Nutritional Improvement Correlates with Recovery of Activities of Daily Living among Malnourished Elderly Stroke Patients in the Convalescent Stage: A Cross-Sectional Study

Abstract

Background: Whether nutritional improvement correlates with functional recovery in convalescent stroke patients is unclear.

Objective: This study was conducted to examine the relationship between nutritional improvement and recovery of activities of daily living among malnourished elderly stroke patients in the convalescent stage.

Design: This study used a cross-sectional study design.

Participants/setting: One hundred seventy-eight malnourished stroke patients aged 65 years and older from convalescent rehabilitation wards in Japan between April 2012 and December 2014 were included in the analyses.

Main outcome measures: The participants were classified into three groups according to the Mini Nutritional Assessment Short-Form (MNA-SF) score at discharge (0 to 7 as no improvement, 8 to 11 as lesser improvement, and 12 to 14 as greater improvement). The primary outcome was functional independence measure (FIM) efficiency (FIM gain/length of hospital stay). The secondary outcomes were FIM gain and discharge outcome.

Statistical analysis: One-way analysis of variance, χ(2) test, and Kruskal-Wallis test were performed for univariate analysis. Linear regression analysis was used to adjust for covariates such as age, sex, length of hospital stay, FIM (motor and cognitive) on admission, and lower-order items of MNA-SF. Binomial logistic analysis for discharge outcome (home/others) was performed to adjust for covariates such as age, sex, and FIM.

Results: Study participants included 85 men and 93 women with a mean age of 77 years. Based on MNA-SF, 16 were classified as no improvement, 113 as lesser improvement, and 49 as greater improvement. The median FIM efficiency and length of hospital stay were 0.27 points/day and 151.5 days, respectively. The greater improvement group had significantly higher FIM efficiency than the other groups (P<0.001). Home discharge rate was also higher in the GI group (P=0.014). Linear regression analysis for FIM efficiency indicated that mobility, neuropsychological problems, and weight loss, which were lower-order items of MNA-SF at discharge, were independent explanatory variables (R(2)=0.373; P<0.001).

Conclusions: These findings suggest that nutritional improvement such as maintenance of body weight is associated with the efficient recovery of activities of daily living among malnourished elderly convalescent stroke patients.

Keywords: Convalescent rehabilitation stage; Cross-sectional study; Elderly stroke patients; Nutritional improvement; Recovery of activities of daily living.