human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Malnutrition is common in patients with hip fractures , and elderly patients with hip fractures lose functional independence and often fail to recover previous functional status . The aim of this study was to determine whether pre-fracture nutritional status predicts functional status of patients with hip fracture at discharge from acute hospitals . METHODS In the present multicenter prospect i ve cohort study , pre-fracture nutritional status was assessed using the  Mini Nutritional Assessment Short-Form ( MNA-SF ) . At discharge from acute hospitals , functional status was evaluated using a functional independent measurement instrument  ( FIM ) . Subsequently , multiple regression analyses were performed using FIM as the dependent variable and MNA-SF as the independent variable . RESULTS Among the 204 patients analyzed in the present study , the  mean length of hospital stay was 26.2 ± 12.6 days , and according to MNA-SF assessment s , 51 ( 25.0 % ) patients were malnourished , 98 ( 48.0 % ) were at risk of malnutrition , and 55 ( 27.0 % ) were well-nourished before fracture . At discharge , FIM scores were higher in patients who were well-nourished than in those who were malnourished or were at risk of malnutrition ( p < 0.01 ) . After adjustment for confounding factors , multiple regression analyses showed that MNA-SF was a significant independent predictor for FIM at discharge ( well-nourished vs. malnourished , β = -0.86 , p < 0.01 ) . CONCLUSIONS Pre-fracture nutritional status was a significant independent predictor for functional status at discharge during the acute phase , warranting early assessment of nutritional status and early intervention for successful postoperative rehabilitation Objectives Malnutrition and functional decline are common in older in patients admitted to subacute care setting s. However the association between changes in nutritional status and relevant functional outcomes remains under- research ed . This study examined changes in nutritional status , function and mobility in patients admitted to a Geriatric Evaluation and Management ( GEM ) unit who had a length of stay ( LOS ) longer than 21 days . Design A prospect i ve , observational study . Setting Two GEM units at St Vincent ’s Hospital Melbourne , Australia . Participants Patients admitted to the GEM units who stayed longer than 21 days were included in the study . Measurements Patients were assessed on admission and prior to discharge using the  Subjective Global Assessment ( SGA ) , Functional Independence Measure ( FIM ) motor domain and the Modified Elderly Mobility Scale ( MEMS ) . Results Fifty-nine patients ( Mean age 84.0 ± 7 years ) met the required length of stay and were included in the study . Fifty-four per cent ( n=32 ) were malnourished on admission ( SGA B/C ) and 44 % ( n=26 ) were malnourished on discharge . Twenty-two per cent ( n=13 ) improved SGA category , 75 % remained stable ( n=44 ) and 3 % deteriorated ( n=2 ) from admission to discharge . Total Motor FIM scores significantly increased from admission to discharge in both the improved ( p<0.001 ) and stable or deteriorated ( p<0.001 ) nutritional status groups . Subjects who improved in nutritional status had a significantly higher MEMS score at discharge ( p<0.001 ) . Conclusion On admission to the GEM unit , just over half the included patients were rated as malnourished defined by SGA category . Nearly one quarter of the sample had improved their nutritional status at the time of discharge . Improvement in nutritional status was associated with greater improvement in mobility scores . Further studies are required to investigate the effectiveness of nutrition interventions , which will inform models of care aim ing to optimise nutritional , functional , and associated clinical outcomes in patients admitted to GEM units Objectives To determine if changes in patients ’ nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for . Design Prospect i ve study .SubjectsA total of 32 non-cachectic patients ( 21 women ; 65–92y ) . Methods Nutritional status was evaluated at admission and discharge using the  Protein-Energy Malnutrition Index which includes BMI , % IBW , TS , MAC , albumin , hemoglobin and lymphocyte count . Food intake was assessed 3 meals/day every other day for an average of 46.2 ± 14.6 meals/participant . Results In all , 47 % of the study sample was malnourished at admission . Nutritional status improved in 73 % of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission . Total energy intake correlated with improvements in BMI , % IBW and total lymphocyte count ( all p < 0.04 ) . Improvement in PEMI score for the whole group was associated with functional status ( p < 0.05 ) . Controlling for this variable , energy ( kj/kg body weight ) and protein ( g/kg body weight ) intakes correlated positively with improvements in BMI , % IBW and MAC ( Energy : partial r = 0.644 , 0.624 , 0.466 respectively ; Protein : partial r = 0.582 , 0.554 , 0.433 respectively ; all p < 0.05 ) . Conclusions Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for , st and ard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay Purpose . To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models . Methods . Analytical cross-sectional study arising from baseline assessment s from 107 subjects drawn from a r and omised controlled trial of community rehabilitation service delivery models .  