role of nutritional status as a mediator of several health-related conditions in older people. Indeed, given the burden it poses in terms of adverse health outcomes, increased (research) efforts should be paid to nutritional status. A multidimensional and multidisciplinary approach is pivotal for the early identification of people presenting nutritional issues in order to prevent the onset of serious complications.