Setting . A community rehabilitation team based in Brisbane , Queensl and , Australia . Measures . Primary outcome variables include quality of life ( EQ-5D & VAS ) and Carer Strain Index . Predictor variables include participation in functional activities , history of falls , number of medications , number of co-morbidities , depression , environmental hazards , physical function and nutrition . Association between variables assessed using linear regression . Results . Major factors contributing to reduced quality of life were having reduced participation in daily activities , depression , and having poor vision . Having poor nutrition and no longer driving also contributed to poor quality of life . The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person . Conclusions . Community rehabilitation services working with older population s must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain BACKGROUND calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss , with an enhanced risk of osteoporotic fractures . Although hip fractures are a serious consequence , few therapeutic measures are given for primary or secondary prevention . A combination of calcium and vitamin D may not be the most effective treatment for all patients . OBJECTIVE to investigate the effects of hypovitaminosis D on the calcium-parathyroid hormone endocrine axis , bone mineral density and fracture type , and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients . DESIGN a population -based , prospect i ve cohort study . METHODS 150 elderly subjects were recruited from the fast-track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture . This ward accepts people who live at home and are independent in activities of daily living . All subjects had a baseline medical examination , biochemical tests ( parathyroid hormone ,  25-hydroxyvitamin D  and  1,25-dihydroxyvitamin D ) and were referred for bone densitometry . RESULTS at 68 % , the prevalence of hypovitaminosis D ( 25-hydroxyvitamin D<30 nmol/l ) was high . However , only half the patients had evidence of secondary hyperparathyroidism , the rest having a low to normal level of parathyroid hormone ( ' functional hypoparathyroidism ' ) . Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium , higher 1,25-dihydroxyvitamin D , lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ' functional hypoparathyroid ' group ( P<0.01 ) . CONCLUSION there is a high prevalence of hypovitaminosis D in active , elderly people living at home who present with a hip fracture . However , secondary hyperparathyroidism occurs in only half of these patients . This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover , leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures .  Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients , but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ' vitamin D-replete ' subjects needs further evaluation OBJECTIVES To determine change in albumin from hospital discharge to 3-month follow-up and the prognostic significance of persistent hypoalbuminemia in older veteran patients . DESIGN A prospect i ve cohort study . SETTING A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital . PARTICIPANTS The study population consisted of 282 subjects ( of 322 r and omly selected discharges who were free of cancer and terminal conditions ) that completed the 90-day postdischarge assessment ; most were older ( 75.4+/-8.6 ) , white ( 76 % ) , and male ( 99 % ) . MEASUREMENTS Each subject completed a comprehensive discharge assessment , had a repeat albumin an average of 94 days later , and was then tracked for 5 years . The strongest predictors of survival were identified using Cox proportional hazards regression analysis . RESULTS Between hospital discharge and the 3-month re assessment , albumins improved by more than 2 g/L in 122 subjects ( 43 % ) , stayed the same in 112 subjects ( 40 % ) , and deteriorated by more than 2 g/L in the rest . During follow-up , 190 subjects ( 67 % ) died . Of the 38 nutritional , functional , demographic , and illness severity variables evaluated , the 3-month postdischarge albumin was the strongest predictor of long-term mortality . Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater ( relative risk=2.6 , 95 % confidence interval=1.8 - 3.8 ) . After controlling for 3-month albumin , hospital-discharge albumin was not significantly associated with long-term mortality . CONCLUSION In older people , a low serum albumin 3 months after hospital discharge is associated with a poor long-term prognosis . It is not known whether this represents ongoing inflammation or inadequate nutrition OBJECTIVE To investigate the association between nutritional status and rehabilitation outcome in elderly in patients with hospital-associated deconditioning . DESIGN A prospect i ve cohort study . SUBJECTS/ PATIENTS One hundred sixty-nine consecutive elderly in patients diagnosed with hospital-associated deconditioning . METHODS Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center . Body mass index , haemoglobin , albumin , total lymphocyte count , C-reactive protein , cause of malnutrition , and feeding route were also investigated . Primary outcome was Barthel Index score at discharge . RESULTS A total of 148 patients ( 87.6 % ) were malnourished , and 21 were at risk for malnutrition . There were no patients with normal nutritional status . Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition . Chronic disease-related malnutrition , oral intake , and parenteral nutrition were associated with the Barthel Index score at discharge . There were significant correlations between the Barthel Index score at discharge and nutritional score , albumin , and total lymphocyte count . In multiple regression analysis , Mini Nutritional Assessment Short Form , albumin , and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge . CONCLUSION Most elderly in patients with hospital-associated deconditioning are malnourished . Nutritional status , albumin , and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning AIM Texture-modified diets ( TMD ) have significantly lower energy and protein content than normal diets . Therefore , TMD can cause malnutrition and loss of muscle mass . However , few studies have reported the relationship between TMD and decreased skeletal muscle mass . The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass . METHODS We review ed data of 188 older adult patients who were admitted to a rehabilitation hospital . TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation . The Mini Nutritional Assessment -Short Form was used to assess nutritional status ;  dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index , and the cut 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Malnutrition is common in patients with hip fractures , and elderly patients with hip fractures lose functional independence and often fail to recover previous functional status . The aim of this study was to determine whether pre-fracture nutritional status predicts functional status of patients with hip fracture at discharge from acute hospitals . METHODS In the present multicenter prospect i ve cohort study , pre-fracture nutritional status was assessed using the  Mini Nutritional Assessment Short-Form ( MNA-SF ) . At discharge from acute hospitals , functional status was evaluated using a functional independent measurement instrument  ( FIM ) . Subsequently , multiple regression analyses were performed using FIM as the dependent variable and MNA-SF as the independent variable . RESULTS Among the 204 patients analyzed in the present study , the  mean length of hospital stay was 26.2 ± 12.6 days , and according to MNA-SF assessment s , 51 ( 25.0 % ) patients were malnourished , 98 ( 48.0 % ) were at risk of malnutrition , and 55 ( 27.0 % ) were well-nourished before fracture . At discharge , FIM scores were higher in patients who were well-nourished than in those who were malnourished or were at risk of malnutrition ( p < 0.01 ) . After adjustment for confounding factors , multiple regression analyses showed that MNA-SF was a significant independent predictor for FIM at discharge ( well-nourished vs. malnourished , β = -0.86 , p < 0.01 ) . CONCLUSIONS Pre-fracture nutritional status was a significant independent predictor for functional status at discharge during the acute phase , warranting early assessment of nutritional status and early intervention for successful postoperative rehabilitation Objectives Malnutrition and functional decline are common in older in patients admitted to subacute care setting s. However the association between changes in nutritional status and relevant functional outcomes remains under- research ed . This study examined changes in nutritional status , function and mobility in patients admitted to a Geriatric Evaluation and Management ( GEM ) unit who had a length of stay ( LOS ) longer than 21 days . Design A prospect i ve , observational study . Setting Two GEM units at St Vincent ’s Hospital Melbourne , Australia . Participants Patients admitted to the GEM units who stayed longer than 21 days were included in the study . Measurements Patients were assessed on admission and prior to discharge using the  Subjective Global Assessment ( SGA ) , Functional Independence Measure ( FIM ) motor domain and the Modified Elderly Mobility Scale ( MEMS ) . Results Fifty-nine patients ( Mean age 84.0 ± 7 years ) met the required length of stay and were included in the study . Fifty-four per cent ( n=32 ) were malnourished on admission ( SGA B/C ) and 44 % ( n=26 ) were malnourished on discharge . Twenty-two per cent ( n=13 ) improved SGA category , 75 % remained stable ( n=44 ) and 3 % deteriorated ( n=2 ) from admission to discharge . Total Motor FIM scores significantly increased from admission to discharge in both the improved ( p<0.001 ) and stable or deteriorated ( p<0.001 ) nutritional status groups . Subjects who improved in nutritional status had a significantly higher MEMS score at discharge ( p<0.001 ) . Conclusion On admission to the GEM unit , just over half the included patients were rated as malnourished defined by SGA category . Nearly one quarter of the sample had improved their nutritional status at the time of discharge . Improvement in nutritional status was associated with greater improvement in mobility scores . Further studies are required to investigate the effectiveness of nutrition interventions , which will inform models of care aim ing to optimise nutritional , functional , and associated clinical outcomes in patients admitted to GEM units Objectives To determine if changes in patients ’ nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for . Design Prospect i ve study .SubjectsA total of 32 non-cachectic patients ( 21 women ; 65–92y ) . Methods Nutritional status was evaluated at admission and discharge using the  Protein-Energy Malnutrition Index which includes BMI , % IBW , TS , MAC , albumin , hemoglobin and lymphocyte count . Food intake was assessed 3 meals/day every other day for an average of 46.2 ± 14.6 meals/participant . Results In all , 47 % of the study sample was malnourished at admission . Nutritional status improved in 73 % of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission . Total energy intake correlated with improvements in BMI , % IBW and total lymphocyte count ( all p < 0.04 ) . Improvement in PEMI score for the whole group was associated with functional status ( p < 0.05 ) . Controlling for this variable , energy ( kj/kg body weight ) and protein ( g/kg body weight ) intakes correlated positively with improvements in BMI , % IBW and MAC ( Energy : partial r = 0.644 , 0.624 , 0.466 respectively ; Protein : partial r = 0.582 , 0.554 , 0.433 respectively ; all p < 0.05 ) . Conclusions Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for , st and ard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay Purpose . To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models . Methods . Analytical cross-sectional study arising from baseline assessment s from 107 subjects drawn from a r and omised controlled trial of community rehabilitation service delivery models .  Setting . A community rehabilitation team based in Brisbane , Queensl and , Australia . Measures . Primary outcome variables include quality of life ( EQ-5D & VAS ) and Carer Strain Index . Predictor variables include participation in functional activities , history of falls , number of medications , number of co-morbidities , depression , environmental hazards , physical function and nutrition . Association between variables assessed using linear regression . Results . Major factors contributing to reduced quality of life were having reduced participation in daily activities , depression , and having poor vision . Having poor nutrition and no longer driving also contributed to poor quality of life . The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person . Conclusions . Community rehabilitation services working with older population s must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain BACKGROUND calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss , with an enhanced risk of osteoporotic fractures . Although hip fractures are a serious consequence , few therapeutic measures are given for primary or secondary prevention . A combination of calcium and vitamin D may not be the most effective treatment for all patients . OBJECTIVE to investigate the effects of hypovitaminosis D on the calcium-parathyroid hormone endocrine axis , bone mineral density and fracture type , and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients . DESIGN a population -based , prospect i ve cohort study . METHODS 150 elderly subjects were recruited from the fast-track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture . This ward accepts people who live at home and are independent in activities of daily living . All subjects had a baseline medical examination , biochemical tests ( parathyroid hormone ,  25-hydroxyvitamin D  and  1,25-dihydroxyvitamin D ) and were referred for bone densitometry . RESULTS at 68 % , the prevalence of hypovitaminosis D ( 25-hydroxyvitamin D<30 nmol/l ) was high . However , only half the patients had evidence of secondary hyperparathyroidism , the rest having a low to normal level of parathyroid hormone ( ' functional hypoparathyroidism ' ) . Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium , higher 1,25-dihydroxyvitamin D , lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ' functional hypoparathyroid ' group ( P<0.01 ) . CONCLUSION there is a high prevalence of hypovitaminosis D in active , elderly people living at home who present with a hip fracture . However , secondary hyperparathyroidism occurs in only half of these patients . This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover , leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures .  Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients , but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ' vitamin D-replete ' subjects needs further evaluation OBJECTIVES To determine change in albumin from hospital discharge to 3-month follow-up and the prognostic significance of persistent hypoalbuminemia in older veteran patients . DESIGN A prospect i ve cohort study . SETTING A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital . PARTICIPANTS The study population consisted of 282 subjects ( of 322 r and omly selected discharges who were free of cancer and terminal conditions ) that completed the 90-day postdischarge assessment ; most were older ( 75.4+/-8.6 ) , white ( 76 % ) , and male ( 99 % ) . MEASUREMENTS Each subject completed a comprehensive discharge assessment , had a repeat albumin an average of 94 days later , and was then tracked for 5 years . The strongest predictors of survival were identified using Cox proportional hazards regression analysis . RESULTS Between hospital discharge and the 3-month re assessment , albumins improved by more than 2 g/L in 122 subjects ( 43 % ) , stayed the same in 112 subjects ( 40 % ) , and deteriorated by more than 2 g/L in the rest . During follow-up , 190 subjects ( 67 % ) died . Of the 38 nutritional , functional , demographic , and illness severity variables evaluated , the 3-month postdischarge albumin was the strongest predictor of long-term mortality . Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater ( relative risk=2.6 , 95 % confidence interval=1.8 - 3.8 ) . After controlling for 3-month albumin , hospital-discharge albumin was not significantly associated with long-term mortality . CONCLUSION In older people , a low serum albumin 3 months after hospital discharge is associated with a poor long-term prognosis . It is not known whether this represents ongoing inflammation or inadequate nutrition OBJECTIVE To investigate the association between nutritional status and rehabilitation outcome in elderly in patients with hospital-associated deconditioning . DESIGN A prospect i ve cohort study . SUBJECTS/ PATIENTS One hundred sixty-nine consecutive elderly in patients diagnosed with hospital-associated deconditioning . METHODS Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center . Body mass index , haemoglobin , albumin , total lymphocyte count , C-reactive protein , cause of malnutrition , and feeding route were also investigated . Primary outcome was Barthel Index score at discharge . RESULTS A total of 148 patients ( 87.6 % ) were malnourished , and 21 were at risk for malnutrition . There were no patients with normal nutritional status . Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition . Chronic disease-related malnutrition , oral intake , and parenteral nutrition were associated with the Barthel Index score at discharge . There were significant correlations between the Barthel Index score at discharge and nutritional score , albumin , and total lymphocyte count . In multiple regression analysis , Mini Nutritional Assessment Short Form , albumin , and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge . CONCLUSION Most elderly in patients with hospital-associated deconditioning are malnourished . Nutritional status , albumin , and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning AIM Texture-modified diets ( TMD ) have significantly lower energy and protein content than normal diets . Therefore , TMD can cause malnutrition and loss of muscle mass . However , few studies have reported the relationship between TMD and decreased skeletal muscle mass . The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass . METHODS We review ed data of 188 older adult patients who were admitted to a rehabilitation hospital . TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation . The Mini Nutritional Assessment -Short Form was used to assess nutritional status ;  dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index , and the cut 
    Output:
    